ealth care is a complex team sport, where teams come together and disband—sometimes several times a day—all in the service of providing the best possible care to our patients.  

Working as a high-functioning team takes a purposeful effort, a series of actions and ideas that improves our ability to work together. This process, called teaming, helps us create a positive culture for work that benefits not only ourselves as employees, but our patients. 

When you are thinking about teaming, you have to think about the outcome of our work. But you also have to think about the process that gets to that outcome. If the process is difficult or miserable, it can be harmful to our teams. 

As we work toward a relational culture, one in which everyone feels seen, heard and valued for who they are, our goal has to be more than just the best outcomes, it has to be the best possible process to get to that outcome.  

The Benefits of Relational Culture in Healthcare 

Within our healthcare system, we are very interdependent on each other. We cannot deliver good outcomes without working with other departments. For instance, if a patient in the ICU needs a medication, we have to send that order to the pharmacy and they must get it back to us. We rely on each other. 

Relational culture helps us partner together in the most effective way possible. It helps us innovate and grow together. It also gives us a sense of psychological safety. 

Psychological safety is the feeling that you can safely speak up, criticize and/or contribute ideas without humiliation. There are four categories of psychological safety: 

• Inclusion safety means you feel as if you belong with your team 

• Contributor safety means you feel as if you  can share your opinion without retribution 

• Learner safety means you feel you can admit when you don’t know something and ask for help 

• Challenger safety means you can criticize or challenge ideas without punishment 

Teaming and building relational culture both help us create a sense of psychological safety for our teams. 

Stages of Team Development 

Teaming is very intentional. We need to recognize as we move through each stage of team development so we can keep acting with the right intentions. The stages include: 

• Forming a group together, whether for a short-term or long-term project 

• Storming involves the initial disagreements as groups acclimate to each other and bring forth different ideas 

• Norming, the result of storming, means setting up the norms and expectations for our team 

• Performing means working well together toward our project goal and focusing on improvement 

• Transforming occurs when the team or environment changes 

• Adjourning means purposefully coming together at the end of a project and providing feedback on the process and outcome 

As you move through team development, you might not move through these stages in a linear way. A shake-up in transforming might push you back to storming. As long as you as a team are working together, it’s fine to move back and forth between stages. 

You’ll want to set goals and use certain strategies for each stage. For instance, in forming you should create a sense of belonging and explain roles and responsibilities. You can set out processes like how to handle disagreements, which will help you in the storming and in transforming phases. 

As you move into norming, you’ll have to address issues that came in storming and work together to move through them. As you are performing, you have to look out for issues like disengagement. Finally, as you adjourn, you should plan a celebration and time to reflect as team. 

Pitfalls and Practices  

As an organization, we have some work to do to put this framework into practice. We tend to have a culture of positivity that can make storming in a productive way difficult. Too much positivity, called toxic positivity, can make people feel uncomfortable sharing criticism. They may not speak up about problems they see. Overall, this keeps us from psychological safety and hinders the teaming process. 

It can also be hard within healthcare to complete the forming process. We are all very busy, and may not feel like we have to get to know one another and set expectations. But setting these expectations and clarifying our roles is the basis for moving forward as a team. 

These first two stages can really be the most difficult within our organization. We have to work through it together. 

Working through it 

One way to work through these problems is to pay attention to signaling. As social creatures, we are hardwired to pay attention to signals we get from other people. If we are sending signals, such as sighing when someone asks a question, we are sending signals that you shouldn’t speak up. If we look uncomfortable during criticism, we are sending the signal we don’t want to hear it. 

By paying better attention to the signals we are sending, we can work through forming and storming in a more positive, efficient way. This is something we can work on as individuals, especially if we are in leadership positions, that can have a large impact on our ability to team. 

When we start small, with our signals and feelings, within our own teams or units, we have the power to influence the larger hospital culture. As we continue to rely on one another we can create stronger teams that give everyone a voice and a sense of belonging.