Healthcare’s Dysfunctional Team Problem

The J3P team had the honor, recently, of leading a workshop for the American Organization of Nursing Executives (“AONE”) fellowship program.  The focus was the role of self-awareness in leader performance.   It was a fascinating discussion with 25 of the nation’s top nursing executives.

A topic that came up, over and over again, was how healthcare teams struggle with team communication and collaboration.  I’ve seen it myself.  Whether it’s a multi-disciplinary team pulled together to build a new spine program, or senior leaders working on high level strategy, the efforts are often hampered because the team doesn’t function well as a team.

The problem is not unique to healthcare, but it’s been my experience that it’s more pervasive in healthcare and has a bigger negative impact. What we are all trying to do – re-build the entire care delivery system, requires teams that function at their highest level.  They can’t afford to come up short because they don’t work well together.  The AONE fellowship discussion revealed three challenges to effective team function and communication that I thought were worth discussing:

Vulnerability vs. the Culture of Expertise

Much has been written in recent years about the concept of vulnerability.  Brene Brown is a popular speaker on the topic and her Ted Talk has been widely viewed.   Part of her message is that people, need to be willing to be vulnerable in order to innovate. High functioning teams create a culture where vulnerability is accepted and encouraged – where people are comfortable being vulnerable because they know they are supported and that their ideas will be respected.  Members appreciate the value of bringing new ideas to the team, because it’s how organizations innovate and grow.

Healthcare’s culture has grown, to a large degree, around the academic training of nurses and physicians – professions that value, above all else, expertise.  Workshop participants shared experiences from their nursing education – stories of high expectations and low tolerance for mistakes.  These professions have fostered a traditional autocratic leadership and teaching approach that, essentially, discourages people from asking questions, and punishes vulnerability.

Healthcare has always been about silos and advancing by developing and demonstrating expertise in your discipline.  Professionals often bring this background to multi-disciplinary teams.  Rather than open sharing and a collaborative evaluation of ideas, team members feel the need to be right, and to protect their professional turf.

Collaboration vs Autonomy

Every health care profession encourages a strong sense of professional autonomy.  Each, nursing and medicine included, instill in students a profound sense of pride in its very reason for existence.  Each has a wonderful history and is dedicated to taking care of patients and promoting the profession.  In some respects, faculty and mentors communicate or at least imply, that their profession is more vital than others and, not recognized enough for their contributions.  This same sense of pride and autonomy, however, can contribute to a lack of trust, and prevent open collaboration.  Sometimes, in team settings long-standing professional turf-battles influence the dialogue.

Consider collaboration in medicine for a moment.  In a 2015 post for the New York Times Well blog, Dhruv Khullar, M.D., noted, “Though new models of healthcare delivery increasingly focus on collaboration, medical education still does not adequately teach aspiring doctors how to work effectively with a team of caregivers.”  Collaboration and teamwork are not attributes considered much in the medical school application process, nor are they emphasized in residency.   In many respects, the opposite it true.  Both contexts emphasize competition and individual success. 

Even outside of healthcare, complex collaboration is hard.  Gratton and Jackson studied this phenomenon and summarized it in a Harvard Business Review article, Eight Ways to Build Collaborative. Teams.  When organizations need to solve a complex problem, they to form teams of high performing, accomplished experts from their respective fields.  Studying a large number of companies – they found that complex teams of experts tend to NOT:

  • Share knowledge freely
    • Learn from one another
    • Shift workloads
    • Help one another complete tasks
    • Share resources

Is it any wonder that when we put leads from their respective healthcare departments and professions in a room and ask them to solve complex problems, they struggle?  Consider, too that healthcare is notorious for entrenched organizational silos.  Other organizations build their infrastructure around their products, thereby encouraging collaboration. Healthcare is organized around academic or department specialties.  We aren’t built for collaboration. We have to work at it. You can rise to the top of your silo without ever demonstrating strong teamwork skills.

A Lack of Basic Team Communication Skills

If clinicians get training on communication, it’s focused on the patient. It’s not just the clinicians.  There is an art and science to communicating effectively as the member of a team.  Engaging team members, appropriate ways to challenge an idea, to seek clarification, to support an idea, to synthesize seemingly disparate opinions, to ask clarifying questions and to professionally and adeptly bring a discussion back to its original purposes – these all require specific communication techniques and strategies. Few receive effective training in these techniques and strategies.

I had the benefit, early in my career, of extensive training on group facilitation techniques.  I use these skills every day and I’m not sure how I would have ever been effective without them.  Every day, multidisciplinary healthcare teams are meeting to solve complex problems – with none of this training.  It’s no surprise that they struggle.  I’ve watched it happen.  I’ve watched them struggle. I’ve had to intervene by teaching relatively basic team communication skills.

Self-Awareness as the Starting Point

Leaders can’t overcome any of these challenges without, first, gaining a level of self-awareness.  Understanding your own tendencies will inform how you communicate and how you process ideas – especially ideas that might be different from your own.

Leaders can create a culture of vulnerability and collaboration.  It starts with improved self-awareness.  Each leader needs to understand his or her strengths and challenges and seek honest feedback.  Leaders need to deliberately model and reinforce vulnerability, collaboration, and productive group communication techniques – none of this is possible without understanding your own personality traits and tendencies.

Leadership teams are already overburdened.  No one likes the idea of having another meeting – especially if that meeting is to actually talk about meetings!  But – when it’s done well, a well-designed intervention to understand and improve team dynamics, and collaboration, proves it’s worth, quickly.  Sometimes relatively small realizations, and changes to the way leaders interact, can yield significant improvements in a team’s ability to solve difficult problems.  I’ve also found that a frank, open and professional discussion about the topic often reveals which members of the team may be simply unable to collaborate at a high level – a useful piece of talent management data.

Given the challenges facing healthcare teams, they need to function effectively – as a team.  I’d encourage teams to honestly assess whether this is the case in their situation.  If it’s not – seek help. Fix it.  Now.  The energy you spend trying to manage a dysfunctional group would be better spent solving those complex problems.

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