Saving Lives and Providing Better Care: Insights from the

Science of Teamwork

Eduardo Salas, Ph.D.Department of Psychological Sciences

Eduardo.Salas@rice.edu

With collaboration from Scott Tannenbaum, Ph.D.

30+ Years of Team Performance Research

Take-Aways for Today…• Understand what really drives team effectiveness

(“value of teams”)…• Possess a common language for directing your

teams forward…• Create plan for promoting teamwork in your

practice…• Know what evidence there is to foster teamwork

(“what works”)…

About You – Check-In

• Are you on more than one team at work?• Do you lead a team?• Ever been on a team that performed sub-

optimally?• Ever been on a high-performing team?

Why should you care about teamwork?• The data are compelling…

– Meta-analysis of 130 studies -- better teamwork processes 20 to 25% more likely to succeed (LePineet al., 2008)

– Meta-analysis of medical team training--can reduceerrors & save lives (Hughes et al., 2016)

– Organizations that boosted collaborative performance had 5% greater annual revenue increases than those emphasizing individual achievement alone (Corporate Executive Board, 2013)

• True teamwork boosts performance – not just “feel good”– studied their teams – Tip: It’s not whether you

hang out together

What to Expect…I. Share 6 observations about teamsII. Describe the psychological science underlying

teamwork – the 7 C’sIII. Understand what effective teams do, think, and feelIV. Some interesting recent findingsV. A set of tips to apply the science of teamwork

• Highlight a simple, proven way to boost team effectiveness

VI. Open Q&A

I. Seven Observations

“You may have the greatest bunch of individual stars in the world, but if they don't play together, the club

won't be worth a dime." ~ Babe Ruth

“No individual can win a game by himself.”

~ Pelé

Organizations are using teams more than ever and collaboration expectations are rising • All types of teams

– Stable, temporary, co-located, virtual

Two-thirds of 23,000 employees report increased collaboration

requirements (CEB Survey)

Whether you like teams or not… they’re here!

Time spent in collaborative activities has ballooned

50% or more (Cross et al, 2016)

Deloitte study (2016) of 7000+ orgs reveals move towards more team-based

designs

Observation #1

Unfortunately, many teams perform sub-optimallyBusiness

ViewPersonal

View

Ineffective teams hurt our results

Being on an ineffective team drains my energy – I don’t

want to be on another team

92% view teams as

critical, but only 23% view own team as

effective (Davie, 2013)

The intensity of shared experiences, good and bad, is amplified

(Boothby et al., 2014)

Observation #2

Achieving collaboration & teamwork is not a linear event…

Messy, Episodic, Dynamic, Multi-faceted, Multi-level, Implicit…

Teamwork Is A Complex Phenomena...

Easy to say, but collaboration is not always “natural” (and isn’t just about technology)

Observation #3

Teamwork Is A Complex Phenomena...

Reward Systems Management Control Organizational Climate Intergroup RelationsResource Scarcity Levels of Stress Competition Environment Uncertainty

Individual Characteristics

•Task KSAs•General Abilities•Motivation•Attitudes•Personality•Mental Models

Team Characteristics

•Power Distribution•Member Homogeneity•Team Resources•Climate - Team•Cohesiveness

Work Structure

•Work Assignment•Team Norms•CommunicationStructure

Task Characteristics

•Task Organization•Task Type•Task Complexity

Team Processes•Coordination•Communication•Conflict Resolution •Decision Making•Problem Solving•Boundary Spanning

Team Interventions•Individual Training •Team Training•Team Building

Team Changes•New Norms•New Roles•New Communications Patterns•New Processes

Team Performance•Quality •Quantity•Time •Errors•Costs

Individual Changes•Task KSAs•Attitudes•Motivation•Mental Models

Input Throughput Output

Feedback

Organization & Situational Characteristics

What happens in leadership teams can permeate the organization…

It sets the stage for collaboration across units and with patients and partners…

Particularly senior leadership teams!

Observation #4

Even great teams need to self-adjust…

Observation #5The best teams engage in constructive conversations that allow them to self-adjust…

“Human error in medicine, and the adverse events that follow, are problems of psychology and engineering, not medicine”(Senders, 1994, p. 159)

The solutions are in organizational science, human factors psychology…

The life of your patient depends on yourteamwork!

Observation #6

• Fortunately, there is a strong, growing body of team research to help us!

We need to “crack the code”

for team effectiveness…

II. The Science of Teamwork

“Teamwork makes the dream work in space flight.”

~ CMDR Scott Kelly

The Driving Question…

How do we turn a team of experts into an expert team?

All teams are NOT created equal

One key difference: Degree of task interdependence– To what extent are team members reliant on one

another and need to work together? Coordination demands a big driver… It’s a continuum… Matters because competencies needed depends on where

on the continuum…

Low Medium High

Where is your team currently on the continuum?

Ideally, where should it be?

The Research Reveals (Evidence-based)…

7 Drivers… that influence team effectiveness

Thought experiment: As we review the 7 Drivers, think about a team you work with…where is improvement possible?

1. Capability Right people with the right mix of KSA’s?

2. Cooperation Right attitudes about and willingness to team?

3. Coordination

4. Communication

5. Cognition

6. Coaching

7. Conditions

Demonstrate necessary teamwork behaviors?

Communicate effectively with each other and outside?Possess a shared understanding(e.g., priorities, roles, vision)?

Leader and/or team members demo leadership behaviors?

Have favorable conditions (e.g., resources, culture)?

The Seven “C’s” of Teamwork

Interesting Findings…(Capability) Individual competence matters – hard to overcome big talent gaps

Smart (Stewart, 2006), talented (Aguinis & O’Boyle, 2014), capable helps

But, simply adding stars won’t always boost performance (Swaab et al., 2014) In interdependent teams, beyond a threshold, it can hurt

performance – due to “intragroup standing” issues (true for chickens too!)

Teammates and conditions play a big role…

Star financial analysts who change orgs suffer 5 yr. performance decline! Particularly if they moved without their “team”

(Groysberg & Lee, 2008) And to orgs with less favorable conditions

(Groysberg, Lee, & Nanda, 2008)

Interesting Findings…(Cooperation)

A person who has a collective orientation likes being on a team and puts the team first Not simply a “me first” orientation

Collective orientation is related to team performance(Driskell et al., 2010) Improved team interactions (Driskell & Salas, 1992)

Our experience Need enough team players (e.g., Scottie Pippen for the Bulls) Can have collective orientation and still be an individual success

Australian Special Forces (Gayton & Kehoe, 2015) – team player top predictor! 50% of top collaborators are rated as top performers (Cross et al, 2016)

Collective efficacy is the belief that our team will be successful Collective efficacy predicts team performance

Meta-analysis of 67 prior studies (Gully et al., 2002) When interdependence is low then self-efficacy is

more important (Katz-Navon & Erez, 2005)

Our team can save

lives!

Tip: Allocate time to discuss and celebrate wins

Interesting Findings…(Cooperation)

Psychological safety is quite important “A sense of confidence that the team will not embarrass, reject,

or punish someone for speaking up” (Edmondson, 1999) Or for seeking feedback, asking questions, requesting help Can you be and express yourself on this team?

Positively related to team learning and performance

Interesting Findings…(Cooperation)

Interesting findings aboutpsychological safety

• Recent meta analysis – 136 samples, over 5000 groups (Frazier et al., 2016)

• Googl in-house research• Mount Everest climb – “I will tolerate no dissension”

Psychological Safety

• Engagement, satisfaction & commitment

• Information sharing• Learning behaviors• OCBs• Performance

• Leadership behaviors

• Peer support

• Role clarity

Teamwork behaviors drive performance (LePine et al., 2008)

My experience – backup is a function of staffing, training, expectations and attitude

Type of TeamworkProcesses Examples

Transition Processes Analysis, Reflecting, Planning

Action Processes Monitoring, Backup, Feedback

Interpersonal Processes Conflict Management, Motivating

More Interdependent More Important

(Marks, Mathieu, & Zaccaro, 2001)

Interesting Findings…(Coordination)

Conflict about… Performance deWit et al., 2012

Meta-analysis of 8800 teams

Psychological safety (Bradley et al., 2013) How conflict is handled (DeChurch et al., 2013; 3200 teams)

Styles: Compete – Avoid – Collaborate

Interpersonal

Process

Task It dependsWhat is the

predominantconflict style in

your area?

Interesting Findings…(Coordination)

Info sharing a key to team success Meta analysis of 72 studies (Mesmer-Magnus & DeChurch, 2009)

Keys: Sharing of unique info (not just talking) and closed loop communications (to ensure understanding)

Be aware… People naturally assume others “know” stuff In hierarchical teams, must actively encourage

speaking up Counterintuitive finding, in high performing teams…

Sometimes less communication is more – the quiet kitchen

Tip: Get in the habit of asking,

“who else should know about that?”

Interesting Findings…(Communication)

Interesting Findings…(Cognition) Teams that possess a shared mental model (SMM)

perform better, particularly when coordination is required Meta-analysis - 23 studies (DeChurch & Mesmer-Magnus, 2010)

SMM about: task, if-then, vision, roles, priorities, etc. Allows for “implicit coordination” Quiet kitchen Blind pass in basketball Scalpel ready before request

Row Fast

Row Fast

Row Fast

Relax

Culture, resources, norms can be facilitators or inhibitors

Teamwork actions at the top sends signals – even when unseen! (Raes, Bruch, DeJong, 2012) Study of 63 top management teams Leadership cooperation (helping one another, exchanging

info, joint decision making) was positively related to employee satisfaction and retention

Interesting Findings…(Conditions)

1. Capability Right people with the right mix of KSA’s?

2. Cooperation Right attitudes about and willingness to team?

3. Coordination

4. Communication

5. Cognition

6. Coaching

7. Conditions

Demonstrate necessary teamwork behaviors?

Communicate effectively with each other and outside?Possess a shared understanding(e.g., priorities, roles, vision)?

Leader and/or team members demo leadership behaviors?

Have favorable conditions (e.g., resources, culture)?

Where are the opportunities for improvement? Where might an adjustment help your team?

The Seven “C’s” of Teamwork

Conditions – The most important of the 7 C’s?

Some conditions may be…

• Non-negotiable – outside your control or influence

• Within our influence – can’t control but might affect it (need permission/support)

• Controllable – a few you can change directly

Conditions: Two levels• Local (my team)

• Resources available (e.g., staffing, budget, equipment)

• Amount of autonomy/decision authority• Physical work environment• Time availability• Team design (e.g., size, tasks, and structure)• Mission/purpose

• Broader (business unit or organizational)

Conditions

Diagnostic Questions

and Research

Broader ConditionsA. Policies and practices (e.g., hiring,

performance mgmt, promotions, rewards)B. Senior leadership

– What you say and emphasize (personally and through formal communications)

– How you act (personally and as a senior leadership team)

Conditions

“No individual can win a game by himself.”

~ Pele

III. What Effective Teams Do, Feel & Think…evidence-basedinsights to improve your practice!

What Effective Teams Do, Feel & Think…1. They have clear roles and

responsibilities.– …manage expectations.– …have members who understand each

others’ roles and how they fit together.

What Effective Teams Do, Feel & Think…2. They have a clear, engaging,

compelling, valued, & shared vision.– …have a clear common purpose.– …a reason to be a team.– …energized by their shared mission.

What Effective Teams Do, Feel & Think…3. They have a strong coach (team

leader).– …are led by someone with good

leadership skills and not just technical competence.

– …leaders that institute and maintain the conditions for teamwork.

– …leaders that directly intervene to enact teamwork processes.

– …have team members who believe the leaders cares about them.

What Effective Teams Do, Feel & Think…• They have strong team leadership.

(cont.)– …foster teamwork, coordination, and

cooperation.– …they care, promote, develop teamwork.– …self-correct first.– …handle whatever is not being handled to

meet team needs (Do Whatever It Takes).

What Effective Teams Do, Feel & Think4. They engage in a cycle (a discipline) of

pre-brief performance debrief.– …regularly provide feedback to each other, both

individually and as a team (“de-brief”).– …establish and revise team goals and plans.– …differentiate between higher and lower priorities.– …have mechanisms for anticipating and reviewing

issues/problems of members.– …periodically diagnose team "effectiveness”,

including its results, its processes, and its vitality (morale, retention, energy).

What Effective Teams Do, Feel & Think5. They develop a strong sense of the

“collective” - teamness, confidence, psychological safety– …have a strong sense of team orientation.– …strongly believe in the team’s collective

capability to succeed.– …feel free to express their ideas, opinions,

and beliefs.

6. They hold shared mental models.– …have members who anticipate each

other.– …can coordinate without overt

communication.

What Effective Teams Do, Feel & Think

What Effective Teams Do, Feel & Think7. They have teammates who trust each

other.– …trust other team members’ “intentions”.– …eases conflict resolution.– …fosters continuous learning/adaptation.

What Effective Teams Do, Feel & Think8. They set expectations well (and are

managed).– …provides foundation and markers for

individual/team self-correction.– …increases shared understanding and

awareness.– …increases satisfaction.

9. They have the right organizational conditions. – …negotiate for the resources needed to

succeed.– …supportive environment.– …teamwork measured, reinforced.– …develop task-based and team-based

norms

What Effective Teams Do, Feel & Think

What Effective Teams Do, Feel & Think10. They have precise information exchange

protocols--…clear, accurate terminology.--…engage in closed-loop

communication.--…search for relevant information from all

relevant sources.--…recognize that you have information

that is needed.

What Effective Teams Do, Feel & Think…11.They share unique information

– …focus on individual rather than common knowledge

– …share “just enough” of the right kind of information

– …ensure that fellow team members have the information they need to be able to contribute.

What Effective Teams Do, Feel & Think12.They are deployed correctly

--…kick-off meeting, matters!

IV. Some Interesting Recent Findings

There is a special kind of intimacy involved in sharing meals and teams that eat lunch together perform better (Kniffin, Wansink, Devine, & Sobal, 2015)

Some Recent Interesting Findings...

Teams have higher adaptive performance when performance data isn’t “weaponized” – linked to bonuses, promotions, or firing decisions.

– Team members are more able to stick their neck out, take risks, and try something new when they aren’t worried about negative consequences. (McGregor & Doshi, 2017)

Some Recent Interesting Findings...

Teams that set regular, reasonable hours support a healthy lifestyle, which in turn enables better teamwork.

- (Zucker, 2017)

Some Recent Interesting Findings...

Some Advice…

Some Advice…

1. Ensure all team members are trainedon team-based KSA’s…around six of the C’s…– Team training ≠ Team building– TeamSTEPPS, an option– Transportable skills!– Follow the science of training!

• Avoid “killers” of transfer• Before, During and After• Motivation matters!

Some Advice…

2. Teach how to Debrief and Huddle! -Simple, Powerful, & Underutilized (Reyes, Tannenbaum, Salas, 2018)– What worked?– What can be improved?– What needs to be done differently?– Debriefing works! (Tannenbaum & Cerasoli, 2013)

• 25% Performance improvement!

Some Advice…

3. Measure and Reinforce teamwork!-- Not perfect…-- No “silver bullet”-- Labor intensive…-- Self-report measures, dominates…-- Context matters!

• Why? The Purpose…– Performance evaluation; feedback; training/development

• What? The Content…– How do you define effective team performance?

• When? Timing…– What is the meaningful performance cycle?

• Where? Fidelity of Setting…– Context influences measurement!

• How? Measurement Techniques…– Observation (e.g., checklists); simulation; communication

analysis; vignette-based ratings; pair-wise comparison

Some Advice…

4. Use Simulation!– Games, role-plays– Accelerates expertise!– Embed instructional

features

Some Advice…

5. Determine you team’s coordinationdemands…

6. For sustainability…leadership support needed…– …the administrative board must be engaged

and supportive– …ask: what conditions we must have– …not an event, a journey—one team at a time!

Some Advice…

7. Use the science of teamwork!– Guide, reference– Not perfect, but useful and practical

8. Curriculum/training alone won’t be enough…Conditions!

9. Think about—change management- Build the “DNA” of the organization/unit

10. Start tomorrow!

QUESTIONS…

VI. Q & A

Aguinis, H., & O’Boyle, E. (2014). Star performers in twenty-first century organizations. Personnel Psychology, 67(2), 313-350. doi: 10.1111/peps.12054

Boothby, E.J., Clark, M.S., & Bargh, J.A. (2014). Shared Experiences Are Amplified. Psychological Science, 25(12), 2209-2216. doi: 10.1177/0956797614551162Bradley, B.H., Baur, J.E., Banford, C.G., & Postlethwaite, B.E. (2013). Team players and collective performance: How agreeableness affects team performance over time. Small Group Research, 44(6), 680-711. doi: 10.1177/1046496413507609Cross, R., Rebele, R., & Grant, A. (2016). Collaborative Overload. Harvard Business Review. Retrieved from https://hbr.org/2016/01/collaborative-overload

Davy, L. (2013). You First: Inspire Your Team to Grow Up, Get Along, and Get Stuff Done. New Jersey: John Wiley & Sons

DeChurch, L.A., & Mesmer-Magnus, J.R. (2010). The cognitive underpinnings of effective teamwork: A meta-analysis. Journal of Applied Psychology, 95(1), 32-53. doi: 10.1037/a0017328

DeChurch, L., Mesmer-Magnus, J., & Doty, D. (2013). Moving beyond relationship and task conflict: Toward a process-state perspective. Journal of Applied Psychology, 98(4), 599-578. doi: 10.1037/a0032896

de Wit, F.R., Greer, L.L., & Jehn, K.A. (2012). The paradox of intragroup conflict: a meta-analysis. Journal of Applied Psychology, 97(2), 360-390. doi: 10.1037/a0024844

Driskell, J.E., & Salas, E. (1992). Collective orientation and team performance. Human Factors, 34(3), 277-288. Retrieved from http://journals.sagepub.com/doi/pdf/10.1177/001872089203400303

Driskell, J.E., Salas, E., & Hughes, S. (2010). Collective orientation and team performance: development of an individual differences measure. Human Factors, 52(2), 316-328. doi: 10.1177/0018720809359522

Edmondson, A. (1999). Psychological Safety and Learning Behavior in Work Teams. Administrative Science Quarterly, 44(2), 350-383. doi: 10.2307/2666999Frazier, L.M., Fainshmidt, S., Klinger, R., Pezeshkan, A., & Vracheva, V. (2016). Psychological Safety: A Meta-Analytic Review and Extension. Personnel Psychology, 70(1), 113-165. doi: 10.1111/peps.12183Gayton, S.D., Kehoe, E.J. (2015). A prospective study of character strengths as predictors of selection into the Australian army special force. Military Medicine, 180(2), 151-157. doi: 10.7205/MILMED-D-14-00181.

Groysberg, B., & Lee, L.E. (2008). The effect of colleague quality on top performance: the case of security analysts. Journal of Organizational Behavior, 29(8), 1123-1144. doi: 10.1002/job.558

Groysberg, B., Lee, L.E., & Nanda, A. (2018). Can they take it with them? The portability of star knowledge workers’ performance. Management Science, (54)7, 1213-1230, doi: 10.1287/mnsc.1070.0809

Gully, S.M., Incalcaterra, K.A., Joshi, A., & Beauien, J.M. (2002). A meta-analysis of team efficacy, potency, and performance: interdependence and level of analysis as moderators of observed relationships. Journal of Applied Psychology, 87(5), 819-832. doi: 10.1037/0021-9010.87.5.819

Hughes, A. M., Gregory, M. E., Joseph, D. L., Sonesh, S. C., Marlow, S. L., Lacerenza, C. N., & Salas, E. (2016). Saving lives: A meta-analysis of team training in healthcare. Journal of Applied Psychology, 101(9), 1266-1304. http://dx.doi.org/10.1037/apl0000120

Hoch, J.A., Pearce, C.L., & Welzel, L. (2010). Is the Most Effective Team Leadership Shared? The Impact of Shared Leadership, Age Diversity, and Coordination on Team Performance. Journal of Personnel Psychology, 9(3), 105-116. doi: 10.1027/1866-5888/a000020

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