Creating a Team Culture That Responds Effectively to Change

In the past ten years, nursing has changed dramatically because of improved technology, demographic factors such as the increasing number of Generation X nurses in the workforce, and varying service delivery systems. Nursing needs to respond to change by becoming a more holistic practice that combines care with, among other things, technological savvy, skill in dealing with people, and an understanding of health care models (Higgins, 2003). Additionally, well-rounded practice includes relationship-centered care as well as relationship-centered practice.

Nursing teams must focus on relationships as they practice because relationships have become increasingly critical to working in health care. It is far more difficult today than it was perhaps twenty years ago to operate in a vacuum when it comes to patient care. One reason is that due to financial pressures, quality improvement programs, and expectations of patients, patient care delivery has to constantly be improved, and one nurse cannot improve patient care alone. One of the best ways to facilitate relationships is by encouraging and practicing empathy. There are several actions that can be promulgated by leaders to promote empathy within their team (Arthur, Wall, and Halligan, 2003).

EMPHASIZE QUALITY. Few things make a nurse unhappier than feeling that the quality of the care he provides is compromised by cost control, staff shortages, or overwork. The essence of nursing is quality care, although quality is frequently compromised by organizations seeking to establish or maintain a successful bottom line. The team leader needs to assure nurses that quality is given utmost importance in any decisions that are made. As nurses in a self-directed team or advisory council make recommendations, they should be encouraged to emphasize quality in their recommendations, with specific emphasis on how quality of care affects everything from efficiency to, ultimately, cost. Not only does this emphasis on quality have implications for the organization and patient care, but it also recognizes and uses a strong emotional issue, not shortchanging patient care, to promote a good outcome. Leaders who pay attention to quality and promote quality care promote empathy by sending the message, "I value your concern for good patient care, because your desire to give quality care is one reason you practice nursing."

CLARIFY OBJECTIVES. "The apparent lack of respect for nursing in terms of what professional nurses actually do in hospitals has been detrimental to the nursing profession," according to Ray, Turkel, and Marino (2002, p. 2). These authors posit that trust and fairness have eroded under the pressure of constant change. There is no better time than the present to reestablish with nurses what their roles actually are, so that they, their leaders, and their colleagues understand their role. This role has come to include acting as decision maker, facilitator, and business manager. Nurses who have been in the profession for a long time have felt the brunt of the change in the profession, while those who are newly educated may not have received adequate training in their respective programs. The empathic team leader will recognize the potential benefits in bolstering the nursing team's understanding of the objectives of their practice and who they need to be in order to reach those objectives. The leader who clarifies objectives is saying to constituents, "I know who you are and what you are capable of. Here is an affirmation of what you and your profession represent." This message promotes empathy by recognizing the professional capabilities of the individual nurse and showing concern for her perception of how she is valued.

INTRODUCE INNOVATION. Unfortunately, many of the ideas and innovations for health care reform that have been introduced over the past decade, including managed care, managed competition, and integrated care, have fallen short of expectations. The health care industry continues to strive for solutions that will support the polarities of cost and quality (Ham, 2003). A team of nurses faces a similar challenge on a much smaller scale. "Improvement of the performance of health care depends first and foremost on making a difference to the experience of patients and service users, which in turn hinges on changing the day-to-day decisions of doctors, nurses, and other staff," posits Ham (2003, p. 1978). When clinicians are engaged in orchestrating innovation in the organization, they feel they are leading the process rather than being led blindly through yet another change. In hospitals and health care service organizations that are empathic in culture, the need for nurses to participate in such innovation is understood and acted upon. Team members receive the message, "we understand you need input into the direction of your practice."

PROVIDE CLEAR LEADERSHIP. In recent times, scholars and researchers have proposed characteristics of leaders who support innovation and creativity. To cope with the reality of change in health care, the culture of an organization must nurture innovative ways of addressing issues and problems (Andriopoulos, 2001). Clear leadership involves clear direction throughout this innovation process. Particular attention should be given to how innovation affects people, partnerships, processes, and products (Dahlgaard and Dahlgaard, 1999). People should be recognized for their value in creating innovation, and the partnerships necessary for innovation should be encouraged. The teams should be in charge of creating processes and products that reflect their capability and make them proud of who they are. Clear leadership sends the message, "I know you need supportive direction to exercise your capabilities to the fullest, especially when the territory is new."

SET THE TONE WITH HIGH-QUALITY MEETINGS. The quality of meetings within an organization will influence the quality of informal interactions. Meetings are formalized, structured sessions in which team members learn to communicate in ways that take the feelings and reactions of others into account. Most communication, however, takes place outside of formal settings. Communication may occur in the form of dialogue about a patient, education of a family member, or chatting with a colleague about the events of the day.

Besides being boot camp for effective team interactions, all meetings serve a specific purpose. Meetings are called for the purpose of focusing on one specific goal or group of objectives, whether it is to communicate departmental issues or to work on an innovation by collecting viewpoints. The team leader must set the groundwork for respectful meetings in which agendas are followed, feelings and concerns are acknowledged, and negative emotions are not allowed to fester and impede the work of the group. At times, managing emotion and taking time for empathy involves stepping back and stepping away from the agenda. Meetings replete with emotional content will take time, but this time should be allotted, even if an issue needs to be tabled until a separate session. It is not wise to rush a purposeful meeting whose impact will be felt for some time to come (Wall, Solum, and Sobol, 1992). The key is effectively acknowledging emotions related to issues and not allowing them to get out of hand, while staying on track with the purpose and objective of the meeting itself. Making sure the emotional content of meetings is acknowledged and addressed sends the message, "I understand you have important feelings that influence your decisions and your perception of the situation."

PROMOTE HIGH LEVELS OF PARTICIPATION THROUGH UNDERSTANDING AND EDUCATION. Understanding nurses' continual need for education and skill development is key in helping them participate fully in their roles and the role of their department or organization. The frustration that results when a nurse is not aware of or able to adapt to new situations can be debilitating. The team leader should never assume that the nursing staff is aware of a new drug, a new machine, or a new unit policy. Constant education is needed to introduce these advances.

Recall the last time that everyone seemed to know about something— except you. This is an extremely uncomfortable feeling, one that team leaders and team members are tasked with identifying and managing. Bridging a knowledge gap can be accomplished through formal certification programs or distance learning arrangements (Rick, Kearns, and Thompson, 2003). Education on an issue or new technology points out that everyone needs to learn something new, not just one lone nurse who feels she may have missed the boat. Encouraging education sends the message to team members that they are indeed in the same boat with many others who need to learn, that they are expected to learn, and that their desire to practice competently is recognized. Empathy is promoted in the message, "I understand that you have a need to know new information, which in turn will enhance your confidence in your ability. I respect and support your need to know and encourage you to seek education and professional development."

PROMOTE DIVERSITY. The value of diversity awareness in twenty-first century nursing cannot be overemphasized, and at its root is the core essence of empathy. We must understand the issues that can arise from our inherent cultural differences in order to succeed as a team. We must remember at all times that the individual is in the foreground and the culture from which she comes is merely background. This applies in both patient care and team interactions (Manderson, 1998; Phillips, 2003). Parvis (2003) reminds us that multiculturalism actually stimulates creativity in groups. The empathic team openly invites the flexibility that multiculturalism provides; it is a gift!

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