Shirley L.T. Helm, MS, CCRP Senior Administrator for Network Capacity & Workforce Strategies
C. Kenneth & Dianne Wright Center for Clinical and Translational Research
Virginia Commonwealth University
Abstract: The practice of team science allows clinical research professionals to draw from theory-driven principles to build an effective and efficient research team. Inherent in these principles are recognizing team member differences and welcoming diversity in an effort to integrate knowledge to solve complex problems. This article describes the basics of team science and how it can be applied to creating a highly-productive research team across the study continuum, including research administrators, budget developers, investigators, and research coordinators. The development of mutual trust, a shared vision, and open communication are crucial elements of a successful research team and research project. A case study illustrates the team science approach.
Each research team is a community that requires trust, understanding, listening, and engagement. Stokols, Hall, Taylor, Moser, & Syme said that:
“There are many types of research teams, each one as dynamic as its team members. Research teams may comprise investigators from the same or different fields. Research teams also vary by size, organizational complexity, and geographic scope, ranging from as few as two individuals working together to a vast network of interdependent researchers across many institutions. Research teams have diverse goals spanning scientific discovery, training, clinical translation, public health, and health policy.”11 Stokols D, Hall KL, Taylor BK, Moser RP. The science of team science: overview of the field and introduction to the supplement. Am J Prev Med. 2008 Aug;35(2 Suppl):S77-89. Accessed 8/10/20.
Team science arose from the National Science Foundation and the National Institutes of Health, which fund the work of researchers attempting to solve some of the most complex problems that require a multi-disciplinary approach, such as childhood obesity.2 Team science is bringing in elements from various disciplines to solve these major problems.3, 4 This article covers the intersection of team science with effective operationalizing of research teams and how teaming principles can be applied to the functioning of research teams.
Salas and colleagues state that, “a team consists of two or more individuals, who have specific roles, perform interdependent tasks, are adaptable, and share a common goal. . . team members must possess individual and team Knowledge, Skills, Attitudes ….”5 Great teams have a plan for how people act and work together. There are three elements that must be aligned to ensure success: the individual, the team, and the task. Individuals have their own goals. These goals must align, and not compete with, goals of other individuals and team goals. Task goals are the nuts and bolts of clinical research. Like individuals, the team has an identity. It is necessary to provide feedback both as a team and as individuals.
In a typical clinical research team, the clinical investigator is at the center surrounded by the clinical research coordinators. The coordinator is the person who makes the team function. Other members of the typical clinical research team are:
· Research participant/family
· Financial/administrative staff
· Regulatory body (institutional review board)
· Study staff
· Ancillary services such as radiology or pathology
The Teaming Principles
Bruce Tuckman developed the teaming principles in 1965 and revised them in 1977 (Table 1).6 Using the teaming principles is not a linear process. These principles start with establishing the team. The team leader does not have to establish the team. Any team member can use teaming principles to provide a framework and structure and systematically determine what the project needs. Storming is establishing roles and responsibilities, communications, and processes. The storming phase, when everybody has been brought together and is on board with the same goal, is a honeymoon period.
Norming is the heavy lifting of the team’s work. This involves working together effectively and efficiently. Team members must develop trust and comfort with each other. Performing focuses on working together efficiently, and satisfaction for team members and the research participants and their families.
Tuckman added adjourning or transforming to the teaming principles in 1977. The team might end or start working on a new project (study) with a new shared goal. Adjourning or transforming involves determining which processes can be transferred from one research study to another research study.
While the teaming principles seem intuitive and like common sense, people are not raised to be fully cooperative. Using the teaming principles provides framework and structure and takes the emotion out of teamwork. The teaming principles empower team members and provide the structure that is necessary for teams, which are constantly evolving and changing.
The shared goal at the center of the teaming principles provides a sense of purpose. This provides commitment, responsibility, and accountability, along with a clear understanding of roles, responsibilities, competencies, expectations, and contributions. In Dare to lead: Brave work. Tough conversations. Whole hearts, Brené Brown coined the phrase, “clear is kind, unclear is unkind.”7 It is extremely important to define roles and ensure that each team member knows what the other team members are doing. This prevents duplication of effort and ensures that tasks do not fall through the cracks.
How to Use Teaming Principles
Table 2 briefly describes each of the five teaming principles. Forming begins with gathering the team members and involves determining who is needed on the team to ensure success. Each team member must be valued. The team may vary depending upon the study, project, and timelines. During the research study, team members may enter and exit from the team. Forming the team may mean working across boundaries with people and departments that team members do not know. It is also necessary to establish the required competencies and knowledge, skills, and attitudes of team members, and to recognize and celebrate differences. The team must have a shared goal and vision.
Storming the team involves establishing roles, responsibilities, and tasks. This includes determining who has the required competencies to perform tasks such as completing pre-screening logs or consenting research participants. Also, storming involves defining processes, including communication pathways and expectations. Simply sending an email is not an effective way to communicate. Team members need to know whether an email is providing information or requires a response. Expectations for responding to emails should be described and agreed upon by all team members. Emails might be color coded to show whether an email is informational or requires a response. If clinical research sites utilize a clinical trial management system, the process for updating it must be determined and clearly communicated.
Norming is how team members work together. The shared goal is re-visited often under norming. Team members are mutually dependent upon each other and must meet their commitments and established deadlines.
Trust lies at the heart of the team. Building trust takes work and does not come naturally. It is helpful to understand that there are several types of trust. Identity-based trust is based on personal understanding and is usually seen in relationships between partners, spouses, siblings, or best friends. This type of trust does not usually occur in the workplace.
Workplace trust resides in calculus-based trust and competence-based trust. Calculus-based trust is about keeping commitments, meeting deadlines, and meeting expectations. There are some people who can be counted upon to always do what they are supposed to do. These people have earned calculus-based trust. Competence-based trust is confidence in another person’s skills or competencies.
Swift trust is immediate and necessary during extreme situations where there is not time to develop deeper connections with individuals. It relies on personal experiences, stereotypes, and biases. Some people are naturally more trusting than other people.
The teaming principle of performing involves satisfaction in progressing toward the goal and being proactive in preventing issues from arising. There will always be issues; however, the most effective teams learn from issues and have processes for resolving them. This makes a team efficient. Performing also includes revisiting the shared goal, embracing diversity and differences, and continually improving knowledge, skills, and attitudes.
Adjourning/transforming is the completion of tasks and identification of lessons learned. Team members need to circle back and determine what worked well and can be applied to the next study. Celebrating successes and acknowledging the contributions of all team members are also an aspect of adjourning/transforming. When the author was managing a core laboratory, she performed tests for an oncology investigator’s study. Months later, the investigator gave her a thank-you card for her contribution to the study that was unexpected but greatly appreciated.
Strengthening the Team
Without a framework and structure, team dysfunction is likely. In The five dysfunctions of a team: A leadership fable, Lencioni presented team dysfunction as a pyramid.8 Absence of trust is at the bottom of the pyramid. Absence of trust results in questioning everything people do and results in team members unwilling to share or to ask for help. Without asking for help, mistakes will be made.
Absence of trust leads to a fear of conflict and an inability to resolve issues or improve efficiencies. Fear of conflict leads to lack of commitment. Doubt prevails, team members lack confidence, and the goal is diminished. Team dysfunction leads to avoidance of accountability. Follow-through is poor and mediocrity is accepted, breeding resentment among team members.
At the top of the team dysfunction pyramid is inattention to results, which leads to loss of team members and future research studies. There are some teams where people are constantly moving in and out. This is
a symptom of team dysfunction. Loss of respect and reputation of the team, department, and individual team members is another consequence of inattention to results.
Table 3 highlights ways to strengthen the team. Recognizing the strengths of each team member starts with self-awareness. For example, the author had to understand her communication and learning style and how this is similar to and different than that of other team members. The VIA Institute of Character offers a free assessment that could be a fun activity for research teams.
There is no one road to self-awareness; however, each team member must recognize that other team members do not necessarily share their understanding or perceptions. There are many options and possibilities for how others may understand or perceive an experience, none of which are right or wrong. Each team member should appreciate that different understanding and perceptions of experiences do not have to threaten their identity or relationships.
One quick way to show this is through ambiguous images, in which people see entirely different things in the same image. Once they are aware that there are different ways of seeing the same thing, they can appreciate other perspectives. As Pablo Picasso said, “There is only one way to see things, until someone shows us how to look at them with different eyes.” Strengthening the team requires embracing demographic, educational, and personality diversity.
Open and honest communication should be encouraged. Team members should give and receive constructive feedback. This is a learned skill that is often difficult. However, tools are available for assessing communication and listening styles. Many institutions and human resource departments utilize the Crucial Conversations program by VitalSmarts, LC. One member of the team can participate in Crucial Conversations and bring the knowledge back to the team. Communication must include managing conflict and an awareness of cultural differences.
Opportunities for education and training to acquire new knowledge, skills, and attitudes/competencies should be provided. Education may be transportable across teams or may be study specific. Team members should be cross-trained, which may be accomplished through several methods. Positional clarification is where one person is told what another person is doing, which is primarily for information transfer. Positional modeling is receiving the information but also shadowing the other person while they perform the task/skill. Positional rotation is performing another person’s job. This is best for back-up positions, which are necessary for research teams.
Team success is facilitated by recognizing individual successes and commitment to shared goals. Recognizing individual successes reflects team success. For example, if a team member becomes a certified clinical research professional, this is a success for both the individual and the team. Also, the team must have a shared understanding of the goal or purpose. This shared goal must be linked to the individual goal of each team member.
Teamwork needs constant attention and annual evaluations, and team meetings are not sufficient. It is extremely important to regularly check in with people. Team members can check in with other team members simply to ask how things are going. Misunderstandings should be dealt with immediately. Clear direction, accountability, and rewards are necessary.
The author has a bell on her desk that team members ring when they have a success. This sounds cheesy, however, it is fun and team members really enjoy it. For example, when the author finished her slides for the SOCRA annual conference on time, she rang the bell. Her team members asked what happened, and they had a mini celebration. This small item helps to build and strengthen a team with small successes leading to larger successes.
Case Study Using the Teaming Principles
The following case study illustrates the application of the teaming principles to a team involving four major players. Olivia is a clinician with three clinic days and teaching duties who is a sought-after speaker for international conferences. In addition, Olivia is the clinical investigator for four clinical research studies: two studies are active, one is in long-term follow up, and one is in closeout. The studies are a blend of industry sponsored and investigator initiated. Olivia is also a co-clinical investigator on two additional studies and relies heavily upon Ansh for coordination of all studies and management of two research assistants.
Ansh is the lead research coordinator with seven years of experience in critical care research. Ansh is very detail-oriented and takes pride in error-free case report forms, coordinates with external monitors, and manages two research assistants as well as the day-to-day operations of Olivia’s research studies.
Bernita is a research assistant with six months of work experience in obtaining informed consents, scheduling study visits, and coordinating with ancillary services. Bernita is responsible for contacting participants for scheduled visits and providing participant payments. Bernita is developing coordinating skills, seeks out training and educational opportunities, and is a real people person.
Delroy is the regulatory affairs specialist for the Critical Care Department, which consists of eight clinicians (not all of whom are engaged in research). Studies include one multi-site clinical trial for which the clinical research site is the coordinating site, and one faculty-held Investigational New Drug/Investigational Device Exemption study. The department’s studies are a mixture of federal- and industry-funded studies. Delroy has been with the department for five years in this capacity. However, Delroy’s coworker recently and unexpectedly took family and medical leave, leaving Delroy to manage all regulatory issues for the department. Also, the department chair recently made growing the department’s industry-sponsored study portfolio a priority.
Olivia has received an invitation to be added as a clinical research site for a highly sought-after ongoing Phase II, multisite, industry-sponsored study comparing two asthma medications in an adult outpatient setting. The study uses a central institutional review board (IRB) and has competitive enrollment. It will require the following ancillary services: investigational pharmacy, radiology, and outpatient asthma clinic nursing. For the purposes of this case study, all contracts have been negotiated and all of the regulatory documents are available (e.g., FDA Form 1572, informed consent template, and the current protocol). The institution utilizes a clinical trial management system.
Oliva shares the study information and study enrollment goals with Ansh with the charge of getting this study activated and enrolling within 40 days. What are the potential barriers that might affect this outcome? One potential barrier to the study activation timeline is Delroy’s heavy workload. To ensure that the timeline is met, Ansh might contact Delroy and explain the situation, asking what Ansh can do to help facilitate study start-up to ensure that the timeline is met. Ansh should be clear in determining what Delroy needs for study activation, the deadlines for each item, and assist in facilitation of communicating to other members of the study activation team (e.g., ancillary services, IRB) what is needed. Priorities include the regulatory work and staff training. Barriers include managing the regulatory issues on time. This might be a good opportunity to connect with Bernita for providing Delroy some assistance, as Bernita is knowledgeable and eager to acquire additional skills and training. The shared goal of starting the study on time should be shared with all team members in order to meet the 40 day study activation and enrollment goal.
Nuggets for Success as a Team Member or Leader
Members of a research team must know the other team members and available resources. They need to know who is needed for a particular study. This will change during studies and across studies. Roles and responsibilities among the broader team should be identified.
Table 4 outlines nuggets of success as a team member or leader, starting with using the framework of the teaming principles. Next, the team member or leader should build and create networks for knowledge and access. A knowledge network enables team members to know who to contact to provide an answer to specific questions. Each team member is a knowledge network for someone else. Also, each team member should find a person who they admire to serve as a mentor, even informally.
Team members should take advantage of available training. LinkedIn has many free training programs, and the institution’s human resources department also offers training. Meeting times should be scheduled to set aside time for reflection. Team members should check in often with the team as a whole and individual team members, set realistic boundaries, and establish priorities. Team members should avoid making assumptions, and instead, communicate clearly and often. Other keys to team success are to be respectful and present, participate, and practice humanity.
This work was supported by CTSA award No. UL1TR002649 from the National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.
Overview of the Teaming Principles
- Establish team (top-down and bottom-up)
- Establish roles and responsibilities, communications, and processes
- Working together effectively and efficiently
- Individuals develop trust and comfort
- Work together efficiently
- Focus on a shared vision
- Resolves issues
- Adjourning or transforming:
- Natural end:dissolution
- New project (study) with a new shared goal
Description of the Teaming Principles
- Requirements for success
- Team members may vary depending upon the study, project, and timelines
- Work across boundaries
- Appropriate competencies and knowledge, skills, and attitudes
- Recognize and celebrate differences
- Shared goal and vision
- Requirements for success
- Roles, responsibilities, and tasks:
- Determining who has the competencies for specific study tasks
- Define processes
- Communication pathways and expectation
- Completing clinical trial management systems updates
- Roles, responsibilities, and tasks:
- Revisit the shared goal often
- Requires mutual dependence
- Work to build trust:
- Identity-based: personal understanding
- Calculus-based: keep commitments, meet deadlines, meet expectations
- Competence-based: confidence in skills, competencies of another
- Satisfaction in progressing toward goal
- Proactive in preventing issues from arising
- Revisit the shared goal
- Embrace diversity and differences
- Continuous improvement in knowledge, skills, and attitudes
- Completion of tasks
- Identify lessons learned
- Celebrate success and acknowledge the contributions of all
Strengthening the Team
- Recognize the strengths of each team member:
- Self-awareness and assessments
- Embrace diversity:
- Encourage open and honest communication:
- Give and receive constructive feedback
- Provide opportunities for education and training:
- Acquire new knowledge, skills, and attitudes/competencies
- Recognize individual success, which reflects team success
- Commit to shared goals
Nuggets of Success as a Team Member of Leader
- Use the teaming principles as a framework
- Build and create networks for knowledge and access
- Find a mentor
- Take advantage of training
- Schedule meeting times for reflection
- Check in with the team and team members
- Set boundaries and priorities
- Never make assumptions
- Be respectful and present
- Practice humanity
1 Stokols D, Hall KL, Taylor BK, Moser RP. The science of team science: overview of the field and introduction to the supplement. Am J Prev Med. 2008 Aug;35(2 Suppl):S77-89. Accessed 8/10/20.
2 Bennett LM, Gadlin H, Marchand C. Team Collaboration Field Guide. Publication No. 18-7660, 2nd ed., National Institutes of Health; 2018. Accessed 8/10/20.
3 National Research Council. Enhancing the Effectiveness of Team Science. Washington, DC: The National Academies Press; 2015. Accessed 8/10/20.
4 Teambuilding 1: How to build effective teams in healthcare. Nursing Times. Accessed 8/10/20.
5 Salas E, Dickinson TL, Converse SA. Toward an Understanding of Team Performance and Training. In: Swezey R W, Salas E, editors. Teams: Their Training and Performance. Norwood, NJ: Ablex; 1992. pp. 3–29.
6 Tuckman, BW, Jensen MA. Stages of small-group development revisited. Group and Organization Studies, 2. 1977: 419-427.
7 Brown B. Dare to lead: Brave work. Tough conversations. Whole hearts. New York: Random House, 2018.
8 Lencioni P. The five dysfunctions of a team: A leadership fable. San Francisco: Jossey-Bass: 2002.