Coming together is a beginning.
Keeping together is progress.
Working together is success. - -Henry Ford
Public health has always required multidisciplinary collaboration. In recent years, the field has redefined how public health professionals should collaborate and who should be included. For example, the Institute of Medicine has called on public health leaders to collaborate with private industry, media, healthcare, academia, and government.1 The National Institutes of Health's "roadmap" states that "research teams of the future" must be multidisciplinary and involve public and private alliances to spur innovation and accelerate the translation of science to practice.2 More broadly, the global "New Public Management" movement, known as "reinventing government" in the United States, calls for agencies to decentralize and partner to develop creative solutions to health and social problems.2-4
So, public health managers have to link up with new partners. But how can managers actually form collaborative teams that improve public health work?
Frank LaFasto and Carl Larson, who have studied thousands of teams in a variety of organizations, define teams as "a special type of collaborative group that forms to create or change something specific."5 Teams are built to act. This makes them different from task forces or boards that are formed only to advise or support an effort. Furthermore, collaborative teams rely on joint decision making and peer leadership and may not have a single leader with executive authority.5,6 Team members, therefore, need to be able to work together to accomplish specific tasks. Because health programs can stand or fall depending on how well teams work together, developing competent teams has become a priority in health management and leadership training.
Offered by the School of Public Health and the Kenan-Flagler Business School at the University of North Carolina at Chapel Hill, the Management Academy for Public Health is a leadership and management training program that has worked with teams of public health managers and community partners for almost a decade.7 The Academy's hallmark is its focus on team and project-based learning. Teams learn skills in managing people, money, and data. To practice the skills and develop innovative strategies, each team develops a business plan for a health program within its community or state. Nonprofit business experts and academy faculty coach teams through business plan development and implementation.8
Recently, we interviewed representatives from 40 teams who attended the academy during 2003-2005. We asked them what factors are most important to accomplishing team goals, in this case implementing their business plans. Many of their conclusions echoed LaFasto and Larson. We have selected the top five themes to present here, along with some suggestions for how you, as a manager, could try to implement their advice.
Team Members Must Commit to a Common Goal
The first task of the team is to articulate and agree on what they are trying to achieve. As one manager put it, "You all need to know where you're going and what you're doing." Articulating a common goal is as much about the process as it is the end point. Some respondents explained that reaching a common goal meant that all team members had input and "bought in" to their overall business plan concept.
How can you keep the team goal-oriented? There is nothing like writing things down to get them moving forward. Get your team members to hash out exactly what their expectations are, identify and agree on the primary goals, write them down, and all sign the document. In our office, we print out the list and make it into a poster, laminated, and mounted on the wall of our meeting room. At the end of the time frame for the project, we put stars next to the goals that have been met, add new ones, or carry over those that need further work. Logic models are another excellent tool for building consensus and mutual understanding of where the team is trying to achieve--and how progress can be measured.9
Team Members Must Commit to Doing the Work
When team members "buy in" to the project goal, they are likely more motivated to execute project tasks than when they concede to a majority or unilateral decision. As one respondent explained, "All people on the team need to be passionate about the plan, otherwise you'll run out of steam halfway through." This seems particularly important for teams with few members and those operating without a solid organizational structure to provide support and team replacements. Good teams quickly identify members who are not able or willing to see tasks through: the "weakest links" can drag on team members' motivation and progress toward their goal. But when they see all members contributing, they draw on the energy and stay focused.
How can you build commitment? Think about drawing many people into your decision-making process, so you are not just dumping work on people's desks. Once a project is under way, find out who needs and wants more direction from you, and step in to help. On the other hand, give more freedom to those who want to work more independently. If you identify a weak link, work with that person to identify how he or she can contribute to the program, or what problems he or she is experiencing that are not being expressed. Strong social ties also help; we will put forth a lot of effort to help our colleagues when we are also friends in the journey. So team leaders should build the bonds among team members-over meals or coffee, through going to a ball game-to forge stronger commitment. If you make your team more of a caring "family," it will be easier to address conflicts or misunderstandings when they emerge. Strong teams must trust one another's commitment and intentions, as well as one another's wisdom and skills.
Teams Should Build on Their Members' Strengths
Management Academy strengthens management and leadership skills. As managers' skills grow, our research shows, so does their confidence. Some team members, however, are good at managing people, while others are more comfortable-and effective-with money or data. "Don't try to make creative people into accountants," one participant told us, a sentiment echoed by many. Identify team members' strengths and "nonstrengths," identify leaders, and set people up to succeed at their assigned tasks.
How can you identify and build on strengths? Many individual development instruments help identify individuals' strengths and preferences with regard to work style, personality traits that affect work, and strengths to build on. Team-building experts often work such instruments into their activities, for the benefit of both the manager's and individuals' own understanding of their strengths and weaknesses. Use your team members' annual evaluations to talk about what they like best to do, what you perceive they are best at, and think about ways you can help them be more effective at all of their tasks. If you do not use the instruments, start off team projects with an open discussion of who is good at what, how each member likes to work, and how the team will function. That can help the team get off on the right foot. Many teams find "team charters" to be a great tool.10
Team leaders Must Facilitate Effective Communication
Collaborative leadership is driven by consensus instead of executive decision making. That means communication is essential. Some of our participants believe that the team leaders' major role is to facilitate communication so that the team can reach agreement on actions. Team leaders should seek input from all team members and encourage dialogue among members, especially when problems or conflicts arise. In fact, several participants expressed that "healthy conflict can be a dialogue," and managing conflict through productive discussions was key to progressing in plan implementation. With respect to leaders and communication, one manager explained:
The leader needs to have the skill to manage the team[horizontal ellipsis] to encourage [the person who is introverted] to give ideas and concepts and make sure that the person that tends to dominate the conversation is held to a minimum-in a kind and tactful manner so that one person does not dominate the entire plan.
Communication is important to bringing together people with different personalities, work styles, and perspectives to work toward a common goal.
How can you facilitate better communication? Do not be afraid to bring up or deal openly with conflicts or other difficult issues. Without pointing fingers or putting any one on the spot, try to air things that seem to be holding up work. Leaders may need to apologize for oversights or mistakes-and thereby to set the tone for humility and problem-solving on the team. Be sure also to communicate when things are going well: hold up good examples of teamwork and accomplishments, give "awards" that show you are recognizing the hard work the team is putting in. At the end of a period of hard work, our team often has a meeting in which specific accomplishments are named and kudos are generously given-supplemented with gourmet ice cream bars!!
Balance Team Member Diversity and Common Interests
Team diversity is important to accomplishing project goals. Many participants talked about how different skills, perspectives, and interests made their team stronger. In particular, teams need expertise in finance and data management, program development, and community outreach. Some participants, however, found that common interests with teammates helped build their relationships. For example, one team consisted of epidemiologists from different health districts. This team found their common backgrounds helped them discuss project issues and empathize with their teammates.
How can you build diverse teams that work well? If you have a role in hiring process in your organization, you may be able to build your staff with the teams in mind. Hire people with good team skills, in addition to technical competence. Hiring people who "fit" with the values of the team and organization, and who work well on teams, will help programs flourish. Those kinds of people are also likely to stay longer in your shop. In your dealings with the community, local business people and other healthcare professionals try to forge connections with people who will bring a different perspective to your teams. You may have to educate people as to what public health is and does, how public health affects many other realms of society, and why they should care about (and become partners with) public health practice. In sum, finding people with different perspectives and interests can help your team, as long as the interests are not extremely divergent, and as long as they know how to work well on a team.
As organizations move toward a new management style that emphasizes collaboration and innovation, competent teamwork is very important. In our study, managers shared their advice on what managers and supervisors should consider when developing teams within their organizations, as well as when they link across professional fields and sectors. Focusing on team goal development, emphasizing project buy-in while clearly defining individual tasks and goals, identifying and using individual strengths, and allowing for teams to be made up of members with variable skill sets while building on common interests or backgrounds are all key components to successful team development. We recognize, and our own research shows, that a large part of what makes a team successful is external to the team: the organizations, communities, and other outside interests have substantial influence on what teams can accomplish. A good start, however, is to build a team that has the best potential to work.
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