Team Building Part 5—Putting It All Together
In this series about team building, we have looked at several different aspects of the process. In the first article we considered Google’s studies that have found that character issues determine managerial success in team function. In the second article we considered the impact of culture and the process of socialization that new team members undergo when joining an existing team. In the third article we considered the intellectual processes team use to function effectively. In the fourth article we considered the psychological aspects of team processes. In this article, I want to explore what medical organizations should be doing to build stable, high functioning medical teams. I will start by stating what I see as the task at hand for any successful medical team.
First, all the available data, and my personal experience, suggest the key determinant of team function in medical organizations is the quality of small unit leadership. Successful small unit leadership requires technical knowledge, both explicit and tacit, about the medical tasks the team must execute, but success really depends upon the emotional intelligence and the integrity of the leader.
Second, being effective in the medical context means being able to see the “big picture” as well as the details of the treatment processes. The big picture means being able to see how the three primary forces bounding all medical units—clinical, human, and financial—bear upon both care in general and care for specific patients at specific points in time. Detail means being aware of the care process steps, measuring and improving key factors in those processes, and finding ways to adapt the process to the needs of the individual patient. Said another way, the successful small unit leader will be able to see the care delivered both wholesale and retail.
Third, clinicians, both nurses, technical staff, and physicians, don’t receive training in leadership, either as a general topic or in the context of small unit leadership. Everyone has had experience being in a team, but what they have learned, and whether their role models were effective or not is normally happenstance.
With these three “givens” what should the larger organization be doing to facilitate small unit leadership? First, senior management must come to terms with the real limitations on what they can expect to do “from the top down.” Senior management’s job is to set expectations and work to create a culture where safety, clinical excellence, and financial efficiency are not buzz words, but real objectives for team processes. In many organizations, the CEO is seen at the apex of the organizational pyramid, but I think a successful medical organization thinks of the pyramid as inverted—all management should be designed to support the clinical interaction between the individual patient and the individual clinician, be it at the bedside, in the clinic, or in the front office.
Second, successful organizations develop curricula to provide education to all their clinicians. I think most of these lessons need to be based on clinical case studies, preferably ones that have occurred in the organization. Of course, the studies should be electronically delivered and succinct. If they are less than 15 minutes in length, clinicians can look at them during respites, rather than having to find time to go to an hour long meeting at some remote location.
Third, small unit leadership requires practice, so the successful organization will establish both formal and informal mentoring links. These days an internal “wiki” type conversation is easy to establish and permits the small unit leader to overcome the isolation that often occurs. Finding out others have confronted the same problem can provide some comfort. And finding out what worked and didn’t work for others can speed the learning curve.
Fourth, the successful organization will find ways to identify and spread “best practices.” Leadership is not an isolated skill set. It always occurs in a specific organizational/relational matrix, with specific operational practices. I have noted a common assumption that off the shelf approaches can be used in “plug and play” mode. Some technics and methods can be imported, but real success occurs only in the specific context mentioned. A corollary is that persons who have been successful in one area, say the operating room, may not be successful in another, say the emergency room. As mentioned, success at the small unit level does require technical knowledge, which is usually acquired only by experience.
The successful organization will find ways to facilitate communication among all the leaders—clinical and administrative. Practicing physicians are unlikely to ever develop the habits of mind that characterize people who have pursued an administrative career. This emphatically does not mean physicians need to get MBA’s. Rather, what is needed is at least a few people who are bilingual—physicians who understand administrators and administrators who understand physicians.
Since many physicians and administrators will not become fluent in the other’s language and mind-sets, developing trust is the necessary pre-condition for success. When physicians and administrators trust that everyone is really trying to do the best they can for the patients, disagreements become issue-based, not personality based. Now it may be difficult to remember there was a time when Republicans and Democrats disagreed with each other about which policies to pursue, but all assumed everyone was trying his/her best to make good decisions for the country. Watching the news channels today makes it clear many on each side of the aisle assume the other side is out only for its own good, so opposition is a moral duty, not a political choice. A medical organization where the clinicians and the administrators feel that way about each other is heading for failure, both clinically and financially.
A word of caution to my fellow physicians. As a doctor, you want to get it right every time when it comes to patient care, even though you know it won’t happen. When it comes to leading teams and dealing with people, there is rarely a single best answer. Also, when leading teams and dealing with people no one gets it right every time. Like in baseball, being a .400 hitter will get you in the hall of fame. This is where our administrative colleagues have an advantage—they are comfortable with the notion that don’t have to be perfectly correct.
A word of caution to administrators is also in order. You are trained to increase the odds of success by careful deliberation and aligning all the players/factors involved. You, too, want to get it right, but you can end up with “paralysis by analysis.” Physicians, on the other hand, are usually comfortable “winging it.” They are okay with deciding and then changing it if it isn’t working. The trick in a successful organization is deciding which kinds of problems need the physician approach, which need an administrator approach, and which ones need an amalgam of both.
15 April 2018
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