Team involvement in shared decision making included autonomy, or the team’s authority to make action item decisions. Some teams worked collaboratively with their operations leaders to identify realistic workload action items, whereas other teams worked on action items selected or endorsed by the operations leaders. As participant observers, we documented the degree of autonomy or voice the team had during shared decision making. We also tracked team independence, or the team’s ability to take initiative and engage in processes on their own. Independent teams, for example, consisted of team members who actively participated in project work; they addressed emotional challenges, such as emotional conflict with each other and their operations leaders; and they negotiated their need for additional resources and supports to complete change management projects. The outcomes matrix also includes the length of time it took for teams to function independently.
Site narrative summaries
The following site summaries provide additional context for Tables 2 and 3, illustrating the presence of conflict, and reinforcing the importance of effective SP linkages among team members and between team members and their operational leaders. At Site 1, the team understood the project purpose, and they were eager to get started on project work. Conflict arose during orientation as the team discussed team roles/responsibilities and team ground rules. Although the team agreed that ‘respect for each other’ was an important ground rule, some team members indicated that they did not feel ‘equal in representation’ because of their status (e.g. care aide versus LPN or RN). Team members had positive work relationships before the beginning of the project, and awareness of trust/respect issues among themselves were quickly resolved through open, honest discussions about each team member’s importance to team work. The team was able to forge a strong team identity after initial conflict. Communications conflict with the operations leader occurred throughout the project and it was related primarily to trust/respect and past history issues. The operations leader had organizational priorities which competed with the team’s activities. She cancelled team meetings and was unavailable to discuss action items with the team. The team reported that this was a past pattern, and they interpreted the operations leader’s ‘blocking’ behaviour as disrespect for them. As a consequence, they stated that they did not trust her to provide the necessary supports for project success. The team was unsure what to communicate to staff, creating staff confusion over project work. With our assistance, the team had some quick win successes, and they were proud of these accomplishments. The staff knew about the quick win projects, but they did not understand their connection to the overall project purpose. Team independence and autonomy were hampered by lack of operations leader engagement, and although the operations leader told us that she was interested in pursuing some of the project work, no firm commitments were in place by the end of the project.
At Site 2, the team had good relationships among themselves, and the project leader was a strong advocate for the project. The team members were culturally diverse with a traditional view of the nursing hierarchy, and there was initial discomfort with establishing ground rules around active participation and team member equity. Team members heavily depended on their project leader, and throughout the project, the team leader had to address team members’ roles and responsibilities. This conflict was because of past history: team members were used to a passive role with respect to decision making. Specific team members, for instance, were responsible for communications with us and staff, but they did not follow through without team leader prompting. The team also expected the team leader to do all the communications with the operations leader. The team leader was an excellent role model for her team, and she respectfully challenged the other team members to get engaged in project functions. By the end of the project, team members were acting independently. The greatest conflict resulted from past history and trust/respect issues with the operations leader. The operations leader had a ‘directive’ style, and throughout the project, it was difficult for her to cede control to the team. With some assistance from us, the project leader tied project team action items to current organizational initiatives. The operations leader became more supportive, the team began having quick wins which helped build their confidence and pride, and the staff became aware of the project and supported team efforts. Although the operations leader supported project work and its sustainability, she made final project decisions for the team, dampening their autonomy. The operation leader’s behaviour also reinforced past history and team mistrust for her motives: ‘She still controls what we do. That may never change’.