Lately I have been concentrating on team building with my leadership group. A recent focus of discussion was an article by DeSteno called “How to Cultivate Gratitude, Compassion, and Pride on Your Team.” He began the article by looking at Google’s Project Oxygen, designed to identify managerial attributes associated with team success.
“What they found is that yes, driving a team to be productive and results-oriented mattered, but so did being even-keeled, making time for one-on-one meetings, working with a team in the trenches to solve problems, and taking an interest in employees’ social lives. In fact, these “character” qualities outranked sheer drive and technical expertise when it came to predicting success.”
My team thought the most important element was being in the trenches solving problems, which is not surprising. After all, I select nurse managers based on their effectiveness as dialysis nurses—being at the patient’s side is their first love and their core expertise. The administrator and I usually think they are overly involved in their staff’s personal lives—in small units it is hard not to have “too much information.” Sometimes this information makes it hard for them to put the needs of the patients and the unit ahead of the individual’s perceived needs.
DeSteno writes, “So what is the best way to instill grit and grace in your team? My research shows that its about cultivating three specific emotions: gratitude, compassion, and pride.” He notes the power of appreciation in motivating people, but as my team discussed these ideas, it became clear the key issue was trust. Do the staff see the nurse manager as trustworthy? Does the nurse manager see the staff as trustworthy?
I have concluded some people simply lack the capacity to trust—probably because the adults in their lives were not reliable when they were very young. But for many, the problem is one of mindset. What do I mean by this? Let me give a couple of examples.
How does the leader view the staff? Are they employees, or, God forbid, FTE’s? Or are they Mary, Susie, Bob, and Joe? In the days when medicine was almost exclusively a cottage industry everyone expected to know the individuals working with them. When I entered practice, I expected to have at least passing familiarity with the nurses on the units where I saw my patients. Now with corporatization of medical practice, younger associates don’t even expect to know their colleagues, much less the staff. We have exceeded Dunbar’s number, and forgotten getting things done always comes down to the people who must do it. This corporate perspective also makes it difficult to see the individual known as “patient” to the clinician, or “customer” to the manager.
How does the leader view the team, as opposed to the individuals on the team? Is it a static thing or a dynamic thing? Belief that there is something called the “status quo” is one of the bigger impediments to team function. Leaders, and team members sometimes forget the team, like a marriage, must be worked on all the time. Team building is never “done.” But we want it to be that way—it seems to hard to have to keep doing it.
Then there are real issues with the bad apples. It is all well and good to assume that most people want to come to work and do their best, but there are some who do not. Dimmock and Gerken addressed this issue recently in the same forum.
“And while it would be nice to think that the honest employees would prompt the dishonest employees to better choices, that’s rarely the case. Among co-workers, it appears easier to learn bad behavior than good. For managers, it is important to realize that the costs of a problematic employee go beyond the direct effects of that employee’s actions—bad behaviors of one employee spill over into the behaviors of other employees through peer effects.”
The authors constructed a data set by examining regulatory filings about complaints concerning financial advisers with special focus on that adviser’s ecosystem. They controlled for organization, presence of a new supervisor, and ethnicity matching between supervisor and adviser, and found the effect remained about the same except for ethnicity, where the effect was doubled if the supervisor and adviser shared ethnicity.
“We found that financial advisers are 37% more likely to commit misconduct if they encounter a new co-worker with a history of misconduct. This result implies that misconduct has a social multiplier of 1.59—meaning that, on average, each case of misconduct results in an additional 0.59 cases of misconduct through peer effects.”
All medical organizations depend upon payment from government health programs, none more so that dialysis clinics, so maintaining integrity of the process is critical for regulatory approval. But this study suggests most of the top down “compliance efforts” don’t do much to prevent contagion. After all, it is unlikely the financial firms in the study said anything that could have suggested it was okay to be dishonest. The authors conclude it is informal social networking that works to stop the contagion—plus getting rid of the bad apple.
However, improving quality and safety in dialysis units must be about design, not inspection. Picking out the bad apples won’t improve the rest of the crop. From the manager’s perspective, though, it is hard to be positive, encouraging, and open to adaptive change, while making sure the bad apples don’t spoil the entire enterprise. So how can one maintain equipoise? For me, the issue is to assume people want to do their best and need organizational definition of what “best” means in the context of their jobs. With this approach, people often exceed my expectation of their capabilities. I prefer to be disappointed with the occasional person who does not measure up—and separate them as quickly as possible. The opposite approach, to expect the worst and be occasionally surprised that someone does better than the minimum, is not a recipe for a healthy, satisfying work environment.
In the final analysis, then, I contend all unit performance, clinical and financial, depends on small unit leadership maintaining a focus on quality and safety of care first. But it is not what you say that matters—it is what you do. If you don’t like what you see in your team, start by looking in the mirror. We get the teams we model, not the ones we say we want.
6 March 2018
 DeSteno D. How to Cultivate Gratitude, Compassion, and Pride on Your Team. HBR 20 February 2018. Accessed 21 Feb 2018 at https://hbr.org/2018/02/how-to-cultivate-gratitude-compassion-and-pride-on-your-team.html.
 Dimmock S, Gerken WC. Research: How One Bad Employee Can Corrupt a Whole Team. HBR 5 March 2018. Accessed at https://hbr.org/2018/03/research-how-one-bad-employee-can-corrupt-a-whole-team.html.
A Good Place To Work
Is your organization a just one? How do you know?
Building Team Effectiveness
Leading Through Teams
Measuring Stress in Your Team
Making health care organizations more successful may begin with recognizing distress in the persons providing the care. But how?
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.
Teams and Learning Organizations
A brief introduction to the concept of the learning organization for physicians.