Groups and teams
An alternative concept to ‘team’ that is used for entities consisting of individuals is ‘group’. Both the concepts of group and team are not infrequently used without definition and as synonyms [1,6]. Confusion exists because ‘team’ carries the connotation of both sequential cooperation, where the members have minimal interaction, and synchronous cooperation, where the members take advantage of each other's skills without aspiration of prestige . Procter and Mueller  describe how team has developed from a socio-technical tradition in which autonomous groups were considered to have an optimizing effect on organizations. Expressions that can be found in this context are work group, autonomous group and group process. The word ‘group’ is defined as ‘a number of people or things located, gathered, or classed together . . .’. One difference between the concepts is that a group need not consist of individuals but may just as easily refer to abstract things that are in the same place. However, a team always involves individuals. Another difference between the concepts is that a team is considered to be more focused than a group and to display a greater degree of homogeneity. Team also presupposes the joint action of its members to solve a shared task, which is not always the case for groups .
What by definition distinguishes a team from a group is that every member of the team needs to know what is to be achieved jointly . The task should be sufficiently explicit for all the members of the team to understand their own functions and have the scope to take their own initiatives. The tasks should not be susceptible to varying interpretations by the members of the team but easy to focus and agree on [12–15]. Another factor in the formation of a team is that its members are given the scope to function as a team. This makes certain demands when it comes to independence, authorization and the specific composition of the members of the team [16,17]. However, idealized descriptions of teams go one step farther. Here it is maintained that the members of the team have a collective aim, have shared goals and that the members of the team are committed .
This contradicts the argument of Cyert and March  that individuals have goals while organizations do not. In many cases the goals of an organization are the same as those expressed by its leaders, which need not have any relation to others involved in the organization [3,20]. Katzenbach and Smith  claim, however, not only that teams work best when they are clearly demarcated and have clear tasks. They also assert that teams distribute tasks internally and in agreement with each other. Literature dealing specifically with teams in the health and medical services offers similar descriptions. The members of a team are said to devote themselves jointly and simultaneously and in agreement with each other to interrelated tasks. Opie  describes how the members of health care teams representing different disciplines jointly assess, treat and examine the caring needs of individuals. Another example is Antoniadis and Videlock , who define an efficient health care team as one that displays a relaxed atmosphere while at the same time there are regular discussions between its members, who are eager to listen to each other. It is emphasized that in this type of team differences of opinion and criticism are permitted. They display few hidden agendas and leadership is shared [21,22].
Such ideal descriptions of how teams are formed describe a frictionless interaction between leadership and the members in the team's development phase. One untested assumption is that teams form spontaneously. Katzenbach and Smith  claim that it is enough to assemble a group for a specific task for a team to be created. In other words, teams become teams when a task or a challenge is accepted and approached collectively. A group of individuals with different characters can then move from individual treatment of the task into an intensive phase where there are no considerations of prestige to prevent collective intervention in each other's tasks to enable joint solution of the problem. Seen in this way, teams should only be organized by offering groups of individuals challenges for them to group around. Autonomy and trust will then guarantee that the participants will act spontaneously and in accord. It is asserted that given the right conditions with regard to the individuals involved, their qualification, the task and the intention, teams will gradually come into being. This approach has, however, contributed to the creation of teams that have been teams only in name rather than in how they function. Teams have been constructed, have jointly undertaken a task and then been expected to develop mutual give-and-take with discouraging results. They have turned out to evolve into differentiated groups with internal oppositions whose members develop sequential ways of working and shun the tasks undertaken collectively . Differentiated groups tend to be called ‘teams’, although the members are independent of each other .
Katzenbach and Smith  also claim that leadership is shared when a team is created. There is a shift from having a nominated leader to a state in which all of its members can exercise control in a spontaneous, not predetermined, alternating leadership. This phenomenon has been confirmed in studies of palliative teams. When the team convenes, its leadership alters informally as various aspects of the patient's situation are dealt with. When one member can no longer contribute, another member of the team takes over control on the basis of the patient's needs . In both cases an anti-hierarchical attitude to leadership prevails. The team leader has a passive role and it seems to be able to achieve consensus with all of the members taken into account. Team leadership therefore is said to be supporting rather than leading, and is described by the term team coaching . Here criticism has been expressed by Benders and Van Hootegem , who asserts that autonomous teams without leaders that make decisions hardly exist. Nevertheless, the belief in autonomy and the harmonious rotation of leadership survives as an ideal when teams are created.
The team terminology has come to overlap the group terminology. This has been criticized by Saltmans et al. , who distinguishes between team and group in the fact that team are simultaneous and intersubjective, whereas groups are split up and individual. This study is supported by the definitions mentioned herein as synchronous and sequential. To this we add a mean form which is simultaneous and individual cooperation. This mean form, here called parallel, has been identified as common in acute health care teams . These three forms of cooperation are here suggested to make out a reference frame which will then be used to analyse the trauma team studied within the scope of this study.
Sequential cooperation comprises a traditional step-by-step working process in which each participant waits for her or his turn to perform a specific task. Sequential cooperation has also been called intra-organizational task division and decentralization . This technique has its roots in scientific management traditions which focus on individual performance and where collective, integrated cooperative methods are considered to lead to free riding and slacking . The definition of team used in this article means that they do not involve sequential methods of working. Organizations with long historical traditions are more than likely, however, to embody fragments of traditional sequential techniques. These administrative relics make it more difficult to establish teams . The health care sector is one that offers examples of organizations in which there are built-in unwieldy administrative processes that sustain a sequential approach to their operation . Good illustrations of this can be found in the Swedish health care system, which is characterized by the predominance of groups. For example, Westrin  describes how doctors in the Swedish health care system have helped to promote sequential working methods. The most characteristic example is the system of referral, in which specialists take over from each other in the management of patient needs or the patients themselves are transferred from one specialist to another. Holmberg  offers a similar description of how health care staff divided into professional, semi-professional and non-professional groups are separated from each other by a sequential organization of their tasks. The distance between the groups is maintained by linguistic and communication barriers and working processes in which each group undertakes its own tasks [31,32]. This kind of situation can also be encountered in groups of staff that describe themselves as teams but which are never able to become more than loosely connected groups that work sequentially.
A team in which parallel cooperation takes place can succeed in undertaking tasks at the same time but lacks the ability to perform them jointly. This means that the members of the team act as a group, which involves focusing on their own tasks and avoiding consideration of the overall needs, but with the difference that the tasks are performed at the same time. Lind and Skärvad  describe parallel cooperation in what they call a role-integrated team. By definition, a role-integrated team is as close to being a group as to being a team. Tasks are divided strictly between the members of the team and the work is undertaken in parallel in a way that makes it impossible for the members of the team to switch positions. The work is standardized on the basis of the different roles allocated to the members. One example of parallel cooperative techniques can be found in the allocation of roles between the different members of the staff in an operating theatre. The aim is to enable the participants to work according to their own professional agendas with clearly defined tasks but that at the same time these should interact seamlessly . Indeed, standardization of tasks, which distinguishes parallel cooperation, has been regarded as both hindering and enabling team creation. Adler & Borys  maintain that standardization generally encourages simplified and repeated behaviour that augments conformity instead of stimulating individual thinking and creativity. Another factor contributing to parallel techniques is high workload and stress. A synchronous cooperation can during stress increase an individual focus .
Synchronous cooperation is characteristic of the ideal descriptions of teams. This differs from parallel cooperation in that tasks are not only undertaken at the same time but the members of the team swap tasks and cover for each other unhampered by prestige. The members of the team focus not only on their own tasks but they identify needs and weaknesses in the teamwork as a whole by displaying mobility and by rapidly reallocating resources. Savage  uses the expression ‘multiplexing’ to describe how the members of a team continually shift focus from one task to another. Similarly, Drucker  describes how team cooperation takes place synchronously when the team cuts across traditional demarcation lines. To achieve this, a team needs to coordinate its tasks and at the same time not be bound to comply with a predetermined workflow. In the words of Drucker  the music is then created ‘as it is played’. Like Drucker , Davis  believes that focus is shifting from traditional sequential procedures to the implementation of multiple functions simultaneously. Davis  uses the metaphor of holism, which means that a team relates all the elements of a totality to each other in exchanges that are shorn of concerns about prestige.
The links and differences between sequential, parallel and synchronous forms of cooperation can be summarized in the diagram below (see Fig. 1).
The levels of cooperation described above are important constituents of the empirical systematization in this study and in the ensuing analysis.