Is Your Medical Group Storming?

Another important group dynamic at play in medical groups relates to a key theory about how teams develop over time.  This theory is known as the Four Stages of Team Development.

Under this concept, a group or team goes through a set of identifiable stages that affect their performance as a group.  These stages include:

 1. Forming

In the Forming stage, group members test the waters to determine what type of behavior will be acceptable, what the nature of the group’s task is, and how the group will be used to get the work done.  Forming is a period of dependency during which members look to the leader, to other group members, or to some existing rules for guidance.  During the forming stage, there is a lack of clarity about the purpose of the group and about the expectations of the members.  Members do not know each other well so they tend to be polite and obedient.  We often see such behavior in medical group mergers we facilitate.

2. Storming


Is Your Group Stuck in Storming?

Storming is characterized by conflict and hostility among group members and toward the leader as members resist the structure of the group.  The initial reluctance to express opinions in the Forming stage is followed by a period of disagreement.  Members feel free to disagree with each other and with the leader.  Ideas are challenged, closely evaluated, and are often “shot down.”  Members form alliances resulting in group conflict, and questions arise about both the task and process of the group.  Some members even enjoy the arguments.  Groups that fail to experience Storming never learned how to deal with differences.  As a result, they develop a form of passive resistance whereby members simply go along with the leader or a small cadre of members even though they are not really in agreement.

 3. Norming

The Norming stage is characterized by: (1) acceptance of the members that they are a part of a group: (2) recognition their personal success if significantly affected by group success; (3) a willingness to make it work, and; (4) the development of group norms.  Norms are standards of behavior that the group develops for guiding members’ interactions and for dealing with the task.  Information is freely shared and acted upon, and openness and trust emerge among group members.  The group establishes guidelines for resolving conflict, making decisions, interpersonal communication, completing assignments, and the management of meetings.  A competitive cohesion develops as the group feels superior to other groups, and there is laughing and joking that is associated with the informality of effective groups.

4. Performing

As interpersonal relationships become stabilized and as roles are clarified, the team moves into the fourth and final stage, Performing.  The group has a structure, purpose, and role and is ready to tackle the task.  The emphasis here is on results, so positive problem solving and decision making take place. This is the payoff stage. The group is sailing along; they have learned how to be a team; there is agreement on goals, roles, and norms, and members are aligned toward producing results.


Unfortunately many groups, especially physicians groups, get stuck in the Storming phase with lots of conflict and hostility among group members.  This is often because they don’t want to do the things needed to move on to the Norming stage (as highlighted in the paragraph on Norming above).

To move on to Norming, Medical groups need to establish group norms around:

  • Resolving conflict.
  • Making decisions.
  • Interpersonal communication.
  • Completion of assignments.
  • Management of meetings.

I will provide specific recommendations about how to establish such norms in future posts.

 Self Assessment Questions:

  1. Which stage is your group currently experiencing?
  2. What, if anything, do you think needs to be done to move your group to the next developmental stage?


Please contact me if you’d like to discuss this post.

Will Latham

Related Posts

Comments are closed.