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Leading Through Teams
The Gallup organization recently published a survey of U. S. businesses that show 84% of employees are “matrixed,” that is, work on multiple teams every day reporting to the same or different managers.[1] They further subdivided this into three groups. 49% served on multiple teams some days, (slightly matrixed), 18% served on multiple teams every day, but usually reporting to the same manager, (matrixed), and the remaining 17%, the supermatrixed, worked on different teams every day reporting to different managers. Quoting an article in “The Economist,” the Gallup authors note teams are a two edged sword—they may provide insight, creativity and knowledge, but may also lead to confusion, delay, and poor decision-making. Furthermore, competition among teams can hinder progress and employees may become less clear about their roles and accountability, which are important drivers of employee engagement. The authors note: “Gallup research indicates that an engaged, high-performing workforce is founded on clarity of expectations. Clear and accountable roles promote organizational health and performance…The matrix structure is notorious for frequently obscuring lines of accountability. One common complaint is that matrixed organizations lack clarity of responsibility and expectations, and it can be difficult to understand who reports to whom. Leaders need to address the problem of role ambiguity that pervades matrixed companies, helping employees by continually setting clear expectations that are in step with company objectives. This clarity should involve frequent conversations between managers and workers about the specific role each person plays in advancing organizational goals. It's on leaders' and managers' shoulders to ensure that employees understand whom they answer to and the duties for which they are responsible.” A related article published in The Harvard Business Review,[2] Fitzsimons notes: “Consider the challenges of the 21st century enterprise: things change too fast for one individual to know how to best respond; there are many explanations for any event, and multiple perspectives are needed to understand what that event means and decide what to do; a pipeline of future leaders is essential to companies’ long term success. No wonder organizations today are drawn to the benefit of leadership that is shared, rather than concentrated in a single, charismatic individual. Regardless of the exact organizational structure or what it’s called, the times seem to call for leaders who can be first among equals…Recent research on change management teams, virtual teams and new startup teams has shown that teams in which leadership is shared, rather than vested on a single individual, can be very effective, demonstrating through quantitative methods that shared leadership can, and does, lead to improved organizational performance. And yet organizations remain stubbornly hierarchical. Anyone who has tried to share the burdens and privileges of leadership in their teams has probably noticed that doing so is far from straightforward.” He reports on his experience helping an international professional services firm deal with shared leadership over an 18 month period. He notes the changed relationships may be difficult to navigate. Specifically, the vice-president in charge of each area may have difficulty holding his/her colleagues accountable for performance, and may scapegoat one manager for the failure of the project. They may also set up the nominal leader for failure as a way of avoiding their responsibility. Team leadership also makes relationships with subordinate levels difficult. “For starters, you may notice attempts to export conflicts. Difficult conversations that the team is avoiding may get acted out in the level below. The classic sign is that while your team celebrates its harmony, those who report to them develop increasingly acrimonious relationship among each other. Your job is to ensure that good feelings in the senior team do not come at the expense of confusion and frustration in the level below. Also, a senior team going through the transition to shared leadership may prefer to keep its doors more firmly closed to other managers than usual, while they sort out their relationships. We learn early to keep our team’s struggles behind closed doors, and this is normal to an extent. However, it may contribute to feelings of confusion in the levels below, and adversely influence motivation and performance. Finally, executive team members may bolster their view of themselves as truly sharing leadership by developing a story that blames the levels below for the very difficulty described above. You may hear complaints about middle managers’ lack of mutual accountability, dependency on their boss, resistance to change, and so on—the very same issues you and your team may be struggling with.” Clearly, the team based approach to getting work done has its difficulties. Since I have strongly advocated for a team-based leadership structure in medical organizations, it is important to think about these issues and how they might differ in a hospital, for instance, than in a typical business organization. Medical organizations have an inherent duality—they are clinical enterprises designed to deliver medical care, but they are also big businesses with complicated financial and regulatory structures. The people who deliver the care aren’t really qualified to deal with the business, but the business people aren’t really qualified to deal with the medical care. Successful organizations must find a functional way to link these two aspects of the business at every level, which means team leadership. So how can a medical organization function with team leadership in an environment where the delivery of medical care depends upon ad hoc assemblies of teams, which I call the clinical microsystem, and avoid some of the traps outlined in these two articles? The short answer, of course, is that the traps are there for every organization, because they are rooted in human behaviors. Having experimented with shared leadership on the clinical side for thirty years with many different individuals, I have found there are some who simply cannot function in that sort of environment. They find taking responsibility for making decisions too anxiety-provoking. It is more comfortable to call “the boss” and pass all decision making along to him/her. The second challenge is avoiding the traps inherent in the psychological triangle involved in medical leadership team of physician, nurse, and administrator. The Russians have a long history of the “troika” as a means of controlling absolute power, because of the probability of division 2 to 1 along any issue or challenge. In the context of dialysis units, where I have the most practical experience, this usually means the administrator and the nurse are in conflict, and both try to enlist the medical director as an ally, usually without telling the physician what the issue really is. The third challenge, is that all members of the leadership team have to have respect for the skill sets the other persons bring to the task. If respect and skill exist, then a problem can be defined as mainly in one or the other member’s “sphere of expertise” to steal a geopolitical phrase, and they can be expected to have the deciding voice. Again, using the dialysis unit as the model, a contract issue is clearly in the administrator’s sphere, but the physician and nurse manager need to know if the contract is going to place demands on them that are different from routine work, and need to make sure they can deliver on the contract before it is signed. An issue involving medical care ultimately belongs to the physician, but the team has to be included in the decision making, since the change has to be paid for and the staff have to be able to execute the new plan. Teams are not a panacea—they do not solve all the organizations problems. But in the context of healthcare organizations, there really is no question in my mind that they are superior to command and control models of decision making which are dysfunctional. Perhaps it is an echo of Churchill’s epigram on democracy—it may be bad, but it is better than any other model of government. 21 May 2016 [1] Rigoni B, Nelson B. The Matrix: Teams are Gaining Greater Power in Companies. 17 May 2016. Accessed 20 May 2016 at http://www.gallup.com/businessjournal/191516/matrix-teams-gaining-greater-power -companies.aspx?utm source=email&utm_content=morelink&utm_campaign=syndication. [2] Fitzsimons D. How Shared Leadership Changes Our Relationships at Work. Harvard Business Review, 12 May 2016. https://hbr.org/2016/05/how-shared-leadership-changes-our-relationships-at-work. |
Further Reading
Building Team Effectiveness Clinical Microsystems Clinical microsystems are composed of front-line clinicians engaged in direct patient care. Despite a lack of formal authority, they are the key to successful healthcare reform. Measuring Teamwork Measuring teamwork is difficult, but important if healthcare systems are to invest in their development. This article reviews the literature and provides suggestions for action now. Organizing for Success - Lessons from Keystone The Keystone Cooperative ICU Project obtained major improvements in safety. The "soft science" lessons need to be applied more widely. Teams and Learning Organizations A brief introduction to the concept of the learning organization for physicians. Teamwork |