By Renya Larson

Renya is a specialist with PHI’s Training and Organizational Development team.

In recent years, research has begun to demonstrate the critical importance of teamwork in health care. Much of this research has focused on acute care settings. For example, one study of surgical nurses found that “negative team factors in the operating room contributed to delays in 40 percent of all cases studied and 30 percent of adverse events.”¹

Research on teamwork in long-term care has focused on how it contributes to reaching key goals for the industry. For example, studies suggest that it may lead to higher job satisfaction among direct-care workers, which may in turn lead to lower turnover.² Lowering turnover is a high priority given that the national annual turnover rate for nursing assistants in long-term care settings is currently 66 percent (50 percent for licensed practical nurses).³

What is Teamwork?

In a recent study titled “Staff Teamwork in Long-Term Care Facilities⁴,” Dr. Denise A. Tyler and Victoria A. Parker studied teamwork among nursing assistants in 20 nursing homes. They identified five key behaviors that describe effective teamwork:

• Working interdependently (i.e., completing tasks together as needed)
• Coordination of tasks (i.e., planning together about when to complete tasks)
• Free exchange of information (i.e., sharing key information with others)
• Dynamic interaction (i.e., following through on information that is shared)
• Working toward common goals (i.e., helping out beyond assigned tasks)

In their study, Tyler and Parker identified four nursing homes in which direct-care workers exhibited all five of these key teamwork behaviors. They then conducted interviews with staff to identify what organizational practices in these nursing homes had in common. They discovered three key organizational practices that seem to foster effective teamwork among direct-care workers in nursing homes.

What Practices Promote Teamwork?

Training and development. Leaders and managers in facilities where teamwork thrives are highly committed to training and development. They invest in training beyond what is mandated by regulations. In addition, they tailor training to the needs of the individual.

One key training strategy identified by the research is mentorship. Mentors in high-teamwork facilities not only support new direct-care workers in learning the tasks they are required to perform; mentors also model the behaviors and attitudes that support effective communication and teamwork.

Flexible and collaborative management. Managers in high-teamwork facilities exhibit a flexible and collaborative approach. For example, these managers take the unique characteristics of their facilities into account in making decisions about what changes to implement. They also seek input from direct-care workers about changes before they are made.

Consistent, appreciative feedback. High-teamwork facilities offer employee feedback on a regular basis. In particular, they have mechanisms in place for acknowledging the positive contributions of direct-care workers. In contrast, low-teamwork facilities tend to only offer feedback in disciplinary situations.

Related Resources

• PHI Training and Organizational Development Services (Including PHI Coaching Supervision℠, Communication & Problem Solving, Peer Mentoring, Executive Leadership Development)
• BEST PRACTICE: Peer Mentoring at CNR
• CASE STUDY: Peer Mentoring at Loretto’s PACE Central New York
• CASE STUDY: Coaching Supervision at The Edgewood Centre
• CASE STUDY: Coaching Supervision at Orchard Cove

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1. Christian CK, Gustafson ML, Roth DM, Sheridan TB, Gandhi TK, Dwyer K, Zinner MJ, Dierks MM. A prospective study of patient safety in the operating room. Surgery 2006;(139)159-73.
2. Donoghue, C. (2010). Nursing Home staff turnover and retention: An analysis of national level data. Journal of Applied Gerontology, 29, 9-106.
3. American Health Care Association Department of Research (2008). “Report of Findings 2007 AHCA Survey Nursing Staff Vacancy and Turnover In Nursing Facilities.”
4. Tyler, Denise A., Parker, Victoria A. (2010) Staff teamwork in long-term care facilities: the influence of management style, training and feedback. Research in Gerontological Nursing, Vol. 4, No. 2, 135- 146.