Annamarie Fuchs, Creator. Partners in Health | Conversations and Teri Price, Executive Director. Greg’s Wings.
“You’re a skilled clinician. If you want to be an excellent clinician, you need your team alongside you.”
June 2022. Recent conversation between a clinician and an educator.
I’ve spent my professional life working in healthcare where we’ve known for a generation that teamwork is essential. Without it, people can die. Teri Price, our co-author, and Executive Director of Greg’s Wings, represents a family whose son and brother Greg’s journey through the system demonstrated tragically what can happen when teamwork – and the mindsets, conditions, and systems to enable it are absent.
Teams and Teamwork
Teamwork as a concept is far more complex than we might think. We easily accept the notion of teaming in sports or teams of people supporting voyages into space and how the interdependence of everyone on those teams is literally the difference between success and failure. And yet in healthcare there seems to be an abundance of obstacles that prevent us from implementing consistent teams and achieving team effectiveness. We recognize groups of people working alongside each other trying to manage demand while they move from crisis to crisis and assume they are functioning effectively as a team. However, there is a world of difference between groups working side by side and teams of individuals who trust each other to function in a cohesive and collaborative way with a shared goal of providing value to the people they serve.
Despite the widespread agreement that that teamwork is indeed essential to any high performing health system, it’s far more likely that we’ll encounter silos of well meaning multi-disciplinary groups trying to achieve reliable results in environments where complexity continues to grow. And there are no more complex environments than those found in the healthcare space.’
In healthcare, a single visit requires collaboration among a multidisciplinary group of clinicians, administrative staff, patients, and their loved ones. Multiple visits often occur across different clinicians working in different organizations. … The coordination and delivery of safe, high-quality care demands reliable teamwork and collaboration within, as well as across organizational, disciplinary, technical, and cultural boundaries.
Building effective teams based on certain characteristics allows us to navigate cultural variation, beliefs and values, and personal attitudes as each member is provided with the tools necessary to work alongside one another to meet the needs of the people they serve.
Teri Price from Greg’s Wings routinely speaks with audiences about how, after 10 years since the loss of her brother Greg, her belief is even more resolute: that we need a stronger foundation of teamwork in healthcare. There have been times when advocating for teamwork seems a bit counter intuitive. But the sort of teamwork that Greg’s Wings and other organizations are promoting would require significant system transformation alongside a change in the mindset of many providers who continue to rely on autonomous practice as essential to professionalism. Some of the most challenging obstacles preventing us from forming cohesive and reliable team based environments originate in large part with longstanding divergent expectations between government and established professional hierarchies that continue to this day. Despite those struggles, the relationship between team effectiveness and high performing health systems has become more and more apparent. And yet most of us have simply settled for working in groups rather than working in teams.
Over the last 20 years the literature around teamwork in healthcare has grown considerably together with the development of dozens of frameworks for establishing teams. But, if each of us was to reflect about what makes us feel safe and valued when working alongside others, we would all agree with the following statements. To feel safe and valued…
- We need to know who’s on the team
- We build teams to meet the unique needs of the patient.
- We understand each person’s role in addition to ours and respect everyone’s contributions.
- We reflect on, respond to, and are accountable to the people we serve.
- We each have a shared understanding of the situation we are faced with at any given time, the plan of action for each situation, and what to do if something doesn’t go according to plan.
- We are empowered and encouraged to speak up at any time because the environment is psychologically safe.
- We recognize and are supported to respond to risk
- We support and rely upon each other and make decisions together as a team.
In a team, it is also well understood that everyone relies on each other to be successful, and everyone works toward achieving common goals. Rick DuFour talks about the three essential characteristics that distinguish groups from teams in the following YouTube video https://youtu.be/0hV65KIItlE In short, he explains that all members of an effective team…
- Work interdependently creating interdependent relationship with their team members
- Have shared goals that everyone agrees with
- Are equally and mutually accountable
We believe there are four key elements that will ensure all teams, regardless of the situation, will be effective, efficient, and responsive.
Steven Covey is known to have claimed that “change moves at the speed of trust.” We cannot implement or sustain change without trusted relationships where each of us is valued for our individual (and collective) contributions. In fact, we would argue that despite the emphasis on expertise, data, and technology as being highly valued in a high performing health system, trust is the fundamental currency of healthcare. People are not widgets. We will never will be widgets. While data and technological advances have transformed healthcare decision making, it’s only when we operate at ALL levels of healthcare from a point of trust within effective teams that we will achieve the outcomes that any high performing health system aspires to.
Healthcare is a team sport that requires absolute trust between all members of the team. And yet, In the last 100 years, as technology and expertise has progressed, the public’s trust in healthcare providers and systems has become consistently eroded. Trust is foundational to individual relationships between single providers and their patients, but it is even more essential in highly technical or complex team-based environments if we hope to deliver high quality outcomes with fewer errors. When we communicate effectively, and hold ourselves and each other accountable, trust will grow and the relationships with the people we serve will improve because patients will also know they can rely on their providers to treat them as partners and members of the team.
2. Patient Centeredness
Terms such as ‘patient centered care’ or ‘relationship centered care’ are also abundant throughout the literature. However, in the clinical environment, examples where patients and their family, friends, or caregiver advocates are actively sought out to participate in decision making can be difficult to find. Just this past month I’ve been interviewing a woman for an article about the difficulty she has been experiencing in accessing urgent care where she was told to “toughen up. There are patients who are far worse off than you.” This woman happens to be a retired health professional who understands how essential it is to advocate for her own healthcare. After 300 days of illness with subsequent comorbid issues complicating an already tenuous and high-risk situation, this is what one of her clinicians told her when she questioned why her surgical wait might be as long as 3 years. This is NOT an example of a patient centered teamwork approach.
A truly patient centered teamwork approach occurs when teamwork isn’t merely used to improve patient experience but the patient and the family, friend, caregiver advocates walk alongside that team as equal, valued, and contributing members of that team to ensure that the interests and the values of that patient are preserved and acted upon. Without explicitly seeking to understand the patient’s own experience, needs, and insights, errors will continue to occur, and patients will continue to “Fall Through the Cracks.”
3. Collective Competence
Teamwork in healthcare is the purest and best example of the value of group think. Group think is a type of collective intelligence where we understand that the whole is greater than the sum of its parts. But keep in mind that having a bunch of smart people in a group doesn’t make the group smart. Instead, ‘collective competence’ emerges when patient care is dependent on teams and networks of individuals working effectively together in a complex system.
Collective competence is about more than the people on the team and how they function as members of that team. It’s about what happens when individual experts can function with a sense of awareness (and Teri and I would add ‘trust’) of one another as well as an awareness of the various structures and resources in the system that either support them to work together or inhibit them from working together.
4. Psychological safety
The final element we believe essential for effective teamwork is psychological safety. Psychological safety occurs in high performing teams where the influence of team leaders, interpersonal relationships, and individual characteristics all enable individuals to take risks. In other words – psychologically safe environments enable everyone within a team to trust the environment and the people on that team to allow them to contribute in the most effective, high-quality way. According to Amy Edmundson, there are three indicators of psychological safety.
- Model fallibility and invite participation.
- It starts at the top where leaders own up to their knowledge gaps and admit mistakes so that all members of the team feel safe to do the same. They also acknowledge that they may make mistakes and need each member of the team to stay vigilant and point out anything that concerns them.
- Frame the work.
- In other words, it’s about getting people on the team on the same page by helping everyone to understand what lies ahead and how they are all going to need to depend on each other to get things right. By putting a layer of meaning around the work each of the team members contribute (by using value statements and descriptors) it provides clarity about why the voices of each member of that team matter.
- Embrace the messenger
- When someone points out a mistake or a risk, are they going to be attacked, berated, or demeaned? Or do the other team members thank the individual for pointing out the issue, even if that person is wrong? When we fight the instinct to react negatively, we elevate the trust that is essential between and among all team members.
Teams often fail to take hold because we lack a clear understanding about what it means to be an effective team, who the absolute priorities should be centered around, and because we have a widespread unwillingness to let go of real or perceived power. On the part of decision makers, there appears to be little understanding about what value ‘teaming’ as a key strategic enabler offers the entire health system.
As healthcare continues to evolve, team-based systems are becoming more and more essential as key contributors to better patient experience and high-quality patient outcomes, and as a means to strengthen provider experience and reduce burnout. The Institute for Healthcare Improvement also suggests that teaming can contribute to overall ‘value management’ by enabling team members to discover and share more effective ways to reduce the cost of care while improving quality.”
When teams fail, everyone fails. But when everyone on every team becomes empowered to share a common vision and to trust each other, when open communication takes place from a position of trust, and where patients and their family and friend caregiver advocates are central to all decision making, everyone wins.
 Satell, G. Here’s How you Build Transformative Teams. Digital Tonto, June 12, 2022.
 Rosen M.A., DiazGranados, D., Dietz, A.S., Benishek, L.E., Thopson, D., Pronovost, P.J. and Weaver, S.J. Teamwork in Healthcare: Key Discoveries Enabling Safer, High-Quality Care. American Journal of Sychology, 2018 May-June; 73(4): 433-450. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361117/
 Youth Thrive, America’s Promise Alliance. Change Moves at the Speed of Trust: Community Leader spotlight with Sara Carter. 2017, Tuesday September 26. https://www.americaspromise.org/news/change-moves-speed-trust-community-leader-spotlight-sara-carter#:~:text=%E2%80%9CChange%20moves%20at%20the%20speed,real%20value%20for%20their%20contributions.
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