Thursday, April 26, 2012

Why Understanding Teaming Is Critical for Health Care Leaders

Solving the American health care system crisis is among the most complex and important challenges facing this generation. Is it possible to provide high quality care with better access at a more affordable cost? Is this problem solvable or simply to complicated?  Though that answer is not yet clear, what is increasingly apparent is that a new type leadership is needed if there is any hope in achieving this goal.
Professor Amy Edmondson of Harvard Business school has crafted a practical evidenced based book on how leaders and organizations must approach the increasing complexity of problems they face. Unlike the mindset of execution, which was successful in the past, Professor Edmondson demonstrates that in an increasingly competitive global economy a different approach is needed.

Organizations must learn by teaming.

It is a must read for physician leaders or other leaders in health care.

She provides leaders a clear understanding of how individual and organizational psychology, the reality of hierarchical status, cultural differences, and distance can and do separate team members which can prevent successful teaming. Leaders can close these gaps by understanding the existence of these obstacles and by adapting their leadership style to support and facilitate teaming successfully. She demonstrates the challenges as well as the solutions where teaming has gone well and not so well (the "impossible" rescue of miners in Chile and space shuttle Columbia tragedy) with numerous case studies and insights.

Professor Edmondson also notes that leaders must also thoughtfully identify where the challenges they face fit on the Process Knowledge Spectrum (routine, complex, or innovation). Routine operations could be a car manufacturing plant where outcomes and certainty are known. At the other extreme, innovation operations, like an academic research lab, the outcomes and certainty are quite unknown. Hospitals are considered complex operations. Although the teaming framework applies in each of these three cases, the leader's specific behaviors and actions change. Having excellent outcomes and teaming necessitates matching the right approach to the correct operation.

Interestingly to maximize learning, conflict and failure are necessary for teaming to be successful. These can only occur if leaders create an environment of psychological safety. Learning thoughtfully from these failures and framing them as essential for continuous improvement and innovation is key for organizations to benefit from teaming.

Most importantly, the learning never stops.

Professor Edmondson provides many examples from health care as she has "spent an inordinate amount of time studying people in hospitals." In one example, she notes how two of four cardiovascular surgical teams studied successfully implemented Minimally Invasive Cardiac Surgery (MICS) because of how the leader framed the challenge. It was a shared learning experience. The other two teams failed because they focused on the individual surgeon rather than on the team. For doctors, being able to ask others for help is culturally difficult and yet vitally important given the increasingly complexity of hospitals and medical knowledge. She notes that the "single most powerful factor explaining success" among the the four teams was how the leader framed the challenge.

She notes that for 23 hospital ICU improvement teams, those most successful in changing were those "who engaged in the interpersonal learning behaviors crucial to teaming".

One of the three case studies is about leading teaming in a complex operations at Children's Hospital. The goal of Julie Morath, the chief operating officer, was to harm no patients and achieve a 100 percent in patient safety. She engaged her staff to solve the problems. She eliminated the tendency of the medical culture to view and blame a medical error as the fault of the individual. Instead via "blameless reporting", observers merely communicated what they saw and analysis followed. aBy creating a culture of psychological safety, the hospital learned from their "accident" and explored ways to improve the their care. As a result, the hospital became nationally recognized as a leader in patient safety.

"For over a century, we've focused too much on relentless execution and depended too much on fear to get things done. That era is over...human and organizational obstacles to teaming and learning can be overcome...Few of today's most pressing social problems can be solved within the four walls of any organization, no matter how enlightened or extraordinary... Generating ideas to solve problems is the currency of the future; teaming is the way to develop, implement, and improve those ideas."

Although at times, the conclusions from her twenty years of research and observation seem counterintuitive, her findings and stories woven into a actionable framework and structure makes Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy compelling. It is destined to be a classic reference for leaders today and in the foreseeable future as they lead their colleagues and organizations into confronting and solving increasingly complex problems and challenges.

Professor Edmondson hopes that her book will enable organizations to execute at a higher level only "when leaders empower, rather than control; when they ask the right questions, rather than provide the right answers; and when they focus on flexibility, rather than insistent on adherence... When people know their ideas are welcome, they will offer innovative ways to lower costs and improve quality, thus laying a more solid foundation for meaningful work and organizational success."

She succeeds at every level.

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