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Leadership 104 – Great Teams

April 26, 2021

Hey friends,
This post is a bit longer than usual, but this leadership series, especially teamwork, deserves a little more ink. Enjoy!

Written by Clay Smith

Spoon Feed
Teams make excellent health care possible. We are better and more effective as a part of a team. We’ll cover four ways to build great teams.

Why does this matter?
A team can do what an individual never could. I loved playing high school football. I still love my coach, Al Martin, and I will never forget him. It feels great to be on a team. Think of the power of a team. Tom Brady is an amazing quarterback (Deflategate and other scandals aside…), but he could never move the ball downfield against 11 defenders alone. In health care, teams are even more important. There is overwhelming evidence for the impact teamwork has in improving a host of patient outcomes, including mortality. This article was written from the perspective of the author, and he tells the story of how he assumes the attending role on a new pulmonary consult service team. He buys everyone Starbucks and sits down and gets to know them before they start seeing patients. I was floored. I would seriously like to meet Dr. Stoller (not just for the Starbucks, although if he’s buying…). I am so grateful for his leadership series in Chest, this being the last of four installments. I will put these principles of teamwork in the context of the ED.

Red 10, Red 10, Set…Hut!

There are four key aspects to forming a team: 1) establish the culture, 2) charter the goals, 3) clarify roles and responsibilities, 4) adopt an appreciative perspective. By the way, the ideal team size is 5-10 members. Jeff Bezos says a team is the number of people that can eat two pizzas (teenagers have smaller teams, I guess…).

Establish the culture

  • The foundation of a healthy team is respect for other team members. Punctuality is an essential way to demonstrate respect for your team members’ time. Generosity is surprising, disarming, and shows you care. Bringing a snack or buying coffee goes a long way in setting the culture. Psychological safety is one of the most crucial aspects for teams. Each person is valued and feels safe to speak up.

  • In the ED, we form short-term micro-teams every shift that are part of the broader EM team. We can create a positive culture in four simple ways: 1) show up early; 2) bring something to share (Stack and Tyson…looking at you!); 3) get to know your team members personally (where they grew up, hobbies, etc); 4) actively listen to their input about patients. Make sure they feel safe to speak up. Ask questions to draw out their opinions.

Charter the goals

  • A charter is a document that establishes an entity, like a college, and defines the rights and privileges that come with it. Explicitly establishing the charter for your team is essential. It is less a charter coming from an authority figure and more, “getting everyone’s hopes and expectations for the rotation [or task of the team] to achieve alignment of goals.” That’s part of what Dr. Stoller does in the pulmonary team’s first Starbucks meeting.

  • In the ED, ask what your trainees and colleagues want to learn this shift, where they want to grow, and what’s important to them. And open up about what you want to learn, teach, and accomplish as well.

Clarify roles and responsibilities

  • Complementary skills and diversity are crucial for successful teams and also help us avoid “group think.” Lay out who does what on the team. As Brené Brown says, “Clear is kind.” Though there are different roles, “Every member of the team must authentically feel that he or she matters, has a voice, and can both contribute and benefit from the work of the team, as must the patients we are serving.”

  • In the ED, we can clarify roles several ways. If you are going to do level 1 and 2 trauma notes as the attending, make that clear. In the moment, we can determine roles. Who will run the code? Who will take airway when the gunshot wound is dropped off? Who is going to do what procedure? How can we prioritize and divide up tasks to get our team out on time?

Adopt an appreciative perspective

  • This was new to me. Hang in there. Appreciative inquiry means, “the search for the best in people, their organizations, and the relevant world around them…” Now, before you dismiss this as “pie in the sky,” only for optimistic personality types, please consider this first. This way of thinking can be learned by anyone, even those with a more pessimistic outlook. In medicine, we often focus on deficit-based thinking; namely, we focus on the problem at hand, differential diagnosis, and how to solve it. This works great for clinical reasoning. But it isn’t best for team functioning. I wasn’t sure what the author meant, until I realized I needed to think of appreciative in the sense of an “appreciative audience,” meaning supportive or encouraging. The opposite of an appreciative perspective would be a harsh, judgmental, or overly critical perspective. Teams wither and patients suffer under that kind of leadership.

  • What this means is asking questions that help our teams see something at its best. The author asks his team on day one at Starbucks, “Please tell me, if this rotation were successful beyond your wildest dreams, if it was the best rotation you’ve ever had, what would happen?” In the ED, instead of asking, “What’s the problem that our patient experience metrics are so bad?” we might instead ask, “What would make a patient feel pleasantly surprised, happy, or even wowed by their experience in our ED?” Asking this type of question helps us think of far better solutions than just solving a problem. Remember from Leadership 101, leaders are hopeful. An appreciative perspective can help our teams lift their eyes to see beyond problems to imagine and achieve better things.

We can’t do this job alone. We need great health care teams to accomplish the best outcomes for our patients. In fact, our ability to form teams is as serious as life and death. Patients flourish or suffer depending on the quality of our teamwork. But building great teams gives us even more. Being part of a team is a big part of what makes our work worth doing – it’s how we come to know each other as people and as friends, working beside each other for the good of our patients.

Building Teams in Health Care. Chest. 2020 Sep 21:S0012-3692(20)34513-X. doi: 10.1016/j.chest.2020.09.092. Epub ahead of print.

What are your thoughts?