Building More Cohesive Nursing Teams - The Power of Familiarity

By Rose O. Sherman, EdD, RN, FAAN

As part of an emerging nurse leader project, we have conducted focus groups with young nurses who are entering the program to learn more about their perspectives on nursing leadership and their practice environment. In reading the transcripts of these focus groups, I am struck by how many times the lack of teamwork on nursing units is mentioned by focus group members. One participant discussed the difficulties she had when working with certain staff who were not team oriented – “good teams win championships but others don’t and you can see the differences it makes for both patients and staff”. Building cohesive teams can be very challenging. Our expectations about how well staff who don’t know each other well will work together are often unrealistic. In a very interesting article in the December 2013 issue of the Harvard Business Review, researchers Robert Huckman and Bradley Staats contend that leaders often underestimate the power of familiarity.

The Hidden Benefits of Keeping Teams Intact

Most managers can intuitively understand that when teams work together frequently, they usually function more effectively. Huckman and Staats contend that their research indicates that this is a phenomena that should not be ignored. Team familiarity is a better predictor of performance than the experience of any individual team member or the team leader. Examples from their work indicate that high performance teams can complete OR procedures more quickly, decrease defects in software products by 19% and increase client satisfaction with team performance in all industries. They warn that although sometimes leaders like to “shake teams up” to promote innovation – there is a downside to what they describe as “stranger danger”.

Five Key Factors that Occur with Team Familiarity

Huckman and Staats identify the following five key factors that make team familiarity important to team outcomes:

1. Coordinating activities – team communication is critical to team success yet it does not happen overnight. Teams that work together over time learn to better manage conflict and communication.

2. Learning where knowledge lies – teams often struggle to tap into the knowledge of individual team members and unearthing this knowledge can take time and effort. With familiarity, teams learn about the strengths and knowledge of each team member.

3. Responding to change – research indicates that teams that work together frequently and are more cohesive also are better able to meet new demands.

4. Integrating knowledge to innovate – although it might be counterintuitive, teams that work together have been shown to better integrate new knowledge and come up with coherent, innovative solutions.

5. Capturing values – teamwork can be a very powerful thing that retains individuals in an organization and makes it unlikely that competitors can easily replicate success by hiring one team member.

Building More Cohesive Teams

There are many implications in this work for nurse leaders. Team familiarity should be viewed as a tool which can improve care. Although we clearly recognize the importance of teamwork in health care, this is often lost in our individualistic culture where people worry more about their own schedules when staffing plans are developed. We sometimes fail to consider the impact of assembling teams of contracted nurses on shifts who have no team familiarity. There should be intention in scheduling to develop work teams with some degree of familiarity and the importance of this should be conveyed to staff.

There are many reasons for the level of fragmentation that we see in today’s healthcare environment. As leaders, we must also take responsibility for our contribution to the problem with the widespread adoption of shifts and schedules that don’t promote team cohesion and familiarity.

Read to Lead

Huckman, R. and Staats, B. (December 2013). The hidden benefits of keeping teams intact. The Harvard Business Review.