Nothing is as demoralizing as being part of a dysfunctional team.
Nothing is as empowering, rewarding, and engaging, as being part of a team that is cohesive, supportive, and effective.
You CAN create powerful teams. You simply need a process, guidance, and the willingness to do the work…
Organization-Wide Initiatives Accomplish Nothing
Patient safety. Quality. Patient Experience. Cost and Efficiency. Patient access. Physician, nursing and staff engagement, retention, and wellness . . .
None of these metrics move because of top-down, organization-wide, initiatives. Yes, leadership creates the vision, and puts in place the tools and resources to accomplish these goals, but that’s all they can do.
Studies show that the surest way to improve engagement scores is to increase the sense of connection to other workers, on the front lines. There is no program that makes this happen.
Psychological safety isn’t created by system-wide LMS training, but by leaders, and front line managers integrating these concepts into the daily work. Improving patient access, creating clinical integration, or making EHR systems a useful resource – none of these happen in strategic planning meetings. They “happen” in small multi-disciplinary groups – if and only if, these groups are effective as teams.
Healthcare organizations, too often, fail to invest the time, money, and energy to do the work “at the bedside” to make these initiatives successful. We simply roll-out yet another program for managers, another LMS training program, internal marketing campaign, or wellness program.
We challenge leaders and teams to solve complicated problems. They don’t struggle because of a lack of intellectual capability, or effort. They fail because leaders, and team members, never learn how to create a powerful, effective team. Too often, they are trying to achieve their goals within a consistently deteriorating team dynamic.
Would it cost money to give front line teams the tools, and skills, to succeed? Yes. Consider though, the money and time been wasted on system-wide initiatives that fail to drive change?
Would it cost money to give front line teams the tools, and skills, to succeed? Yes. Consider though, the money and time been wasted on system-wide initiatives that fail to drive change?
Doing the Work at the Front Lines, Works –
We Know it Does
Yes. Healthcare is unique. It’s not SO unique, though, that we can’t learn from other industries. Surgical checklists, progressive talent strategies, Lean, and similar models….we’ve adapted all of these to healthcare.
A few years ago, Google famously told us that effective teams are better at achieving their goals. They also showed us what drives team effectiveness. It’s not THAT complicated. It’s not rocket science, by any means, but it DOES require focused attention. Google appreciates the value of this work. The ROI is a no-brainer to them.
And as far as healthcare being “unique,” - in recent years, there is a growing body of research confirming that effective teamwork and collaboration correlate with improved healthcare performance, including patient outcomes.
We need to build effective teams, because they move the metrics that we value.
It could be argued that building effective teams, is the THE most important job of every leader.
Healthcare’s Unique Challenges
Healthcare professionals are naturally skeptical. It’s the nature of the work. Question the data. Challenge new ideas. Find the problem. Lean on tradition and start with the notion that concepts of “team” from manufacturing, or sports, won’t work in healthcare, because it is so different.
Let’s acknowledge the variables that do, indeed, contribute to a lot of healthcare team dysfunction:
Differences in Education – While cognitive diversity is valuable, healthcare often brings together groups of individuals trained in completely different modes of thinking, and problem solving.
Frequently Forming Teams – Teams rarely get to work together for long periods and work through the normal “team-forming” process. Physicians and nurses are often on many teams – sometimes for short periods of time.
High Pressure Environments – Obviously, a team working in the Emergency Department, or a birthing center, or operating room, is facing intense pressure that impacts team dynamics.
Organizational Silos – A manufacturing facility is DESIGNED around the end product, which encourages organization-wide cohesion. Hospitals, meanwhile, are highly matrixed organizations which have, traditionally, reinforced departmental autonomy (vs. collaboration).
A Culture of Expertise – Healthcare has traditionally valued expertise and professional autonomy – often to a degree that it impedes collaboration.
Lack of Focus on Team Skills – Healthcare professionals get no real training on team and collaboration during their education. Once in practice, it’s simply not a topic of discussion, and rarely part of formal on-going development. If it is – it’s generally ineffective.
Dysfunctional Teams
It’s no surprise, then, that many teams struggle. Dysfunctional teams display:
1. A punitive, power-driven social climate which hinders effective care;
2. A negative social climate making it hard to learn from mistakes; and
3. Are simply unable to learn, self-regulate, and effectively coordinate their efforts.
I’ve been asked on several occasions, to work with teams that were really struggling. Departments where the culture had deteriorated to the point of extreme frustration, futility, and an inability to make progress on any meaningful initiative – even those necessary to address serious quality issues.
In each case, we were able to make substantial gains in just a few months. It was not easy, by any means. Where leadership saw no hope, though, in each case, they were surprised to see a team come together, repair relationships, achieve goals, and begin to find joy in the work.
Why, though, do we wait until a team is in crisis? Imagine the impact you could have if EVERY team invested time in improving how it functions. Every team would be more likely to make progress. We’d likely avoid any team getting to the point of dysfunction, and would, absolutely, improve engagement and emotional wellness.
Why, though, do we wait until a team is in crisis? Imagine the impact you could have if EVERY team invested time in improving how it functions.
A Practical, Operationally-Based, Approach to Creating Powerful Teams
Why don’t hospitals focus on individual team performance? Mostly because they have no idea where to begin. The approaches I see most often:
1. The team is told to “be more collaborative”!
2. The team leader receives individual coaching.
3. The team is provided a project management resource.
4. The team (more likely the entire organization) is forced to go through “training” on teamwork.
The first strategy is absurd. The second is only helpful if the leader’s behavior is the ONLY problem limiting the team (assuming the coaching is effective). The third is helpful if team process is the only problem. The fourth, is a waste of time.
Imagine a football coach putting his players through online “teamwork” training, but then ignoring that training when they are on the practice field working on strategy and technique. This is EXACTLY what traditional training on teamwork looks like in healthcare (if it’s done at all).
Based on two decades of experience as a member, and leader, of multi-disciplinary healthcare teams, experience with teams in other industries, teaching leadership skills, effective communication, group facilitation, and work with incredibly talented organizational development and industrial organizational psychologists – I’ve landed on an approach that has proven effective even when a team is struggling mightily.
Depending on the situation, some teams can make strides in a single workshop. More often, it requires focused attention over a period of weeks, or months.
Six Steps
While the specific approach will vary based on the specific situation, there are six critical steps to improving team performance.
1. Individual team members recognize, and accept that team effectiveness matters to their goals and what they value.
2. Acknowledge the unique healthcare team dynamics, discussed above.
3. Team members come to understand the psychology of teams - the attributes and behaviors of effective teams, and those of teams that struggle.
4. Each team member then owns his or her individual behaviors via enhanced self-awareness and a willingness to change – because these changes will support their goals and what they value. This requires work, and humility.
5. An objective, psychologically safe, analysis of their productivity, effectiveness, and culture – measured against the attributes and behaviors they just learned about.
6. Finally, and perhaps most importantly, the group must identify and deploy the group, and individual team behaviors WHILE doing the work. This includes being keenly aware of team attributes, and pointing out, and correcting, themselves, each other, and the group as a whole – professionally. In other words, improving team function becomes, in itself, a team function!!!
Leading This Change
It’s unlikely that any team can undertake this work on their own. If there is a leader who has remained completely above the fray, objective, and is respected and valued for his or her team leadership and facilitation skills – it MAY work.
More often, it requires a skilled facilitator who understands individual and group dynamics AND the operational challenges facing the group. It requires frank discussions, and the ability to connect with people, while also holding them accountable. Ideally the facilitator can get team members to appreciate that this work will improve not only their performance, but also their joy in the work.
In the best cases, the group learns that improving team function can be fun, rewarding, and simply become part of their function, as a team. Even then, though, one of the skills they learn is to continually be sensitive to team function issues.
This takes work – but far LESS work than trying to achieve your goals as part of a dysfunctional team!
I firmly believe that this is what’s missing in healthcare - front line work on improving how teams function. It drives engagement, connection to colleagues, and our ability to achieve our goals.
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