Health Care Teams

Today I found this excellent white paper called Turnover RX: How to Cure the Retention Problems Ailing Your Health Care Organization.

The money quote from the report is “To lower turnover, you must create an environment where employees want to work, and the first step in doing this is to remove the challenges workers face. Enriching your workplace environment will help ensure your employees don’t uproot and take their skills elsewhere.” On its face, this seems pretty obvious and yet, based on what front line employees tell me, they don’t believe their employers are making much of an effort to do this.

For nurses the top three concerns were:

1. Lack of advancement
2. Too few staff
3. Work overload

As is usually the case with these kinds of surveys, salary is important, but not at the top of the list as many health care administrators might assume.

Read the report. Love to hear your reaction.

When I’m leading a session for front-line staff, I’m often asked the question, “Are the managers going through this training?” When I tell them that they are not; I am met with eye rolls, heavy sighs, and some pretty direct statements about not walking the talk. So much for creating a positive learning environment.

There are plenty of times when employees should be learning skills that the managers have already mastered, or at least should have mastered at some point along the way. Here’s the problem, employees don’t see it or believe it. Sometimes being a good manager means going first, even if it’s something you’ve already seen.

As a trainer I sometimes show a video. Trainers rule #1 when showing a video: Watch along with the participants. It helps create the impression that this is an interesting and worthwhile video. Also know that I’ve seen some of these videos more than 100 times…I could be the understudy for any of the actors. And still I watch because it supports the learning process.

If you are a manager, be aware of your actions. Your employees are watching and what you do (or don’t do) makes a difference.

It’s tough being in charge.

If someone asked you how good your team is, what would you say? Let’s imagine you answered, “My team is great!” In that case I hope you would also be prepared to answer the question, “How do you know?”

It’s easy to feel over-confident about a group you are leading or of which you are a member.  The danger in this is that the group becomes apathetic about its own effectiveness and slowly begins to decay. One day, the group finds itself to be a wreck, and nobody seems able to figure out how things became as bad as they did.

Your team doesn’t have to be perfect, but it ought to be continually working on improving performance.  This process always starts with an honest assessment of the current state of affairs.

The team’s results can serve as one effectiveness indicator. On the other hand, using results can be misleading. Not achieving goals does suggest major problems with the team; however, the converse is not necessarily true. A team might hit its goals, but may have used up far more resources than necessary to achieve that result. Not only can this show up as an immediate productivity problem, but it may show up later in the form of serious morale problems on the team, resulting in the team’s inability to achieve some future goal.

To better understand some of the process concerns that a team has, you need to ask the team members. The problem is that they probably won’t tell the leader what they really think.  No matter how strong the leader’s relationship is with each team member, people still hedge when talking with the boss about problems they are experiencing.

This is when an outside assessor can help find the issues that might be keeping a team from reaching its potential and suggest ways to turn things around. This first step need not be expensive nor time consuming. A simple online survey, compiled by a neutral party will provide the information you need to start building a team that’s great.

Want to give it a try?  Click to learn more about The TeamCheck Assessment.

Photo by ildmencos

The next time your health care team is in need of a trainer or speaker, I’d suggest you consider these questions:

• What results are you hoping to affect, by what degree, and by when?
• What behaviors and processes have the greatest impact on those results?

Here’s the secret to your project’s success. Approach it as a process, not just a single event.

Behaviors don’t change easily. People need information, encouragement, coaching, practice, time, and incentives. It’s unlikely they will get most of these from a single event or as people in my line of work like to call it, intervention. There are a series of things that should be done to start making progress towards the goals.

Here’s an example. Imagine a group of nurses engaging in malicious gossip that is hurting the team, and naturally you want it to stop. So what should be done? I can think of many things that collectively could help.

• You ought to tell the group what you’ve noticed and share with them the impact that it’s having on the team and on patient care.
• Someone should dig into what the gossip is about and try to make a determination about why it’s happening.
• The group ought to be let in on the findings of this investigatory work.
• The group can then engage around the question, “What should we do to change this behavior?”
• Maybe the group needs some skill development in the areas of assertiveness and listening.
• Maybe they need practice at working through conflicts.
• They could probably benefit from establishing group behavioral norms.
• Some individuals might need more hands-on coaching.
• A monitoring system should be established.
• Follow-up needs to happen.

And the list could go on and on. The point is that real change rarely happens with a single speech, workshop, or team building event. Change comes as a result of a purposeful process that addresses the true concerns and provides the support that people need to move from points A to B.

If you want to tweak people’s interest and get them thinking, a single intervention often will accomplish that goal. If you want to make major change, you’ll need a plan that includes a series of interventions to start moving people towards the goal. And in the perfect world, you take it one step further by creating a system that sustains the organizational culture you are working to create.

Photo by John-Morgan

When I’m asked to facilitate team building sessions, a lack of trust is often one of the core problems that needs to be addressed. As people tell me stories about what’s going on, and I observe the way individuals behave; the low level of trust becomes glaringly obvious.

If a team is ever going to grow and thrive, the members of that team need to trust each other. It is especially important that team members trust the leader, and that the leader trust the team members.

So what’s a leader who wants to build trust to do? I’ve heard plenty of people tell me that you either have trust or you don’t. Implied in that statement is that trust is like magic. It can’t be understood. I disagree.

Trust is a result of concrete behaviors. If you want to build trust on your team, there are things a leader can and should do.  Here are ten ideas to get you started. If you can think of others, just add them to the comments.

1. Be trusting. It starts here. If you want people to trust you, then you need to trust them. For me this means assuming that people are competent, dependable, and act in good faith. With these ideas in my head, trusting behaviors will follow. Will you get burned by this? Most likely. Still, give people the benefit of the doubt, and soon they will start following your lead.
2. Take some personal risk. One reason you want people to trust you and each other is so that they will take reasonable risks. You’re the leader. That means you go first. This might look like sharing feelings, respectfully challenging a superior, or admitting when you’ve screwed up.
3. Reinforce dependability. I trust people who are dependable. When people do what they promised to do, regardless of how seemingly insignificant it was, notice and acknowledge it publicly. People are often more dependable than we think. It’s our job as leaders to start changing that perception by pointing out when people do follow through.
4. Demonstrate open communication. Teach people to say what needs saying in a respectful and direct manner. A lot of times people don’t trust another person because they are making assumptions that aren’t true. We need team members to make their thoughts more transparent so that we can deal with reality rather than assumptions.
5. Provide realistic challenges. A little adversity is a good thing when it comes to building trust. In tough situations, people tend to pull together. If you’ve provided a challenge that people can rise to and meet, they will now have this shared experience of overcoming an obstacle. Trust will likely follow.
6. Focus on ideas and behaviors. Let’s face it, leaders need to make judgments about what are and are not successful results and desirable behaviors. People will never trust each other if they believe they are going to be harshly judged or personally attacked. That’s why when you need to be critical, they need to know you are not focusing on them, but rather the situation.
7. Yield control. The person I most trust is myself. When I’m in charge, I’m pretty comfortable I’m not going to do anything to harm myself. Using this idea in a team setting means that you give other people a chance to be in control once in awhile.
8. Teach conflict management techniques. A lack of trust is often the result of poorly managed conflicts. By encouraging and supporting people in working out conflicts among themselves, you will see trust increase over time. Here’s an example of conflict training I provide to groups attempting to do this.
9. Lighten up. When things get too heavy and serious, stress levels go up and trust tanks. You need to break the tension by making it okay for people to laugh when things don’t go according to plan.
10. Practice patience. At the end of the day, you can follow all these strategies for building trust and you still might not see the impact you hoped. That’s because trust is earned with time. Give people a chance to see the difference, consider what it means, believe in it over time, and eventually make the change towards more trust.

Photo by schmollmolch

If you are like many people, the phrase “Team building” conjures up images of campfires, over-sharing of personal information, and maybe even a group-hug thrown in for good measure. Hang around a work environment long enough, and you’ll probably get to experience some of these team building activities yourself, assuming you haven’t already.

Do they work? As standalone tools, I don’t believe they do. They usually create a strongly positive or negative reaction in folks. Some people love team building activities and particularly like the good feelings they create. For others it’s extremely uncomfortable, and they don’t see the results. For me, I experience a little of both. In general I like participating in them because I find them fun and interesting. In terms of significant and lasting impact on teamwork, I don’t see it.

Here’s the problem, a strong team is a function of many variables. Good feelings gained via shared experience (think high ropes courses) is one contributing factor, but a small one. If you want to build your team, stop thinking about an event or activity and instead think about a process that will help move the group toward effectiveness. I prefer to look at the process in three phases.

Phase One: Vision

People are great at recognizing and complaining about teamwork problems. They know what they don’t want, and will talk unproductively about it to anyone who will listen. When I’m at home complaining to my wife about something I don’t want, she turns my thinking around with a question such as, “Tom, I know what you don’t want. So what is it that you do want?”

The first phase is about changing the group’s focus from complaints to the creation of a positive team vision. Over the years I’ve used a wide variety of exercises to help groups create this vision. Regardless of the approach, the important thing is that in the end the group has something to rally around, a common vision that all members want to achieve.

Phase Two: The Plan

If phase one is successful, the team should be excited about its vision and energized to bring it to life. The challenge is that reality is often a long ways from the vision. That’s okay. Think of the vision as the team’s long-term goal. It’s not going to be achieved easily or quickly. You want the group to start moving towards it. The question to help do this is, “What must we do to move towards our vision?”

Instead of a debilitating focus on all the problems, planning should be an energizing process of identifying and prioritizing goals, developing essential projects/initiatives, and solving the puzzle of how to get it all done.

The secret to creating a good plan is to not bite off too much at once. Pick just one or two goals that will make a noticeable difference and work on them. Once they are accomplished, move to another.

Phase Three: Accountability

Once the plan is in place, the group needs to act. This means individuals need to do what they said they were going to do. This is where the whole process typically falls apart. People don’t keep their commitments, and nobody does anything about it.

You can increase the chances for success in this phase by making sure your planning includes answering the question, “How will we make sure this works?” There are many strategies that can help. Here are some that I think ought to be used in most team building processes:

1. A measuring and monitoring system for all work.
2. Regular check-ins with all team members.
3. A system of rewards and recognition for progress on the plan.
4. The willingness to confront people who aren’t following-through on their commitments.

Build Your Team

Team building isn’t an activity. It’s a process that takes time and persistence. It’s about having an inspiring vision, a workable plan, and the systems and willingness to hold all parties accountable for keeping their promises. The goal isn’t happiness. It’s effectiveness. Is your team ready for team building? If you want to discuss the possibilities, contact us to help.

When chaos reigns and stress levels are high, it’s your job as leader to help your team stay calm and focused. This is easy to say and hard to do. You are in a unique position to help them. Here are some possible approaches for helping folks relax.

You might try putting up cheerful posters that encourage calmness. You could come down hard on people who seem to be in the worst melt down mode and tell them to chill or suffer the consequences. How about this one? Tell people that they are just darn lucky to have a job in this economy so they better buck up.

That should take care of ideas that won’t work. Now let’s look at strategies that might move things in a more positive direction.

• Increase your level of communication. A rapidly changing environment is often present when stress levels are high. The connection is that change means uncertainty and uncertainty breeds fear. The best thing you can do is to stay in the loop about the questions and rumors that are circulating among your staff and make sure you are filling in the gaps with what you know to be the facts.
• Focus your group on the most important goals. Help people get out of worry mode by keeping what’s most important front and center. While there’s plenty of change swirling in the background, the reason you are all there is to provide the best possible patient care. Talk about this. Remind your team about it. Reward people who are doing it.
• Act on that which you control. There are some things within your team’s control and plenty of things that are not. Talking about and worrying about those which are outside of your influence is a waste of time. Make that case in a gentle and respectful way. People almost always know this to be the truth, but need to be reminded of it in times of crisis.
• Set the example. Yes I know that bosses are human beings too. And that means you have the same emotional responses to the turmoil that your staff members have. That’s fine. Experience the feelings and then figure out what you need in order to provide the kind of example you want your team to see.

You very well may be operating in stormy seas right now. Your team is counting on you to calm the waters to the extent you are able. Don’t let them down.

Photo by ingridtaylar