Teamwork a cross teams

Team structure and function in a department

The department of Surgery is divided in four teams each taking care of different diseases but within the same speciality, orthopedics.

  • Team A: elbow & shoulder
  • Team B: hand
  • Team C hip and pelvis
  • Team D knee end ancle

Team A is by far the largest team. It is run by a dedicated old-school doctor loved by every patient and perfectionist in patient-centered care. He sees most new patients and takes personal responsibility in all of them. Subsequently, his schedule is always very busy never leaving time to discussions and cooperation with collegues and staff.

Team B and C are smaller and quietly running. There are a small group of doctors with individual tasks and smooth collaboration with nurses etc. The represent yesterday’s medicine and are traditional in every aspect.

Team D is struggeling with a steady increase in number of patients and fixed number of staff, rooms and payments. The team develops the treatment through clinical studies which ensures the implementation of new treatments, new effective pathways of care and an always on the top patient satisfaction. Having clear work flow and dedicated personell, there is about to be some space for both individual and for team development – which is considered necessary for the teamt to continue functioning. Unfortunately, all extra time is consumed by Team A. Team A is in a constant lack of staff, staff satisfaction is below zero and sick days higher than any other team. In order to keep the production on level, the department chair choses over and over again to allocate ressources from the other teams, especially Team D, to Team A.

The situation is about to escalate and an intervention is highly needed.


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Participant comments on Teamwork a cross teams

  1. It is very difficult to support multiple teams when the goals are not aligned or (as in this case) there are actually incentives to cannibalize resources from one group to another. Although this may be sustainable in the short term, this is, of course, not a formula for long term success. The constrained resources (support personnel in particular) seem to be disproportionately being granted to the “squeaky wheel” (Team A). Your example does not include how the various teams are compensated or if they have specific goals. One approach might be to institute some shared goals (for example, departmental RVU’s rather than individual RVU’s, departmental employee engagement, or patient satisfaction for the entire group). This could focus the individuals on the success of the whole, rather than on competing with one another to commandeer the resources.

  2. To effectively function, the teams must be aligned. I agree with Dr. Smetherman’s suggestion around group production targets and removing incentives which lead to competition and disagreement within the groups. Also, it would be helpful to have regular transparent communications around the shared goals so each team felt comfortable with the contribution of the other groups.

  3. Tough situation. It seems that each team functions quite independently without much collaboration or alignment of operations/processes. Perhaps a good place to start to to synchronize processes across the teams that the basic workflow is similar even though the type of surgery is a little different. I also agree with aligning financial incentives.

  4. This is not an easy situation. However, I think you have the good fortune of having the whole department in your consideration. If Team D is structured and aligned with how you would like the future of the department, I suggest working on incentives and education to help other teams follow this structure.

    Additionally, it sounds like the department as a whole has low resources. This may be a time to lobby for the department to as a whole to get more resources for all teams.

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