HANDLING DILEMMAS AND LAPSES:
PROFESSIONALISM IN TEAMS
Professor Pauline McAvoy and
Dr Jenny King
Professionalism
in teams
Dr Jenny King, DPhil CPsychol AFBPsS
Edgecumbe Consulting Group Ltd
© NCAS Annual Conference 2009: Stream D1 – Professionalism in teams
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Themes
• Recognising early signs of lapses in
professionalism
• Identifying where team difficulties are
situated
• Managing a staged process of addressing
team dysfunction
• Maximising success – and avoiding pitfalls
The context for lapses in
professionalism
• Blurring of professional boundaries and
roles
• Erosion of professional identity
• Transactional demands of practitioners
that conflict with professional values
• Autonomy replaced with accountability
• Disruption and changes of leadership
reverberate down through the
organisation
• Change has become overwhelming
© NCAS Annual Conference 2009: Stream D1 – Professionalism in teams
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Recognising early signs of
lapses of professionalism
What is a team?
A team is a small number of people with
complementary skills who are committed to
a common purpose, performance goals, and
an approach for which they hold themselves
mutually accountable.
(Katzenbach & Smith, 1993)
© NCAS Annual Conference 2009: Stream D1 – Professionalism in teams
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What makes a team effective?
• Clear team goal and objectives
• Clear accountability and authority
• Diversity of skills and personalities
• Clear individual roles
• Shared tasks
• Regular reflection on their work
• Ability to change and develop
• Confronting conflict constructively
• Feedback to individuals and the team
• Team rewards
Borrill et al 2000 Health Care Team Effectiveness Project
Early warning signs of lapses
• Poor patient handover
• Trainees refusing to work with specific individuals
• Sickness and absence higher than usual
• Poor meeting discipline
• Playing off one against another (with other staff feeling
caught in the middle)
• Public contradiction/criticism of professional opinion
• Younger members reluctant to stand up to more senior
ones – a collusion of submissiveness
• Refusal to cover for other members
© NCAS Annual Conference 2009: Stream D1 – Professionalism in teams
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The shadow side of teams
• Collegial collusion - cover for colleagues;
“if you don’t criticise me I won’t criticise
you”
• Competition - for private patients
• Culture of fear - junior staff won’t call
you at unsuitable times
• Sabotage - arriving late for meetings or
not at all; never obviously disagree;
delay decisions by insisting on more
evidence; agree in meetings but rebel
outside
• Liaisons dangereuses…………..
The Five Dysfunctions of a Team
(Lencioni, 1995)
© NCAS Annual Conference 2009: Stream D1 – Professionalism in teams
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Lapses of professionalism
resulting from the 5 dysfunctions
Status and Ego
Low standards
Ambiguity
Artificial harmony
Invulnerabiliy
Professionalism: lapsed or overplayed?
RCP Values
Lapsed
Overplayed
Altruism
Lack of concern or care
Burn-out (cannot say
no)
Not adhering to
Rigidity – not
commitments or stated
shifting from
values
position
Insensitive; hard-hearted;
Over-care; crossing
impersonal
boundaries
Continuous
Complacency; becoming
Relentless change;
improvement
out of date
too far too fast
Excellence
Mediocrity
Obsessionalism
Working in
Working solo; ignoring
Loss of professional
partnership
other professional views
identity
Integrity
Compassion
© NCAS Annual Conference 2009: Stream D1 – Professionalism in teams
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Identifying where team
difficulties are situated
Wanted…….
“Volunteer required to voice difficult,
disillusioned, disengaged elements of the
staff. Only candidates with suitably difficult
personalities should apply…”
Adapted from Obholzer and Roberts (1994) Troublesome individual and
troubled institution
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Who’s the troublemaker?
• Is the team “projecting” its difficulties on to
one individual?
• This helps them disown their own part in the
group’s problem
• The individual’s behaviour may be a response
to the unconscious needs of the group or the
institution (Obholzer and Roberts, 1994)
• The team’s behaviour – similarly – a response
to problems in the institution
• Leaders must tackle the presenting problem
at several levels
Where might team
difficulties be situated?
These can be one of or a combination of
problems within:
• The tasks and responsibilities e.g. lead
roles, training, job design
• The team processes e.g. Leadership,
decision-making, conflict resolution,
communication, meeting management
• The relationships e.g. interpersonal
dynamics, trust, legacy issues
• The institution e.g. leadership; culture;
history; external pressures
© NCAS Annual Conference 2009: Stream D1 – Professionalism in teams
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Questions to ask…
How would the team behave differently if:
• You took a certain individual out of the
team
• You ask the individual to work with
someone different?
• You put the individual into a different
role?
• You ring-fenced the individual from the
team?
…more questions….
• If you changed the leadership how would the
team respond?
• If you took X out of the team where would the
attention or blame next become focussed?
• If you brought someone new into the team
what would happen to them?
• If you reconfigured the team what difference
would this make to the problem?
© NCAS Annual Conference 2009: Stream D1 – Professionalism in teams
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Managing a staged process of
addressing team dysfunction
A staged process
• Identify where the problem is situated
• Agree who will lead the process of team review
and “rehabilitation”
• Define clear terms of reference
• Diagnostic stage: interviews, psychometrics, etc
• Problem-solving phase: facilitated team
meeting(s) to define team vision, task and
objectives and a code of conduct
• Follow up phase: e.g. team training, coaching,
development – and regular reviews against
agreed commitments
© NCAS Annual Conference 2009: Stream D1 – Professionalism in teams
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Example/typical team
scenario
• Mixed professional disciplines
• Cliques and “camps” in the team
• Clear differences in philosophy re: patient
care
• One member under GMC investigation
because of complaints from other
members
• Lack of engagement with managers
• Increasing frequency of SUIs
“Teamship” rules
Extract from a code of behaviour for a clinical team
We will give all individuals adequate opportunity to express their
view without interruption
We will not publicly criticise a colleague
We will not engage in malicious gossip
We will agree to engage in constructive discussion about past
issues
We will not make decisions in factional groups
We will not start side conversations in meetings
We will approach a colleague directly if we have a concern
© NCAS Annual Conference 2009: Stream D1 – Professionalism in teams
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Maximising success – and
avoiding pitfalls
Cautionary note….
At the Battle of Copenhagen in
1801, Admiral Nelson ignored
orders to cease action by putting
his telescope to his blind eye and
claiming he could not see the
signal
© NCAS Annual Conference 2009: Stream D1 – Professionalism in teams
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Myths and bear-traps
• Assuming that if a team has good clinical
results then “a bit of bad behaviour” is
acceptable
• Containing the bad behaviour of a good
practitioner by putting in strong
management
• Mediating between two practitioners when
they work in a “toxic” team
• Hoping that emerging problems will go
away if left alone
• Trying to facilitate internally
Tough at the top:
what should leaders do?
• Attend to the early signs
• Be prepared to examine the problem at more than
one level
• Clear lines in the sand – from the outset
• Visible, consistent and sustained “sponsorship” of
the process from senior NOT junior people
• Being prepared to follow through and where
necessary, exclude, reconfigure, or other tough
decisions
• See the process as a journey requiring sustained
effort and monitoring, not a one-shot effort
© NCAS Annual Conference 2009: Stream D1 – Professionalism in teams
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