A case study on processes in team building and performance improvement at Government Health Centers in Rajasthan, India

Introduction: Public healthcare system in India suffers from poor performance mainly due to the severe shortage and high absenteeism of healthcare providers. The performance is further affected due to low productivity and competencies of the already existing healthcare providers. While management training (with a special focus on human resource issues) to address the shortage to healthcare providers has gained some importance in recent past, there has been a very limited focus on how to use the exiting workforce effectively. With this backdrop, training health providers in issues pertaining to team effectiveness becomes very crucial. The case study discusses some of the dimensions of team building, as well as processes involved in performance improvement including problem identification, prioritization, and problem-solving process as demonstrated by health system improvement teams (HSIT’s). Materials and Methods: HSIT’s have been constituted and are functional at 238 secondary level facilities in Rajasthani. The case writer interacted with five HSIT’s from two districts in Rajasthan. We were able to speak to about four to five members from each team for all the five facilities. The information for the case was gathered in two ways. The first was use of an instrument on team building that was given to each member of the team to gauge their individual perception about various team building aspects. The second was with the help of group discussions that were done with all the team members for each all the five teams. All those who were present and willing to be part of the discussion were given instruments and were included in group discussions. As this was an exploratory case study, the sample size was small and, therefore, the findings from group discussion and instruments have been presented together without any quantification of the data. Results: The findings of the case study indicate moderate team empowerment. While HSIT’s were clear about their respective roles and tasks, they could not establish a link between their own goals and team goals. Limited autonomy is available with very less autonomy to implement solutions that involve money or recruiting people. Most of the team members reported, high support received from senior teams for solving the problems. As far as the team performance improvement processes are concerned, teams reported good collaboration in form of improved and effective communication, and joint problem solving. Most of the team members reported that the decisions are taken based on the consensus of the whole group. Such teams rely on their intuitive power than any management tools for identifying and prioritizing problems. Conclusion: It can be said that performance improvement through HSIT’s is really a unique and innovative concept. There are some positive team building indicators reflected by HSIT’s that have resulted in better work reflected through regular and productive meetings; people having a chance to raise concerns in the meetings; improved communication channels and improvement in infrastructure. However, there are some weaknesses within the processes, as well as some team related aspects. More research and focus should be channeled to study the importance of processes and team building factors in performance improvement of individuals, teams, and the organizations and its link to increased effectiveness.