Establishing High-Performing Teams: Lessons From Health Care

Why is it that teams following the same best practices can achieve different results? We studied new team formation to understand why some teams succeed while others struggle.

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Effective teams can be significant drivers of innovations that enable broader quality improvements and efficiency gains across organizations. But despite the wealth of research and managerial expertise describing characteristics of effective teams, people and organizations still struggle to deploy teams that achieve their potential, regardless of individual effort and good intentions. More puzzling is that teams following the same template of best practices can achieve different results. We studied new team formation to understand why some teams work and others struggle. Our research suggests that transitioning to effective teams depends on mutually reinforcing functional and cultural change processes. The way in which organizations combine these two key change processes is critical for success.

In our study of a dozen primary care clinics trying to establish multidisciplinary health care teams, we identified three prototypical approaches to establishing team-based care: pursuing functional change only, pursuing cultural change only, and pursuing both functional and cultural change processes.1 While functional and cultural change processes were individually important, they were most effective when mobilized in tandem. This taxonomy of approaches to change can inform how organizations go about forming teams and evaluating progress toward effective teamwork.

Making change is difficult in any organization — particularly in health care, a field in which many individuals belong to professions with strong preexisting roles and identities. The dynamics we observed in team formation, however, are not unique to health care, which is just one of many knowledge industries turning to teams to cope with the proliferation of new information, new technologies, and an increasingly pressurized need to marshal data.

Teamwork in Health Care



1. M.A. Kyle, E-L Aveling, and S.A. Singer, “A Mixed Methods Study of Change Processes Enabling Effective Transition to Team-Based Care,” Medical Care Research and Review, Oct. 15, 2019,

2. E.H. Wagner, K. Coleman, R.J. Reid, et al., “The Changes Involved in Patient-Centered Medical Home Transformation,” Primary Care 39, no. 2 (June 2012): 241-259; and L. Schottenfeld, D. Petersen, D. Peikes, et al., “Creating Patient-Centered Team-Based Primary Care,” white paper, Agency for Healthcare Research and Quality, March 2016, 27.

3. J.R. Hackman and R.J. Hackman, “Leading Teams: Setting the Stage for Great Performances” (Boston: Harvard Business School Publishing, 2002).

4. A. Bitton, A. Ellner, E. Pabo, et al., “The Harvard Medical School Academic Innovations Collaborative: Transforming Primary Care Practice and Education,” Academic Medicine 89, no. 9 (September 2014): 1239-1244.

5. C.D. Helfrich, E.D. Dolan, S.D. Fihn, et al., “Association of Medical Home Team-Based Care Functions and Perceived Improvements in Patient-Centered Care at VHA Primary Care Clinics,” Healthcare 2, no. 4 (December 2014): 238-244.

i. J. Øvretveit and D. Gustafson, “Evaluation of Quality Improvement Programmes,” Quality and Safety in Health Care 11, no. 3 (September 2002): 270-275; and H. Song, A.T. Chien, J. Fisher, et al., “Development and Validation of the Primary Care Team Dynamics Survey,” Health Services Research 50, no. 3 (June 1, 2015): 897-921.

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