Step 1—Hire the right people

If you have ever watched children pick teams for a game of baseball, you can understand the fundamentals necessary in selecting the right people for a team. The leaders will carefully pick the most capable, the most proficient, the fastest, and the smartest from the available group. Gradually, the group will be teamed off, until only the perceived poor performers are left.

In the business of health care, it’s the individual unit leader who is responsible for choosing the members of her team. Even when a new leader inherits a pre-established team, there is usually an opportunity to reshuffle and realign until the leader feels the maximum potential has been developed out of the raw material she inherited.

A successful team, regardless of its size or complexity, is realised through the combined efforts of the people that comprise it (Belasco & Stayer 1994). The individual staff members are joined to form a performance team that ultimately becomes the foundation of the nursing unit. It is through the individual staff members that the patient perceives the quality of care provided. Because it is the perception of the patient that governs the quality of the unit, the process of obtaining the proper people to make up the nursing team becomes one of the most critical parts of running the nursing unit. Or, in very simple terms, the best way to avoid problems in patient care is to hire only the very best of the available high quality personnel (people who meet or exceed the standards of the unit) (Hawkins 1997).

As the leader of the nursing unit, the nurse manager must keep herself, and the members of her team, extremely concerned with exactly whom they allow to become new members of the team. The reason for being extremely careful is easy to understand; the people that they allow to join will eventually become the exact individuals who help shape the unit’s and, ultimately, every individual team member’s continued success. The people that the nurse manager hires become part of the only real tool she has to perform the mission she has been given. With this thought in mind, it becomes very easy to see just how critical it is for the manager to put the right person, at the right time, in the right position. Failure to accomplish this fundamental process correctly is more than simply wrong; in fact, such an error can have wideranging ramifications. One of the truisms of management is that it is better to keep the position open than hire the wrong person. The nurse manager should resist the natural impulse to allow the availability of qualified personnel, or lack thereof, to influence her determination to find a quality employee.

Step 2—Make your team diverse

Diversity is one of those words that mean different things to different people. Mostly, ‘diversity’ in today’s business language means the process of incorporating people who are culturally different from the traditional Caucasian who has dominated the business scene for most of the twentieth century. However, for the purposes of this chapter, let’s focus on a narrower meaning of the word.

When you are building your team, it is important that you do not create it in your own image (Nanus & Bennis 1997). A team should not be a reflection of the leader. The team should perhaps complement the leader’s style and beliefs, but in large part should present a means for providing:

An offset for the shortcomings of the leader—No one can do everything well, or has the ability to do all of the things that a team will have to perform. Therefore, the leader should look for people who have skills that the leader does not have. The truly professional manager understands that she needs expertise that both complements her talents and offsets her shortcomings. To not select personnel who are capable of providing this necessity is unprofessional. (Some managers actually hire people they feel comfortable with, and that they do not feel will offer a challenge to them. If you are one of these managers, you are doing yourself, your unit, and your organisation a severe disservice.)

A wide range of views—You will want people who perceive things differently than you do. While it is certainly more difficult to manage people who view things differently, it is also an invaluable asset to have different outlooks available to you. These different views can provide you with at-hand information about market diversity, the potential impact of actions, and different opinions. All of these are invaluable to the leadership of a growing company.

Different skills—When hiring different members of the group, look for people who possess varying skills. Some might be technically oriented, others good administrators, and still others have excellent sales and service skills. The mix will provide the growing business with resident expertise and the ability to cross-train individual members of the team.

While it is generally preferred to lead a team comprised of seasoned veterans, it is most often far more productive to have a good mix of experience and youth. The rookies will force you to sacrifice a little in the professional categories, but they will bring you a fresh perspective and significantly different attitudes. Part of the problem with hiring elite professionals is that they have been there and done that—some of them many times before—and others will think that they have. While experience provides benefits, a growing organisation needs to have enthusiasm, energy and a willingness to try new approaches and concepts. If you load your team down with too much experience, you may be creating a situation where the flexibility you need most will be sacrificed to those who are unwilling to deviate from traditional roles and approaches (Mackay & Blanchard 1999).

We have said that diversity is what you want to strive for in establishing your team. Now, let’s throw in a word of caution: Do not try to make your team too diverse. Diversity can also work against you. For example, if you look into the talent pool and select nothing but newcomers with new, untested ideas, you will run the risk of having to spend your time acting like a firefighter, running from place to place putting out fires. A classic example of bringing in too many young, talented and creative people and not enough seasoned veterans can be seen by reviewing the performance of the Clinton White House in its first 90 days. President Clinton brought a tremendous pool of talented, excited and energetic individuals with him to staff the White House; the problem was that very few, including the President and First Lady, had previous experience in government at that level and together they made some colossal errors. Seemingly insignificant decisions, such as how the White House travel office would be run, ended in a powerful backlash and embarrassing situations for the new president and his government. The lesson learned from the early Clinton days was that intelligence, desire and imagination are not all that is needed to run an organisation. These things need to be tempered with experience and commonsense. Too many inexperienced people will force the leader to spend a disproportionate amount of time solving their problems, instead of working on the team’s goals.

Step 3—Limit team size

The successful team is begun a long time before the first team member is placed. Quality nurse managers will begin developing their team on paper by building a perfect model: i.e. what would the team look like if the organisation could provide the nursing unit with unlimited resources (money, material and people)? After the perfect ‘dream’ team is constructed, the quality leader will immediately start to restructure it so that it fits into the reality of the current nursing unit environment. To do this, the nurse manager asks herself questions such as: ‘Who or what can I do without?’ and ‘Who or what can be eliminated without degrading the potential performance of the team?’

Believe it or not, having a team that is ‘traditional in size’ means very little in establishing its effectiveness or ability to contribute effectively. For example, a ‘traditionally-sized’ professional softball team has nine starting players and a roster of approximately 25 support players. People throughout the sport use the number 34 as the ‘required’ size of a ball team, the belief being that less would not provide sufficient depth to get the team through the season. However, during much of the first half of the twentieth century, a softball team comprising of just five players, and no reserves, toured the country playing other professional ball teams. There was a pitcher of incredible talent, a first baseman, an infielder, outfielder and a catcher. These five players studied softball as a science.

While the nursing unit is a far cry from a baseball field, good ones are developed around a team concept that involves very similar concepts, and, if developed correctly, a small, well-honed team can and will always outperform a large, unprepared one (Bridges 1998). It is not the size that matters in softball, or in nursing—it is the quality. As the developer of the nursing unit’s team, the nurse manager should always be looking to ‘right-size’ her team. In fact, it is a primary responsibility of management to continually look for means to reduce costs and overhead expenses, and if you are not taking hard looks at the size of your unit and developing methods of getting the work done more efficiently and with fewer personnel, you are not doing the complete job. If, however, you are doing these things, your efforts should be governed by the following two basic concepts of team management:

Do not overwork the team—reducing the size of the team, and then forcing the remaining members to pick up the workload of the departed team members can only work if there is a balance between workload and team members. This means that the workforce should not be reduced out of a whim, or because it is fashionable, or even if your immediate senior wishes you to do so (you may have to in this circumstance, but it would then be necessary to advise your senior of the potential ramifications of such an action). While it is important to keep team members challenged by ensuring that each has a full requirement of responsibility, loading them up to a point where they are so burdened that they cannot perform well, or have little or no time for creativity, or they make mistakes, is foolhardy. If you cause the team to become burdened in this regard, what you will be creating is an environment that no one wants to work in, and one in which absenteeism and turnover rates will exceed acceptable norms.

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