Abstract
Teams offer the potential of diverse members pooling information in such a way that better decisions are made and actions taken. Accordingly team success often depends on effective information gathering. However, communication difficulties arise from the different frameworks of team members. Understanding the different frames that team members have can improve our understanding of decision making and improve information seeking. Developing an unique common ground framework within which the team can operate becomes one solution for improving collaborative information seeking in interprofessional health care teams that develop diagnoses and treatment plans. Four frameworks, formal, informal, markets, and professional, are particularly important for the operation of these teams which must develop their own, at times unique, approach to developing an internal framework that provides them with a common ground in which they can collaborate in their information seeking.
A major raison d’etre for teams is the potential of diverse members pooling information collaboratively in such a manner that better decisions are made and actions taken (Shah [86]). Team success often depends on effective information gathering (Ilgen et al. [51]) and teams should be considered information processing units – they encode, store, and retrieve information (Henttonen [44]). They, then, cognitively process this information to reach decisions on courses of action. If there is consensus on a course, then this leads to more commitment, higher performance, and better implementation of decisions. However, communication difficulties that have their foundation in the different frames of team members often leads to problematic interprofessional team performance.
Given the complexity of our health care system, increasingly the operation of interdisciplinary teams is critical to health care outcomes, especially since teams make fewer mistakes than do individuals (Baker et al. [5]). It is widely believed that well-functioning health care teams can improve patient care and increase safety (Thomas et al. [93]) in part stemming from the recommendations of the very influential IOM report To Err is Human: Building a Safer Health System (Buljac-Samardzic et al. [13]).
There is increasing recognition that it is not the sole individual seeking information to support their own decision-making that is the norm in organizations. There has been an increasing focus on collaborative information seeking (CIS), particularly in health care settings. For example, collaborative information seeking through such mechanisms as triage, timeouts, coordinating nurses, and the use of electronic whiteboards is at the core of work flow in emergency departments (Hertzum and Reddy [45]). Health care settings grow more and more complex with people trained in a variety of professions often have differing normative expectations for what constitutes a valid information search. Developing a common ground within which groups can effectively communicate and share the premises of sound decision making processes can lead to what has been termed the wisdom of teams and their superiority over individual decision makers.
Unfortunately most models of information seeking focus on the individual rather than social searching (Evans and Chi [31]). Collaborative information seeking is still a nascent field drawing on a number of different disciplines often with a focus on human interface with information technology such as electronic health records and work performed at a distance (Hansen et al. [43]). Shah’s C5 model suggests that collaborative information seeking entails overlapping sets of: communication (information exchange), contribution, coordination, cooperation, and collaboration (Shah [84,86]).
However, often different perspectives resulting from the varied backgrounds of team members and the differing information they bring to the table results in a storming stage were conflict over the direction of the group occurs and cooperation among group members may be affected (Tuckman and Jensen [96]). This can result in divisive internal coalitions forming within the team. Relatedly, in more complex groupings representing a variety of professions and volunteers communication tends to occur most frequently among those who share similar status (Berteotti and Seibold [10]). Managers are often reluctant to intervene with the operation of professionals turning them into self-managing teams (Berteotti and Seibold [10]).
On the other hand, too much cohesion can also produce harmful impacts on team learning and adaptation. Frames both enable and limit information seeking, making it difficult for well socialized members to see the perspectives of other professions (Cornelissen and Werner [23]). Once developed and reinforced by within group communication, there is a binding nature to the cognitive frames teams develop. They become a way of interpreting and making sense of the world resulting in a common ground that facilitates their communication (Cornelissen and Werner [23]).
In this essay we will first develop definitions of decision making and teams before turning to problems that develop in CIS. We will then focus on how an understanding of the different frames that team members have can improve our understanding of decision making and associated information gathering. The focus of decision/problem solving teams, unlike action teams such as those found in operating rooms, is not on task performance, although they may outline and define job performance for future action teams, but rather on making decisions and solving problems. In accomplishing this at times members may depart from their specialized roles and functions in ways that would be difficult with true action teams. At the core of these teams are decision-making processes such as those involved in making a diagnosis and in determining treatment options. Developing an unique common ground framework within which the team can operate becomes one solution for improving CIS in interprofessional health care teams.
Decision making
In the behavioral decision school an organization can be conceived of as a system for supporting the decision making process and the critical issue for organizations is that well-formed decisions be made (Farace et al. [32]). The communication network in which an individual is embedded, often instantiated by teams, plays a critical role in the decision making process (Connolly [21]). It influences the diversity of an individual’s information sources as well as the volume of information an individual will be exposed to. Following these arguments, the primary purpose of “communication networks is to ensure the presence of certain types of information” (O’Reilly et al. [70, p. 610]) to support decision making processes (Daft and Huber [25], March [64]).
The key element of any definition of decision making is the selection from alternatives. If there are no true alternatives, then the decision is already made. But, if there are many alternatives, all equally beneficial or problematic, then we have no basis for making distinctions and are left with a highly uncertain decision, since we do not have any basis for choosing which of the alternatives is best. So, the number of alternatives, from two to infinity, has much to do with the complexity of decision making (Johnson [55]). Not only do we have to gather information on each alternative relating to the various criteria that differentiate them, but we also have to gather information on how they interact and compare. In this way cohesive, dense networks decrease uncertainty, while wide-ranging networks of weak ties may increase it. Increasingly collaboration in various online forums has involved not only information seeking but information forwarding as well (Kim and Lee [59]) something that is increasingly salient to the operation of teams who collaboratively seek information.
Teams
Fundamentally teams allow organizations to accomplish tasks that are too big for one individual. Teams are the building blocks that make organizational size manageable. Ideally teams increase: consensus concerning a course of action; buy-in, involvement, and commitment; and improve quality (e.g., increasing patient safety) by having more than one set of eyes to look at a problem invoking the wisdom of crowds resulting in better problem solving. The general notion that teams can outperform individuals and shape better decisions has captured the popular imagination and is reflected in such best sellers as The wisdom of teams (Katzenbach and Smith [57]) and the Wisdom of crowds (Surowiecki [92]).
“Teams have a well-defined focus and a sense of purpose and unity that members of other groups do not share” (Poole and Real [74, p. 370]). Team members share leadership roles, are accountable, encourage open-ended discussion, encourage listening, and measure their performance (Katzenbach and Smith [58]). Teams are most appropriate when the organizational problem to be addressed is complex requiring a high degree of interdependence among team members (Sheard and Kakabadse [88]) something that is certainly true of modern health care. Teams have been important elements of health care delivery for over 100 years with accelerating usage over the last couple of decades as technology has continued to rapidly develop and medical care has grown more complex (Poole and Real [74]).
Higgs reviewed 52 authors definition of teams and identified seven common elements: common purpose; interdependence; clarity of roles and contribution; satisfaction from mutual working; mutual and individual accountability; realization of synergies; and empowerment (Sheard and Kakabadse [88]). Many of these elements are included in the following definition: A team is a small number of people with complementary skills who are committed to a common purpose, set of performance goals, and approach which they hold themselves mutually accountable (Katzenbach and Smith [58, p. 39], italics in original). We might add to this definition shared decision making with some understanding of each other’s roles, contributions to team, and that members interact adaptively and dynamically in pursuit of team goals. These definitional components are particularly important for collaborative information seeking.
Problems
Just because one is assigned to a work group does not mean that the group will function as a team (Poole and Real [74]). Realizing the potential of teams is often very problematic (Salas et al. [81]). In spite of their pervasiveness there are still numerous problems with the operation of teams in medical care settings: poor communication, rigid roles, generally disappointing performance (Poole and Real [74]), incompatible communication styles, negative team norms, power differentials, and role conflict (Quinlan [78]). Surgeons, for example, often resist new routines which require them to depend on collaboration and communication with others to “… shift from ‘order giver’ to team member” (Edmondson et al. [29, p. 699]).
“People die due to communication failures” (Nair et al. [66, p. 115]). It has been estimated that up to 80% of healthcare errors are caused by human factors associated with poor team communication (Xyrichis and Ream [105]). The more free-flowing the communication in teams, the greater the possibilities for errors in transmission, but errors can also be mitigated by feedback and the correction of errors as well as improved quality of communication through development of a common ground for understanding which often rests on the frameworks that a team has developed. It has been estimated that over 30 percent of operating teams communication could be characterized as a failure in some way (Firth-Cozens [35]) and a third of these failures jeopardized patient safety by increasing cognitive load, interrupting routine, and increasing tensions in operating rooms (Lingard et al. [62]). Unfortunately, in group contexts, members are more likely to share information they have already discussed, than to share unique information in their possession with the group (Stasser et al. [90]).
Health care teams take on some of the characteristics of negotiated temporary systems with: frequent changes in group composition and communication linkages; less hierarchical emergent group structures; and group relationships that are embedded in a broader external system (Walker and Stohl [101]). These systems may start bumping into the upper limits of individuals and the groups they are embedded in to effectively process information (Walker and Stohl [101]). Organizations in general and health care organizations in particular are becoming increasingly dynamic and unstable while increasingly relying on teams to solve problems in high reliability organizations that operate in hazardous environments where the consequences of error are high and therefore must be kept to an absolute minimum (Baker et al. [5]). In the end the disparate frameworks team members bring to the table must be melded into one that provides its members a common ground for making decisions and collaborating in the information seeking that supports them.
Frameworks for common ground in decision making
One major potential impediment to CIS is the different frameworks that team members represent. Their frameworks influence the information sources they attend to, the information they view as salient, and how they interpret information they find. The frameworks teams operate in can facilitate communication if their members share a common ground ameliorating many of the problems we have just discussed. A necessary condition then for effective CIS is establishing a common ground (Newman et al. [69]). Early on interprofessional teams often expand considerable start-up costs in developing common grounds (Stokols [91]) based on shared understandings and common histories that group members have constituted through their communication activities. For example, to work together members of emergency departments must come to a common understanding of what information means so timeouts (e.g., ten to fifteen minute meetings to discuss patients) were used as a time for reflection following information seeking activities which led to collaborative grounding which might lead to further information seeking (Hertzum and Reddy [45]).
Often this common understanding, or ground, is based on larger frameworks in which individuals are embedded. Frameworks have been used in a variety of social sciences (e.g., Putnam and Holmer [77], Schon and Rein [83], Tversky and Kahneman [97]), especially in work focused on discourse processes (Bateson [8], Goffman [36]). The concept of framing and frame analysis have become central to theorizing about organizational behavior (Cornelissen and Werner [23]). Frameworks indicate both a way of viewing the world and of interpreting it in sense making (Gray [38]). They increase awareness and focus attention on some activities and not others (Shah [84]).
There is growing interest in how context shapes CIS (Newman et al. [69]). Here we will focus on frameworks that provide a more encompassing context for human information behavior within interdisciplinary teams the human side of collaboration in organizations that has been somewhat neglected in this emerging literature which has by and large focused on software and information technologies that transcend time and space (e.g., Shah [84,85]). A framework for interaction is the set of interrelated conditions that promote certain levels of shared understanding of meanings, orient interactants to the nature of the event, and establish the ultimate purpose of continuing interaction (Johnson [53,54]). In some frames, such as exchange, only a minimum amount of shared understandings is needed for collective action (Donnellon et al. [27]).
A framework, then, is the ground that opens doors to social worlds of situated knowledge and governing rationalities providing a programmed way of approaching problems often embodied in organizational routines and associated decision making. They promote receptivity to some messages, while making some others more difficult to understand. Four frameworks, formal, informal, markets and professional, are particularly important for the operation of teams in healthcare settings.
Formal
Formal approaches (e.g., organizational design and bureaucracy) rely heavily on explicit knowledge and well understood code systems, but they are often incomplete and ignore social factors represented in informal communication. Formal frameworks essentially represent the bureaucratic world of the organization, with its specification of patterns of super- and sub-ordination and other hierarchical relationships between parties in a relatively permanent framework (Weber [103]). Usually formal frameworks require only a limited form of understanding, based on system rules, training, and a legalistic understanding of relationships between positions. Actors are presupposed to be governed by the requirements of the positions they occupy in an organization’s formal structure.
The formal organizational chart in effect provides a road map for information seeking. It clearly identifies who should have the expertise in particular areas, who are the authoritative sources, who has the training and experience. The formal organization, indeed, has been identified as one of the first primitive computers (Beninger [9]) with a directory (job titles), programming language (formal rules), information storage systems (written records), and random access memory (manager’s memories). All of this, of course, is rationalized, often explicitly, with relationships formalized (e.g., I have to respond to certain information requests because of job requirements). In the world of formal structure a search, then, often becomes a question of formulating a question in the proper way and directing it to the right formal role incumbent.
Informal
Often interaction results in collective sentiments. Friendship and other more emotional bases for relationship provide the underlying basis for relationships. The shared understandings characteristic of these relationships are often dependent on the depth of emotional involvement. Sentiments recognize the often neglected place of emotions (Mumby and Putnam [65]) and the desire for affiliation in organizational life. They also represent a more intuitive, subjective view of knowledge. Particularly in the presence of clear status differences informal approaches provide another medium in which information can be shared (Blau [11]). Exchange relationships between individuals with deep emotional ties may be more characterized by ‘bad trades,’ where equitable exchanges of material resources are not realized (Clark [18], Erdogan and Bauer [30]).
Issues of accessibility, approachability and the quality of the response are often tied up with informal status systems in organizations. Prior experience with a source and that person’s trustworthiness are particularly important. Cross et al. [24] has described this in more contemporary terms as the degree of safety in a relationship that promotes both learning and creativity. Admissions of ignorance come at substantial costs to one’s own ego. Some individuals just don’t have the interpersonal skills necessary to form the informal network relationships necessary to acquire information (Wilson and Malik [104]). A critical factor that clearly impedes this feeling of safety involves the loss of face and status. In effect, low status people are trying to ‘borrow’ social capital of more central high status others (Balkundi and Kilduff [6]). So, status is an important predictor of information seeking (Argote et al. [4]). A number of studies document cases where organizational members will seek out information from inferior sources because of the reduced costs involved (Allen [3], Blau [11]).
An implied quid pro quo can inhibit the development of relationships more generally (Nebus [68]) with reciprocation wary individuals fearing exploitation in exchange relationships and thereby leery of accessing others knowledge (Gray and Meister [39]). However, isolated members may be more willing to share unique information as an instrumental means of enhancing their standing in a group (Thomas-Hunt et al. [94]), interestingly since they have a lower standing in the group, they were also more likely to share divergent information, in part because they do not face the same social pressures as relatively connected members (Argote et al. [4]). Thus status differentials may actually facilitate organizational change by instituting a primary motivation for bringing in outside perspectives that undercut the points of views of existing organizational elites (Compagni et al. [20]).
Markets
Markets approaches focus on exchange relationships and the paramount importance of trust in characterizing them. Exchange conceptions of relationships within organizations may be the most popular modern framework (Cook [22], Hall [42]), partially because of their linkage to underlying economic theory. In this view individuals are seen as driven to maximize rewards through their interaction with each other.
Markets focus on exchange relationships and the paramount importance of trust in characterizing them. Trust, in turn, greatly facilitates the receptivity of any message. Obviously, an exchange relationship can rest on extremely rudimentary understandings of others, based on such fundamental issues as fair price and a belief that the other party will follow through on bargains. Markets, through the mechanisms of exchanges, operate to diffuse information rapidly to interested parties (von Hayek [99]). Markets have an inherently dynamic view of information exchanges, with individuals compelled to change their ideas as a result of the reactions of others.
In focusing on exchanges this approach provides a theoretical focus for the development of relationships between interactants, who may otherwise lack compelling motives to interact. Indeed, we may seek exchanges with others because they are not like us and they have resources that we do not possess, a fundamental reason for constituting interprofessional teams in the first instance. In recent years health care systems have increasingly taken more virtual, market like forms.
Networks of information exchanges, which also contain market elements, are particularly useful structures for organizations composed of highly skilled work forces who possess knowledge not limited to particular tasks (Powell [75]). Indeed, more generally it has been argued that knowledge flows may be best accomplished by informal organizational structures because of problems in recognizing the significance of information and communicating it effectively and efficiently (Gupta and Govindarajan [41]). This form of decentralization often reduces the possibility of information overload within these organizations, and attendant delays and imperfect planning orders. Thus, in health-care organizations, it may be better to minimize intrusive formal structures and promote wide ranging interactions, while providing a framework in which trading relationships can occur.
Professional
In some ways health organizations become umbrellas for various professional guilds.These professions come together to pursue loosely defined larger objectives (e.g., providing quality care). Relationships between and among professions are often governed by such normative expectations (Cheney and Ashcraft [16]). Over the last three decades cultural factors, which norms encapsulate, have assumed a central place in our theories of organizations. Culture is seen as providing an interpretive framework within which communication is possible; a macromedium for interaction (Johnson [52], Poole and McPhee [73]). Perhaps nowhere in our society is socialization more intensive than in the preparation of a professional. Professions develop near clan forms of identity associated with their unique tacit knowledge. Indeed, the overall configuration of a profession is perhaps best reflected in conceptions of guilds and clans. An advantage of strong cultures is their enhancement of shared understanding between actors and a norm of mutual adjustment through consultation within a system of mutual authority that governs competition (Polanyi and Prosch [72]).
A key element of this socialization is the development of elaborate semantic systems of tacit understandings (von Hayek [100]). The more elaborate and refined the framework, the more effective the communication. A large part of technical education consists of defining for individuals what is an appropriate source of information and how one can gain access to these sources. An individual’s education level probably has the most important consequence for their subsequent information seeking (Chen and Hernon [15]).
The relationships between diverse professional groupings, who jealously guard their domains, has traditionally been a problem, particularly in health care settings (Clark [19], D’Amour et al. [26]). People are reluctant to share knowledge with others if they think the other is incapable of understanding it (Hew and Hara [46]). So, physicians, based on their tacit knowledge, may seek to operate by dicta, since other members of the team cannot possibly have their depth of understanding and they do not have the time to bring their fellow team members up to speed. In our current malpractice system physicians are ultimately accountable for the operation of health care teams which undermines their willingness to defer to others in making health care decisions (Baker et al. [5]). Ironically, in part because of the difficulties inherent in sharing tacit knowledge dialogically across professional boundaries, teams may ultimately be less efficient in delivering medical care (Quinlan [78]).
Most academic work on the professions has focused on how they establish (and protect) their jurisdictions and maintain their status within broader social systems. Knowledge is seen as a key tool in these processes (Abbott [2], Lammers and Garcia [60], Macdonald [63]). Knowledge is intimately related with credentialing and training and the formal (and often legally, state enforced) differentiation of specialties in societies generally and organizations specifically (Macdonald [63]). Professions also develop strong norms of ‘purity’ that impede their ability to confront new, ambiguous problems (Abbott [1]), such as those that are often the focus of interprofessional teams. These teams often compel members to choose between them and the norms of their professions creating very real problems of differing role sets and attendant expectations (Berteotti and Seibold [10]).
The work of interprofessional teams directly confronts this guiding principle of professional life. “Professionals tend to pursue their own aspirations and to maintain their professional autonomy and jurisdiction rather than opening their practice to collaborative behavior” (Sicotte et al. [89, p. 993]). However, balancing cooperation and competition must be achieved, most notably in sharing information that is in the interest of the collective, in spite of individual motivations to hoard (Kalman et al. [56]).
Fundamental to many conceptions of teamwork is the individual subordinating their own interests to the interests of the whole, something that the professions have had a great deal of trouble with since they have often spent decades fighting for their prerogatives. There has been considerable debate over whether teams composed of different professionals can truly achieve the level of collaboration that modern health care and clinical and translational science require. Interestingly some researchers have found that the higher the educational level of team members the more difficult it is for them collaborate and the more likely the team is to disintegrate into nonproductive conflict and stalemate (Gratton and Erickson [37]).
Solutions
… working cooperatively requires that team members coordinate by anticipating and predicting each other’s needs through common understanding of the environment and expectations of performance (Salas et al. [81, p. 565]).
A diagnosis, however, can be not only cognitively, but also socially complex. In many cases, a diagnosis involves obtaining and evaluating the opinions of a number of individuals who may differ in their areas and levels of expertise (Cicourel [17, p. 222]).
It is important to stress that the process of building up common ground is an emergent process, and not a product of design. It is driven by, and results from, local communication processes in which interacting actors are themselves aware of the conventional status of existing frames and associated vocabularies (Cornelissen and Werner [23, p. 212]).
Cornelissen and Werner go on to assert that actors can resist discordant frames and in doing so prevent obstacles to the establishment of an intra-team common ground. Complex new forms of organizations must discover underlying bases for interrelationships among their increasingly pluralistic subgroupings. A central issue for many organizations, then, is how to create contexts that promote cooperative climates and trusting relationships necessary to produce agreements on a course of action (Fiol [34], Johnson [53,54]) which some have argued is best accomplished by convergence on particular frames (Drake and Donohue [28]).
It is possible for individuals in teams to act with others with their unique mix of the forgoing frames, to choose among themselves what frame (or combination of frames) will govern their interactions. It is also possible for two interactants to decide mutually on an idiosyncratic basis for interaction (Nathan and Mitroff [67]). This possibility may become the basis for more complex interrelationships in interprofessional health care teams.
One basic problem in interprofessional health care teams is that doctors and nurses are trained to have different approaches to communication: nurses are taught to have a more holistic, narrative approach, while physicians learn to be very concise and get to the headlines quite quickly (Leonard et al. [61]). The traditional hierarchy of medical teams make it difficult for them to achieve desired levels of coordination and cohesion (Baker et al. [5]). Often the primary advocates of teamwork approaches are nurses since an emphasis on teams has the clear advantage for them of diminishing their status gap with physicians.
In part, because of their higher status physicians are more likely than nurses to think that the two groups are working well together (Bartunek [7], Nair et al. [66]). There are dramatic differences between the two groups in perceptions of collaborations and communication (Xyrichis and Ream [105]) with nurses: reporting it is difficult to speak up; disagreements are not appropriately resolved; and that their input is not well received (Thomas et al. [93]). Most importantly both groups were likely to report that collaboration on decision making regarding care/cure was the least likely to occur (Nair et al. [66]). While both groups see the benefits of successful collaboration, they differ on their perceptions of shared education and physician authority (Hughes and Fitzpatrick [50]). They have different attitudes toward collaboration and. in spite of repeated calls for improvements in their collaborations, it is still not the norm (Nair et al. [66]).
One important characteristics of effective health care teams is that doctors allow themselves to become a partner rather than a dictator (Edmondson et al. [29]) that relationships within them become less hierarchical (Nair et al. [66]) thereby minimizing status and power differentials within a team which inhibit communication (Bronstein [12], Leonard et al. [61]) and that make truly collaborative information seeking unlikely (Shah [84]). Strategies for changing physician’s behavior and performance that embeds them within teams have shown some promise in improving healthcare outcomes (Grol [40]). Team members also need to have a constructive approach; disassociating inevitable mistakes from member’s clinical competency (Leonard et al. [61]). These conditions are necessary to promote sharing and to motivate higher levels of CIS.
Relationships that emerge from the unique characteristics of actors, in opposition to traditional forms, require substantial negotiation among interactants, especially about forms and desired outcomes. So the parties communicate with each other to arrange the nature of their future interaction by mutual agreement much as a reporter decides with a source what is on and off the record. This negotiation is designed to establish a stable ordering of the relationship, governing interactions within it, to move to a state where the underlying base for the interaction is taken-for-granted. At times this negotiation might be explicit, verging on contractual terms, at other times it might grow out of ongoing interactions.
However, if there is in reality, as there often is in organizations like hospitals, multiple, more or less equal subcultures this heightens problems in sharing and seeking information within teams. These conditions also lay the ground for conflict and negotiation. Different professional groups may have different orientations to their clients (e.g., sexual assault victims, substance abusers) which often is a source of conflict in resulting treatment choices. Linda Putnam [76] has a different take on the classic view of negotiation as focused on the outcomes of an individual who wants to achieve their strategic aims. She views negotiation as “not about winning, but about meeting the needs of both parties, through generating creative options, discovering new insights, and altering the name of the game.” (p. 326). This is best achieved through processes of collective sense-making, such as that found in the work of true teams, often embodied in joint storytelling and the creation of new rituals. The frame resonance of stories often provide powerful motivators for groups engaged in framing contests in times of organizational upheaval such as that characteristic of our modern health care system (Cornelissen and Werner [23]).
Pragmatic implications
A number of difficult things must be accomplished before teams can function effectively in health care settings. Interdependence, along with flexibility, collective ownership of goals, and reflection on process, has been seen to play a key role in interprofessional collaboration for social workers (Bronstein [12]). Effective health care teams have: external support; appropriate member attributes (e.g., knowledge and skills); effective interpersonal relationships; organizational attributes (e.g., leadership, defined roles, goals, and so on); pay attention to process, particularly its communication elements (Hirokawa et al. [48]); interdependence; flexibility; collective ownership of goals; a history of collaboration, and reflection on process (Bronstein [12], Stokols [91]). Health care teams often benefit from incorporating information professionals, such as health librarians, who communicate evidence based practices (Newman et al. [69]). Generally it has been argued that increased needs for interdependence associated with differentiation will result in more lateral communication (Victor and Blackburn [98]) such as that found in teams.
From an information processing perspective, one of the primary reasons for the formation of a team is to promote the search for information from a variety of sources, then to interpret the information that is gathered from a variety of frameworks, and to arrive at a decision that reflects the input of the various team members. However, the very diversity that promises to result in more effective decisions can result in teams splintering into coalitions surrounding various interests and being paralyzed by the resulting conflict, especially if the team is too large (Shah [84]). Working collaboratively also increases communication costs associated with coordination and one’s cognitive load (Shah [86]). Information fragmentation in health care requires that members representing different domains with access to different resources must pool their information to make decisions and take action (Reddy and Jansen [79]).
Part of learning the tacit knowledge of a profession is learning how to acquire information and learning the relative value of particular types of knowledge (Polanyi [71]) which both rests on the frames governing their members. In general, Watts [102] has found social networks to be more easily searchable when individuals can judge their similarity to target others along multiple dimensions.
Managers can do a number of things that may ameliorate some of the problems discussed here. One of the things that characterizes effective decision making is knowing what the other knows and when to turn to them (Cross et al. [24]). One role of management in self-managing teams would be providing people with the resources and skills necessary to seek information related to their problems/concerns by facilitating and creating rich information fields. Another strategy is to increase the salience of these issues through better training programs that address optimal search behaviors (e.g., appropriate key word selection) and acquaint individuals with unfamiliar sources of information. In general, organizations do not give their workers sufficient guidance on what the optimal sources of information are (Burke and Bolf [14]). Acquainting individuals with sources that are relevant (Saracevic [82]) and useful in their immediate work is the critical first step to developing better knowledge acquisition habits. Unfortunately there is a shortage of software tools and other specialized approaches that promote and support collaborative information seeking (Shavner and Tang [87]) with most tools at an academic research stage lacking scalability, ease of use, and an array of features that mitigates against their widespread acceptance (Shah [86]). There is also a need for research that demonstrates the concrete processes of common ground formation occur in teams (Cornelissen and Werner [23]).
Unfortunately time spent communicating to develop common frameworks that avoid glitches in patient care is time not spent on the actual work of providing care. Seldom are organizational members rewarded for bringing other people up to speed (Hinds and Pfeffer [47]). It is unlikely that differing professional groups will ever come to perfect understanding, so the real problem is what is the optimal common ground (Hoopes and Postrel [49]). The importance of coordination is increasing as interdisciplinary teams are increasingly operating in virtual communication environments (Faraj and Xian [33]). As we proceed along the different types of interdependence and associated coordination modes the costs of communication and the burdens of decision making increase (Thompson [95]). This implies that under norms of rationality and efficiency organizations will try to minimize the need for more complicated modes of coordination, interdependence, and associated information seeking. This is one of the reasons health care teams often revert back to the traditional hierarchical arrangements: they may not be effective but they certainly are efficient. They also may be perfectly appropriate in routine situations where solutions are clear (Shah [84]).
Conclusion
Watts [102] has suggested that developing more effective social structures may be a more effective solution to search problems than a reliance on centrally designed problem solving tools and data bases a real opportunity for the operation of teams. As we have seen teams can be considered as systems for processing information and there is a commonly held belief that teamwork requires members to have similar cognitive structures represented by frameworks to be on the same page, so to speak. Shared cognitions represented in shared mental models that result in more effective communication is a critical driver of team performance (Salas and Cooke [80]). An advantage of strong cultures is their enhancement of shared understandings between actors and a norm of adjustment through consultation within a system of mutual authority that governs competition (Polanyi and Prosch [72]). Ultimately developing a common ground within which groups can effectively communicate; collaborate in their information seeking; and share the premises of sound decision making processes can lead to what has been termed the wisdom of teams and their superiority over individual decision makers.