High Performance Teams in Health Care Literature Review 2.0

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1 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW Introduction Studying high-performing teams has increased recently, as many organizations realize that this has the potential to be a major asset if properly utilized and implemented. This literature review will study research on high-performance teams, what makes these teams worthwhile, and what concerns and issues can hamper their progress. The focus of the multiple studies will be the making and implementing high performance teams, starting with how the team membership, from supervisory and management personnel, human resources departments, and the leadership of the organization. There will also be analyses on recognizing how various organizations and businesses utilize similar team building methodologies. Lastly, specific focus will be given to health care industries, with a primary look at hospitals and health care systems. Studies will be referenced showing the similarities between health care systems and different industries, as well as areas that are unique and distinctive to health care fields, which will include a two-sided model of leadership (business and clinical) that is a key component of health care systems and hospitals. Search Strategy The strategic plan utilized for this research details non-tangible components of administration and their innateness to employees. A Bass (2019) survey asks employees about their relationship with leadership and their beliefs of how leaders develop. Methodologies of procedure of each aspect of leadership growth is reviewed, recognizing how these aspects evolve together and apart in varied industries (Bass, 2019) . Peer-reviewed studies focusing high-performance team studies develop the impetus of terms and functions establishment. Also, specific articles for health care high performance teams

2 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW are reviewed to connect the overall lessons of the topic to health care industries. The focus of this literature review will include departments of human resources, research or planning and development, and special projects with follow-up on the manner that these departments will impact the teams. There will also be reviewing the clinical and business sides of a health care system, and how a high-performance team in this field will assist in developing cohesive in this field. This literature review also identify factors having significant impacts on health care fields, such as synthesizing leadership structures of the business and clinical sides, recognizing that patients the work product in addition customers, and that maximum cooperation among these interests is the only way a high-performance team can be successful. A high-performance team increases engagement levels throughout the organization (Miao & Cao, 2019) . Their research featured applications through colleges, universities, and vocational schools. Many of the essential skillsets for educational institutions also apply to hospitals. By utilizing high-performing teams, they enable staff to improve thought and communications skills, allowing organizations to remain competitive. Initial success will result in the development of more high-performance teams in all aspects of the organization (Miao & Cao, 2019) . The creation of high-performance teams that emphasize diversity and have the autonomy to implement their recommendations have had particular success (Groysberg, Lee, Price, & Cheng, 2018) . This is a method for the membership of the team to engage with one another, improve capabilities, and understand each other’s roles and responsibilities (Engebo, Klakegg, Lohne, & Laedre, 2020) . This develops an interdependence among team members and improves their individual skillsets toward the overall goals of the team. The authors viewed 16 five-hour sessions and poured through 200 pages of notes they took throughout their meetings. The findings of their showed positive outcomes from consistent reviews and status updates, placing

3 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW an emphasis on positive team dynamics, developing a mutual interest in project outcomes, ensuring a strong support staff, and cooperation in problem solving (Engebo, Klakegg, Lohne, & Laedre, 2020) . In health care, high-performance teams became more essential through Covid-19 pandemic. Many health care entities were forced to alter normal operating standards and procedures (Bennett & McWhorter, 2021) . This required personnel and policy adjustments to handle increased workloads with reduced staff in an unknown environment. This led to creating high-performance teams in many hospitals, who were given the authority to vary standards and procedures as required to ensure the highest level of care possible (Bennett & McWhorter, 2021) . These teams would include clinical and business leadership, admissions, supply chain and risk management, and human resources, who worked in a cooperative manner to adjust as needed. Organizations effectively achieve sustainable success models by being able to adjust implementation of projects as necessary in an evolving environment (Engebo et al., 2020). The study’s research included twenty project research hours, consisting of twelve interviews, and observing twenty interactions in a one-hundred-page report. Their study found that a high performing team requires leadership to listen to the needs of each team member, fostering a sense of collaboration, with clear goals and limitations. This research by Engebo et al. is in line with Scott & Mary’s (2018) research showing high-performance teams produce increased value from the team membership. Their study showed high-performance teams work optimally when they have a workable size but are diverse enough to invite varied opinions while appreciating the team chemistry. The study from Johansen and Sowa (2019) noted the importance of human resource departments in establishing their purpose by selecting the membership, since they should have

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4 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW the best understanding of the team makeup and be able to address potential issues with discipline or personality concerns that might adversely impact the team. High performing teams will embrace certain characteristics for the purpose of accomplishing their objectives. Elucidating a clear purpose is the primary quality of any successful organizational team. It is necessary for members of the teams to have a complete understanding of the goals of the project and what the expectations and duties are for each member, along with an expected timeline for accomplishing the steps along the way toward completion. Well defined goals, tasks, and expectations lead to an enhanced level of cooperation and camaraderie, as well as a willingness to collaborate and assist each other (Driskell, Eduardo, & Tripp, 2018) . Their study also places an emphasis on defining goals explicitly so that each member will know what is expected of them and each other, as well as the manner in which they can contribute to the benefit of all. It is also believed that without clear targets, goals, and methods, the ability to monitor and provide a proper evaluation of the project’s progress becomes difficult, if not impossible. The authors explain that distinctive targets and methods provide an understanding for team members for the roadmap to success and enhance the spirit of cooperation necessary to maintain a positive interest in the team, as well as a sense of pride in achieving progress points on the path to project completion. Clearness of goals and methods ensures unification of purpose, vision, and cooperation (Driskell, Eduardo, & Tripp, 2018) . Additionally, defining goals and using them to manage one’s individual performance has been shown to have a positive impact on the high performing team’s overall success (Alison, 2021) . This concept reinforces the importance for developing a blueprint for success for the team. The research by Allison (2021) collected information from 100 participants in high performance

5 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW teams, and 5 team leaders. The consensus was that a clear explanation of objectives and the methods to be utilized improved employee commitment and established a greater level of faith and trust in the leadership, with the belief that everyone was pulling in the same direction. Conversely, teams that did not adequately have a clear understanding of the concepts and objectives of the project were less likely to become personally invested in the outcomes of the team. The research also defined clear goals as having specificity, being substantive, reasonable, and challenging, and having quantifiable metrics. These concepts are also applicable to health care systems and hospitals, with specific, quantifiable measurements being necessary to establish a pattern of success (Jeyaraman, et al., 2022) . In particular, Emergency Departments are generally determined to be successful or not by a series of quantifiable measuring tools. In addition to successful patient outcomes, many hospitals install high-performance teams to determine the success of other metrics. Among the areas of focus by many of these teams include patient waiting times, paperwork processing accuracy, number of patients seen, readmittance figures, length of stay, Joint Commission infractions, supply chain outages, etc. (Jeyaraman, et al., 2022) . These areas of concern for teams represent a number of different departments within a hospital and demonstrate the need for implementing a high performing team to understand the various components of a successful Emergency Department operation. Each member needs to develop an understanding of the overall project goals, and how much their area of importance impacts other departments and the overall outcome. This is especially important in an organization such as an Emergency Department within a hospital. Since each of the areas involved in the operation rely on specific high-level training and education, there is a tendency to develop a myopic view toward their roles, and lose sight of the interdependency of a successful organization in health care systems

6 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW and the need for cooperation (Jeyaraman, et al., 2022) . This shows how teams designed to foster cooperation and focusing on goals and methods create an atmosphere amenable to successful results. Another area that complements each other is the relationship in organizational team management between innovation and encouragement from leaders toward their employees (Kearney, Meir, Daan, & Florian, 2019) . Leaders that are willing to look for new solutions to existing problems rather than trying the same tactics that have not been successful in the past are more likely to engender support from their team members. These same leaders are also more likely to encourage new ideas and suggestions from their teams, elevating the commitment to the project from the group, and creating a more beneficial atmosphere for improved performance and success. The authors of the study accumulated data from 197 high-performance teams and their leadership. They found that the idea of innovative and encouraging leadership methods provided increased clarity of goals and improved communications and commitment to the operational success. Employees also felt a greater sense of obligation to the team when leadership was encouraging. Greater commitment also led to greater achievement (Kearney, Meir, Daan, & Florian, 2019) . Objectives and Teamwork Purposeful objectives are the ones that are intertwined with the overall objective of their organizations and are able to result in a positive outcome for the business and the surrounding environment. Organizations that have high-performance teams with a complete understanding of

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7 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW project goals and a delineation of responsibilities have a better time accomplishing their essential tasks. Teamwork reflects the manners and methods by which team membership cooperate with other members to reach a common result (Driskell, Eduardo, & Tripp, 2018) . Their study revealed that collaboration and shared work teams improved job satisfaction and a greater emphasis for the positive outcomes for the high-performance team. They also investigated how a team approach to team development has evolved through cooperation. Factors that lead to better cooperation are the utilization of recruitment of team members, job coaches and planners, as well as modelling team approaches to real time and lifestyle situations leading to improved team strategies. Clear goal setting results in increased and quicker assemblage of the data necessary to implement a strategic plan and introduce new and better data as they become available and evolve over the lifetime of the project. Premier teams designed for high-performance outcomes are comprised of employees with shared goals and objectives and strive to achieve these goals in a cooperative manner. Members who adopt this mindset and methodology are less likely to be engaged in unproductive conflicts and personal disputes, while approaching disagreements constructively rather than personal. By approaching disagreements in a constructive and non- confrontational manner, these teams keep the focus on the positive outcomes of the project rather than pettiness and distracting topics. Recognizing that conflicts are inevitable, professional memberships are willing to maintain a cordial cooperative relationship among the members while working together in a collegial atmosphere for the optimal end-result of the project assignment (Driskell, Eduardo, & Tripp, 2018) . Members of a quality high performing team strive to maintain decorum and keep their relationships mutually beneficial for the entire organization and working cooperatively while understanding the perspectives of their teammates, hopefully leading to incorporating the best components and ideas of both or all sides to develop a

8 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW consensus plan which is more positive than either or any individual ideas. This concept is more feasible by establishing high-performance teams from the bottom up (Driskell, Eduardo, & Tripp, 2018) . Encouraging Open and Clear Communication A journal article states that there is an incompatibility between high-performance teams and atmospheres of collaboration within a work environment (Flood & Michael, 2018) . There is no substantive data to support this claim. In fact, especially in health care, the opposite is substantially true. The strongest of high performing teams in health care rely on collaborative insight and cooperation, mutual respect and support, and flexibility. (Meetoo, Rylance, & Abuhaimid, 2018) . The authors also state that as technology has become omnipresent in health care systems, most hospitals require, not just support, high performing teams focusing on mutual collaboration. These technologies often require instantaneous decision-making and rapid reactions to events as they transpire. To expect individuals or even single departments to be able to function independently. As there are numerous areas of expertise and education within most health care systems and hospitals, leaders benefit from the creation of high-performance teams. They are able to extend wide latitude and significant autonomy to the teams, along with the expectation of substantial accountability and results (Meetoo, Rylance, & Abuhaimid, 2018) . While Flood and Michael (2018) emphasize the independence of high-performance teams, it makes an unsupported claim that these teams are not conducive to collaboration with the other organizational entities. In fact, businesses today are more open, also due to technological improvements, which allows for individuals with input to be noticed. This reinforces the idea that high-performing teams are more likely to encourage and benefit from collaborative actions.

9 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW Communications is a key component of any organization, and that is also true of high- performance teams within these entities. Quality communication skills fulfill multiple needs: it ensures that employees and team members are aware of their tasks and responsibilities and methods to accomplish them and assist in developing a team-oriented atmosphere with a greater level of camaraderie among team members. As stated previously by Meetoo et al (2018), technology is an essential component of health care systems, and is often utilized in communication strategies. High-performing teams need to be given entrance to communications and other technological data and are expected to conduct their work activities at a superior level. Many health care systems and hospitals that embrace the idea of high-performance teams also establish professional communication networks to maximize potential and minimize discrepancies (Mundt & Zakletskaia, 2019) . The authors make the point that in a stressed-filled atmosphere such a clinic or hospital, proper and accurate communications are essential for maintaining a productive workspace. They also postulate that positive communications strategies also improves job satisfaction and improves the sense of confidence in their work (Mundt & Zakletskaia, 2019) . Creating Value-Based Teams Leaders of high-performance teams are also more likely to embrace transformative leadership for both the team and for their entire organizational responsibilities, according to Han et al (2018). Their research emphasizes that transformational leadership can improve performance, assuming the entire organization is willing to embrace this strategy. In team-based situations, the authors find that transformational leadership is responsible for increased

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10 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW effectiveness, with a greater focus on value as a determinant. They also note that high- performance teams bring a moderating influence on transformative leadership, with adaptivity to the needs of the team and organization. These teams are often able to thrive with any positive type of leadership and utilize their team skills to recognize the importance of their leadership in their overall success of the project. The Covid-19 pandemic was shown to impose barriers high performing teams because team supervisors have limited training in online or remote team strategies, as most have been trained through in-person training situations (Weiss, Tilin, & Morgan, 2023) . These authors noted that organization leadership executives are used to overseeing the activities of those under them from a distance, a skill that is easily transferrable to the managing of teams and organizations remotely. They also note that in the time since the onset of the pandemic, productive organizational leaders have been able to emphasize the ability of value-based management in remote and in-person situations, assisting teams in establishing a culture of flexibility and cooperation. (Bennett & McWhorter, 2021) reinforce this value-based strategy post-Covid, incorporating the importance of human resource departments in the adaptation of workplace strategies in an ever-evolving business and organizational climate. This culminates for them in noting that leadership in health care systems need to embrace value-based teams with the input and support from human resources departments, in cooperation with the high-performance teams. The journal article by Newman & Robert (2021) makes the suggestion that managers and leadership are able to increase the productivity of workers and teams who are employed remotely through value-based strategies through utilization of five core components. Their first point is the creation and description of the new manner of employment for remote workers; next, they need

11 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW to create and maintain a work environment based on mutual trust and cooperation; third, embrace technology that is proven effective in properly training work from home team members; fourth, give teams that operate remotely the same autonomy and respect as employees locate at the physical workplace: and finally and most importantly, leadership needs to include remote employees in organizational traditions and work assessments, with the same expectations and benefits of in-person employees, and ensure that work modifications due to being remote do not lead to a disadvantageous relationship between remote and in-person employees or them with management. Through the highlights of management values and employee acceptance and embracing, Newman and Robert (2021) recognize and agree with the above mentioned studies that tie this relationship of remote employee adaptations with the concepts of quality human resource management, and the framework necessary to achieve optimal success of individuals and teams. The authors also assert that transformational leadership is a benefit for embracing remote and in-person employees into a cohesive unit to execute organizational policies and outcomes. They also state that unified employment recognition with high-performance teams is conducive to increased employment satisfaction, with a consensus through high performing workplaces and systems. Organizations often create company vision statements, mottos, and other public pronouncements extolling their virtues and positive mindset, but they may not have an acceptance among organizations employees, who have little to no understanding in how to transform these words into a realistic plan of action. Research from another journal article (Groysberg, Lee, Price, & Cheng, 2018) recognize the need for promoting requirement for producing positive outcomes with specificity, defining organizational valuations through intellect and

12 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW responsibility from staff and leadership alike to result in a value-based employment environment. A high-performance team has value cognition to delineates the expectations of employees who work cooperatively for the achievement of team goals and project requirements. These steps should be defined in a proper and easily understood manner that have a connectivity to required performance objectives. A team member who is uncertain as to the nature of their responsibilities and requirements within the team setting will potentially exhibit symptomatic consternation, aggrieved tendencies, tense moments while engaged with others, and at times becoming disruptive to the team or organization. There is a belief that teams will mature, resulting in members having a more coordinated impact as every member does their best in their responsibilities to achieve the results of their area of specialization while simultaneously making a contribution to the entire group. Higher performing organizational teams combine individual members' skill sets into a collection for most beneficial achievement toward team objectives. Organizations that connect the financial needs, objectives, and limitations to a value-based plan of implementation, high performing teams are created. Traits, including tenacity, passion, focus, dedication, etc. are more than just ideas in the abstract. They are employee, team, and organizational qualities that are noticeable and intrinsic to success (Groysberg, Lee, Price, & Cheng, 2018) . Support and Team Management Dastmalchian et al (2020) noted in their research, high-performing teams are now more democratic, and plans have evolved to improve relationships with organizational management and executives. As a corollary to previous research cited (Meetoo, Rylance, & Abuhaimid, 2018) , a high-performance team can surpass their competitors when leadership has the willingness to supersede restrictions and communicate effectively. Leadership that demonstrates their faith the

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13 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW team by trusting employees to utilize their best judgment and be responsible, success is more likely to follow. Companies that employ high performing teams will likely form a connection with team members in a productive manner. Team employees are viewed as being invested in the outcomes as they are staked to the success of the project. This method develops self-assured and trustworthy members that are essential for projects and tasks that require quality input and output. Additional research (Groysberg, Lee, Price, & Cheng, 2018) shows a connection when a team develops a culture of cooperation and performing in a productive manner, Additionally, it is necessary recognize a group that is producing at optimal efficiency. High-performance teams are positively affected by recognition and praise, as well as pay or performance bonuses and promotions. Specific talents and skills that a member brings to the group helps in the determination of the circumstances of their employment status. As a high performing team takes shape, they create a communal attitude and cooperative spirit. If this does not develop, leadership can provide incentive-based rewards for whole team productivity. Emphasizing Key Factors Knowledge is gaining more value as to form of collateral in major organizations, leading to them to embrace online and other virtual learning platforms for their employees (Cooke, 2018) . Their research shows that using such learning tools can assist in the development of high- performance teams and have gained even greater utilization in the period since the Covid-19 pandemic necessitated in-person gatherings to be restricted. In addition to university coursework,

14 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW programs that have been given acceptance in their specific industries on relevant topics are often required. In health care industries, online learning tools have been used for years, with specific classes for each of the voluminous clinical, business, service, and maintenance platforms. It is important for organizations to utilize industry standards and approved coursework, and to allow for sufficient time for the employees to learn and absorb the course material. Without these parameters, there will develop a false sense of security that they are providing tools which in actuality do not adequately prepare the team members to handle the learning materials. In addition to the learning materials acquired through the online and virtual learning coursework, the best teaching will, whenever possible, supplement these materials with hands-on training and other collaborative teaching methods and materials. Another key component for implementing high quality learning tools is the coordination of responsibilities and actions between the department-specific managers and supervisors and human resource department employees with knowledge of the operation of such learning methods and appropriate utilization tools. Conclusion Over the course of this literature review, certain themes appear consistently throughout the various points of emphasis. Creating an atmosphere of camaraderie and team-oriented, quantifiable goal achievement is essential for positive team outcomes. The best high- performance teams understand the purpose and process of the project and are given wide latitude in implementing their ideas into the process. Teams are valued for the abilities of their members,

15 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW and the members are more successful when they respect and trust their managers and organizational leadership. The other area of the research that was evaluated was specific implementation of high-performance teams in the health care and hospitals industry. This reinforced the premise that many of the aspects of these teams share common traits with other industries and organizations, but there are also specific differences in some areas. The unique leadership structure in health care systems and hospitals is responsible for some of them, as is the recognition that the customers in hospitals are also the product. Overall, it became more clear that the differences are less of a concern than previously thought, but still needs to be taken into consideration.

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16 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW References Alison, D. (2021). Communication Skills for Workplace Success. American Psychologist , 334- 344. Baran, B. E., & Woznyj, H. M. (2020). Managing VUCA: The human dynamics of agility. Organizational Dynamics , 50-59. Bass, B. L. (2019). What is Leadership. Journal of Leadership in Surgery , 1-10. Bennett, E. e., & McWhorter, R. R. (2021). Virtual HRD in the crisis and Post Covid-19 world. Advances in Developing Human Resources , 5-25. Dastmalchian, A., Bacon, N., McNeil, N., Steinke, C., Blyton, P., Satish Kumar, M., & Varnali, R. (2020). High performance work systems and organizational performance. Journal of International Business Studies , 88-103. Driskell, J. E., Eduardo, S., & Tripp, D. (2018). Foundations of teamwork and collaboration. American Psychologist , 1-45. Engebo, A., Klakegg, O. J., Lohne, J., & Laedre, O. (2020). A colloaborative project method for design of a high-performance team. International Journal of Managing Projects in Business , 1141-1165. Flood, F., & Michael, K. (2018). High performance work teams and organizations. Global Encyclopedia of Public Administration , 11-16. Groysberg, B., Lee, J., Price, J., & Cheng, J. (2018). The leader's guide to corporate culture. Harvard Business Review , 44-52. Han, J., Hui, L., Susan, T., & Seongsu, K. (2018). Effects of high-performance work systems on transformational leadership and team erformance. Journal of Human Resource Management , 1065-1082. Humble, J., & Forsgren, N. (2018). The science of lean: Building and scaling high perofrmance technology organizations. Portland, OR: IT Revolution Press. Jeyaraman, M., Alder, R., Copstein, L., Al-Yousif, N., Suss, R., & Zarychanski, R. (2022). Impact of employing primary health care professionals in emergency department triage. British Medical Journal (BMJ) . Johansen, M. S., & Sowa, J. E. (2019). Human resource management, employee engagement, and nonprofit hospital performance. Nonprofit Management and Leadership , 549-567. Kearney, E., Meir, S., Daan, v. K., & Florian, A. S. (2019). A paradox perspective on the interactive effects of visionary and empowering leadership. Organizational Behavior , 20-30.

17 HIGH-PERFORMANCE TEAMS LITERATURE REVIEW Liu, X., Chen, M., Li, J., & Ma, L. (2020). How to manage diversity and enhance performance from doctor teams in China. International Journal of Environmental Research and Public Health , 17-48. Lobdell, K. W., Hariharan, S., Smith, W., Rose, G. A., Ferguson, B., & Fussell, C. (2020). Improving health care leadership in the Covid-19 era. Boston: New England Journal of Medicine. Meetoo, D., Rylance, R., & Abuhaimid, H. (2018). Health Care in a technological world. British Journal of Medicine , 1172-1177. Miao, R., & Cao, Y. (2019). High performance work systems, work well being, and employee creativity. International Journal of Environmental Research and Public Health , 1640- 1644. Mundt, M. P., & Zakletskaia, L. I. (2019). Professional communication networks and job satisfaction in primary care clinics. Annals of Family Medicine , 428-435. Newman, S. A., & Ford, R. C. (2021). Five Steps to Leading Your Team in the Covid-19 Workplace. Organizational Dynamics . Sankose, S., & Turkmen, E. (2020). The relationship between transformational leadership perceptions and innovativeness in nursing. Journal of Nursing Management , 1126-1133. Vaughn, V. M., Saint, S., Krein, S. L., Forman, J. H., Meddings, J., Ameling, J., & Chopra, V. (2019). Characteristics of healthcare organizations struggling to improve quality. BMJ Quality and Safety , 74-84. Weiss, D., Tilin, F., & Morgan, M. (2023). The Interpersonal Health Care Team: Leadership and Development. Boston: Jones and Bartlett Learning.

High Performance Teams in Health Care Literature Review 2.0

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