Chapter 5: Leading the Health Team

By Kidist Adamu(MPH,HSM)

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 Chapter Objectives

After completion of this chapter, students will be

able to:
Identify team roles for improving team cohesion
Discuss factors affecting work climate
Demonstrate trust and acknowledgement to
inspire health teams
Identify principles of coaching
Demonstrate effective coaching to support
others
Differentiate compliance from commitment

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 Team Building
 Group: Two or more people who interact with each other to
accomplish certain goal or meet certain need
 Team : A team is a group of people who work together
cooperatively to achieve a common goal
 The success of the team is more important than individual
achievement – synergy
 It is a group that achieves cohesiveness
 members are very clear about working toward one purpose
 It is a group whose members are interdependent
 Team is built through experience - it takes time for members to learn
how to work together
 There is mutual accountability in a team
 All teams are groups but not all groups are teams
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 Team

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 Group Dynamics

The interactions between people who are talking

together in a group setting
Any time there are three or more individuals
interacting or talking together, there are group
dynamics
A great deal of group dynamics can be learned by
observation
If one sits back quietly in a group one will begin to
see certain behavioural patterns

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 Group Dynamics …
There will be at least one person who tends to
take the lead in conversation
There will be at least one person who remains
quiet, sometimes not even appearing interested
There may be someone who tends to interrupt
other people
Someone who wants the conversation to move
along faster
Another person may be concerned about people’s
feelings, and may try to make everyone feel
equally welcome
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 Group Dynamics …

Generally the common roles in teamwork are:

Initiator: initiates an idea or action to address
the situation
Follower: follows or accepts the idea so it
gains momentum
Opposer: opposes or questions the idea, which
encourages the group to refine the idea by
exploring its drawbacks
Observer: watch what is going on and gives
feedback on the group’s progress

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 Group Dynamics …

Role Positive Negative

Initiate Gets action started Dominates

Follow Supports movement of Mindlessly agrees

action

Oppose Thinks critically Obstructs

Observe Reflects and gives feedback Acts passively

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 Group Dynamics …
Group roles are largely determined by a
combination of a person’s personality and his
or her experience with group settings
A person who is shy is more likely to sit back in
a group
A person who is impatient is more likely to
push the discussion ahead
A person who is very confident will offer more
opinions
A group needs to find a balance for all four roles to
be functional
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 Group Dynamics …
The two common roles affecting a group’s
effectiveness are dominants and silent
To manage the dominant person, one might say
something like, “You have a lot of good ideas,
I’ve written them down to discuss later. For
now, we need to talk about ...”
To the quieter person, one might say, “What are
your thoughts on this subject?”
It is best to ask the quieter person a question
that cannot be answered by a simple “yes” or
“no.”
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 Team Development
Team development is a dynamic process.

Most teams are in a continual state of change.

As teams develop and grow, they pass through

five stages of development.

But not every team passes through each of these

stages ,teams that do tend to be better
performers.

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 Team Development …

1. Forming
Initial stage of development

It is the orientation stage

Team members may often have differing ideas

about purpose
There is relatively little trust

People tend to be careful about what they say

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 Team Development …

2. Storming
Arguing that the team defines itself
Characterized by resistance and negativity
There may be conflict about the purpose,
leadership and working procedures
During this stage people often feel the team
will never “come together”
Members may isolate or remove themselves
from the group
Needs high level of directive supervision

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 Team Development …
3. Norming
Constructive or resolution stage
Team members are developing a shared vision
and are setting goals and objectives.
People are getting to know one another’s
strengths and are learning how best to work
together
The team experiences more stability and
productivity
As a leader encourage creative thinking

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 Team Development …

4. Performing
Members have a clear, shared sense of

purpose, high trust, and open communication

The team is effective within the existing

paradigm
Relationships and team spirit are high

Productive or synergy stage

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 Team Development …

5. Transforming /Adjourning
Occurs when the team is at such an effective

level of functioning that it can redefine its

shared purpose and respond quickly to change
The leadership within the team is shared, trust

is high and communication is open

Closure of team process

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 Team Development …
The point of knowing about the stages of a team is
two-fold:
It can be helpful simply to know that there are
stages, and that it is normal to go through
these stages
One can identify the stage of development for
a given group or team, and can assist the
progress through that stage by managing the
interactions or dynamics between and among
the members

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 Group Cohesiveness

The degree to which members are attracted to

their group
It is the extent to which the members of a group
find staying together to be in mutual interest
Three major consequences of group
cohesiveness:
Level of participation
Level of conformity to group norms
Emphasis on group goal accomplishment

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 Group Cohesiveness …

Factors which lead to group cohesiveness are

Group size

Group identity

Healthy competition

Effectively managed diversity

Success

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 Sources and Consequences of
Group Cohesiveness

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 Improving Work Climate
The essential task of management is

Creating opportunities

Releasing potential

Removing obstacles

Encouraging growth

Providing guidance

Work climate is the weather of the workplace

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 Improving Work Climate …
A good work climate can improve an individual’s

work habits, while a poor climate can erode good

work habits
When people work in a supportive environment, they

strive to produce results

Such an environment is called a positive work

climate

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 Improving Work Climate …

Most importantly, a positive work climate stimulates

motivation and performance

Positive work climate  motivation 

capabilities and extra effort  improved job
performance

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 Factors that create a work climate

Factors a manager can influence

Leadership practices
Provide vision, living organizational values
Knowing staff aspirations, skills and interests
Focusing staff attention on critical challenges
Aligning work with skills and interests,
motivating team work
Recognizing accomplishments, and inspiring
confidence in staff

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 Managers can influence …

Management practices
Work group communications, inclusion in decision
making where appropriate
Revision of job descriptions
Improvements in planning, policies, procedures, work
planning
Supervision and feedback including performance
reviews, and job recommendations
The organizations management system, or procedures
and processes that affect both tasks and the flow of
information

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 Factors Beyond the Control of Some Managers

Organizational History
Organizational experience with success and
failure
Its experience with incentives, sanctions, and
consequences
Its reputation in the community
Organizational Culture
Values, beliefs, traditions, and assumptions
shared by employees

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 Factors Beyond Managers …

Management Strategy
Approaches related to job opportunities, and
growth that help an organization meet its goals
Organizational Structure

Defining roles and responsibilities,

Addressing policies regarding rewards and

promotions

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 Factors Beyond Managers …

External environment
The broader context in which the organization
operates
Prevailing disease patterns, political and
economic conditions, regulations, processes of
health sector reform
Donor priorities competition and an
organization’s reputation in the community add
pressures on staff to perform

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 Factors Beyond Managers …
External environment …

Available workforce skills, salary expectations,

cultural and gender barriers, and the condition

of roads and public transportation
These may restrict the pool of potential

employees, possibly requiring a stronger focus

on developing and retaining staff

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 Factors that create …
It is important to know how you can influence

work climate and distinguish between factors

that are within your control and those that are
not
On one hand, you can change a climate that

undermines staff commitment and performance

by managing and leading your team better

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 Factors that create …

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 Ways of Improving Work
Climate in Organizations

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 Staff Motivation

Staff motivation is the most important determinant

of work climate
The boss’s behavior drives climate, which arouses
motivation
And aroused motivation is a major driver of bottom-
line performance
As a manager who leads a work group, you influence
the climate of your work group more than any other
factor

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 Motivation …
People often feel motivated for high performance by
one of three primary motivators:
Power: want positions of visible responsibility
Affiliation: want to work in a group where
the interpersonal relations are pleasant and
supportive
Achievement: want to see results and to
know that their efforts contributed to those
results

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 Know your Staff

To develop a positive work climate know your staff

and establish a good work relationship

Learn about the ideas, past experiences, goals, and

behavior of your staff to understand what makes

each person want to do his or her best

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 Challenge staff to help them grow
Challenge staffs by offering assignments that stretch
them beyond their current level of competence and
confidence
Such assignments offer the possibility of doing
something in a new way
They are opportunities for staff to show leadership
potential
When staff members are not challenged, they do not
grow or learn from mistakes, and they become
bored

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 Clarify Roles and Responsibilities

 Everyone in the organization knows his or

her role and responsibilities
 The organizational goals are known
 People are aware of the clients’ needs
 People know what is expected of them in
terms of level of performance and
consequences of non performance

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 Support Staff

Supporting your group means advocating for its work

and its needs
Make the services your group performs and what it
accomplishes visible to the wider organization
Once you have established a good reputation for the
group, you can follow up by securing or providing the
resources it needs to do its job
These include not only time, materials, and money,
but also political and emotional support

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 Balance Challenge, Clarity, and Support
 Staffs who face challenges but lack support or clarity can
experience stress and frustration
 Without challenge or support, however, staffs who are clear
about expectations may find little intellectual and
professional stimulation at work
 Find the right balance for your group’s climate, to help your
staff improve their performance

 Strengthening communication
 Communicating effectively is a key leadership
competency for developing a motivating work climate
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 Strengthening Communication

When you communicate well, you can create a good

work climate where people learn from one another
Small changes in the way you communicate can
make a big difference in your work climate
Good communication improves morale

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 Coaching to Support Others


Coaching is not about teaching the caterpillar how to
fly; it’s about creating an opening for it to see the
possibility -Paul Lefebvre

It is a leadership tool to support others to successfully

address challenges and produce results
It is enabling others to reflect on their commitments
and find new ways to achieve their intended results

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 Coaching …
Coaching consists of a series of conversations
over time
A coach helps the person being coached:
Understand his behaviour and how it is related
to his performance better
Develop alternative behaviours that are more
effective
Build confidence to practice new behaviours to
produce intended professional as well as
organizational results

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 Coaching …

How coaching differs from Supervision, counselling or

mentoring
Coaching takes place primarily in a one on one

relationship (unlike supervision)

It does not require specialized training (unlike

counselling)
It focuses on an aspect of performance that

needs to be improved (unlike mentoring)

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 Coaching Principles

A coach does not:

Evaluate and judge
Blame, criticize and scold
Give solutions
To be coached, you have to:

Learn and change

Be open to feedback from others

Take responsibility for your own actions

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 Coaching Principles …

An effective coach:

Builds a relationship of trust and support

Cares about the person being coached/has the

other’s growth in mind

Listens well

Asks questions to clarify and illuminate a goal

or challenge

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 Coaching Skills: OALFA technique

 It is important to know the coaching skills and to apply them

when a coaching opportunity arises
 five important skills required for a coach with a simple
acronym of OALFA
Observe individuals to gather accurate information about
their performance prior to having a coaching discussion with
them - helps us start a coaching discussion
Ask questions, so that you can reach an understanding of
the situation.
Listen carefully and thoughtfully to the responses before
speaking again.
Give Feedback that will help the individual improve his or
her performance.
Agree on the action plan and next steps that will lead to

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improved performance
 Gaining commitment not just compliance
It is important to balance mobilizing people for
commitment and setting standards for compliance
so your staff not only own their challenges, but are
also aware of the standards they are expected to
follow
Formal compliance produces many results
Commitment, however, is a key to encouraging staff
to face obstacles, overcome resistance, and realize
sustainable results
It unleashes the extra effort often needed to
develop and implement creative, effective
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 Gaining commitment not compliance

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 Putting first things first: the Important and
Urgent Matrix
 This tool helps individuals and groups set priorities and
organizing and carrying out work based on priorities
 This tool will help individuals and groups learn that the
most important thing is not managing time; it is
managing ourselves!
 We spend our time on activities in one of four ways, by
working on:
I. urgent and important things
II. important but not urgent things
III. urgent but not important things
IV. not important and not urgent things

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 Putting first things first...

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 Putting first things first...
Impact of each quadrant on your energy and
effectiveness
 Results of living in
 Quadrant I: Stress, burnout, crisis management,
always putting out fires
 Quadrant II: Vision, perspective, balance, control, few
crises
 Quadrant III: Short-term focus, crisis management,
feeling victimized and out of control
 Quadrant IV: Irresponsibility, work not completed on
time (or at all), loss of your job
 Most of your time should be spent in Quadrant II,
Important and Not Urgent
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 Thank you

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