COLLABORATING AND LEADING TEAMS

Building and evaluating an intervention requires interactions and collaborations with different stakeholders, professionals, and staff from diverse areas of expertise and backgrounds. Thus, at some point along the pathway of developing an intervention, investigators will find themselves involved with establishing a team and refining their team leadership skills. As group work is typically a dynamic process, drawing upon and applying team principles and learning how to manage team dynamics go a long way to strengthen intervention work. Understanding potential and common emergent challenges in managing individual staff members and the group dynamics can be helpful (Bennett, Gadlin, & Levine-Finley, 2010; Gitlin & Lyons, 2013).

There are many critical aspects of working on, and leading, teams. One key consideration for behavioral intervention research is instilling and maintaining a sense of shared purpose, mission, and clearly articulated goals among staff and key stakeholders. In behavioral intervention research, we see this as the responsibility of the primary investigator who must set the right tone and energize staff and stakeholders concerning the potential importance of the work to which they are contributing. Helping staff understand the background, significance, and potential contributions of the study toward the betterment of the public overall, and their specific role in the process, fosters a strong sense of mission, purpose, and team work.

When directing intervention work, having staff work as a team is paramount. Fourteen indicators outlined in Table 22.2 can serve as a guide to fostering positive team work (Gitlin & Lyons, 2013). These indicators and the associated self-reflective questions shown in Table 22.2 capture the essential ingredients of effective team functioning. Applied to intervention studies, reinforcing mutual respect, valuing each team member’s role and his or her contributions, fostering a safe environment for conveying issues as they arise, and troubleshooting are all critical for several reasons. They assure that, as problems develop in the field (which they will!), staff will feel empowered and comfortable expressing such events as they occur. As staff are on the front line, so to speak, of implementing a study and an intervention, its knowledge of field conditions and what is working or not is invaluable and can inform meaningful course corrections before it is too late. Given staff’s direct experiences with the actual implementation of a study protocol and knowledge of field conditions, its involvement in troubleshooting is significant and key.

The value of team work is important to instill in the hiring process, and then it needs to be continually reinforced in staff training, supervision, and staff meetings. Setting the right tone in each of these situations is up to the primary investigator or leader of the intervention work, but also should be modeled and reinforced by the project manager and others who provide oversight in the field.

Developing a team for intervention work is not limited just to staff development. Team principles can be applied to any intervention phase and work activity involving community partners, stakeholders, and/or national leaders to advance an understanding and testing of an intervention. Effective involvement of stakeholders early on in the intervention development process to shape intervention delivery characteristics (or when translating, implementing, or disseminating an intervention within a practice context) will depend upon the extent to which the 14

TABLE 22.2 Indicators of Effective Team Work

Domain

Key Self-Reflective Questions

1. Clear statement of goals, expectations, and procedures

Are project team members aware of and endorse the goals of the project?

2. Role differentiation

Do team members understand their

respective roles and responsibilities and procedures?

3. Open communication

Do team members listen and pay attention to each other and are ideas expressed openly and honestly?

4. Open, honest negotiation

Do team members feel free to suggest ideas for the direction of a project? Are differences of opinion sought out and clarified? Do team members feel free to disagree openly with each other's ideas?

5. Mutual goals

Do all team members share the group's goals and are they committed to carrying out the group's task?

6. Climate of trust

Do team members engage in active listening, disclose their ideas, feelings, and reactions, and demonstrate respect, confidence, and trust in one another?

7. Cooperation

Do team members seek out opportunities to work with one another on tasks?

8. Shared decision making

Do team members take responsibility for providing input into group decisions?

9. Conflict resolution

Are disagreements brought out into the open and faced directly?

10. Equality of participation

Does each individual, in light of his or her experience and skills, feel free to provide input to team deliberations?

11. Group cohesion

Do team members try to make sure others enjoy being members of the team?

12. Decision by consensus

Do team members listen to and consider other members' points of view before pressing their ideas?

13. Shared leadership

Do team members assume responsibility for making decisions for the group related to task accomplishment?

14. Shared responsibility for participation

Do all members of the team participate in discussions about important issues?

indicators are achieved. Of utmost importance is identifying, nurturing, and supporting mutual goals, respect, and expectations.

It is an unfair expectation that a single investigator have all of the requisite knowledge and skills to develop, evaluate, translate/implement, and disseminate any type of intervention. Intervention researchers, therefore, necessarily need to reach out to other experts and involve individuals, groups, and/or organizations in the work of building, evaluating, and implementing interventions. For example, although the investigators may have the content expertise, they may not know the clinical nuances or strategies for achieving a desired impact; thus, collaborating with clinicians can enhance treatment development. Similarly, an investigator may need to develop new items for measuring impact; collaborating with a psychometrician can improve measurement development and testing. As new statistical techniques emerge to tease out treatment effects, examine dose-response relationships, or identify who benefits and why, collaborating with statistical experts and methodologists becomes essential. Furthermore, as disseminating a proven intervention involves advancing value propositions (see Chapter 21) and understanding stakeholder interests in addition to developing a marketing plan, outsourcing these activities or collaborating with dissemination experts may be preferred.

An investigator for a behavioral intervention study is similar to a conductor of an orchestra—bringing together, coordinating and synthesizing varied nuances, components, and knowledge to the intervention research enterprise. As noted earlier, an investigator needs to develop a level of comfort with this orchestration process, which includes organizing and running meetings and facilitating a team spirit to assure all partners and their unique contributions are valued equally.

 
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