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Section III (Chapter 13, 14, 15, 16, and 17) presents ideas for improving teams and teamwork. It assumes that teams are present and regarded as standard practice in organizations. In many organizations, however, this is not the case—in fact, organizational policies and practices often work against rather than promote the success of teamwork. Senior leaders of these organizations are responsible for creating the cultures and structures in which teams thrive and also for providing needed resources for teams to succeed. In this section of the book, we first (in Chapter 18) provide guidelines for senior leaders committed to improving team presence and performance in their organizations. Then in Chapter 19 we discuss the potential for a future in which teamwork is expected and rewarded throughout the healthcare sector.

Senior leaders of healthcare organizations are not those with the highest age or tenure, but those in the highest positions of authority in the organization. They are the leaders with the power to allocate scarce resources, set and enforce organizational values and norms, and represent the organization to external constituents. Typically, the term senior leader includes those at the level of vice president and above in large organizations, or department director and above in smaller organizations. In some organizations, like medical group practices, the senior leaders may include all of the partners if the group is small, or a small elected group from among the partners if the group is large.

Senior leaders of healthcare organizations face a difficult challenge when they commit to improving their organizations through expanded use of teamwork. Improvement comes with risk, because it requires change from the status quo, and change often meets resistance. Some healthcare leaders are content to sustain the status quo and not "rock the boat," particularly if change involves upsetting existing patterns in clinical care delivery developed by powerful and largely autonomous professionals. However, to the extent that improvements in team-based care and teamwork effectiveness depend on changes in the organization, senior leaders must be willing to step up to the challenge.

Senior leaders are responsible for creating a context that builds, supports, and nurtures interprofessional teams. With respect to supporting teams, senior leaders have 3 major tasks: (1) creating and sustaining a team-based organizational culture, (2) creating and sustaining a team-based organizational structure, and (3) providing key resources. The 3 tasks are listed in Table 18–1. The first of these tasks is paramount, because cultures set the philosophy and operating assumptions that guide behavior in the organization, independent of how work is structured. Organizational culture refers to the prevailing beliefs and values in an organization. These beliefs and values drive "the way we do things around here," which is a common interpretation of the meaning of culture in organizations (Deal and Kennedy, 1982, p. 4). Organizational cultures can encourage, discourage, or ignore teamwork. For example, the MIT Media ...

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