Building the perfect beast

Last week while I was off on Amalia’s Spring 2015 North American Tour, one of the highlights was moderating a breakfast session at the American Burn Association with the theme of “Building a high-functioning team in stressful environments.” We had a great group in attendance with diverse areas of practice in the Burn Team, with lots of wonderful ideas contributed from varied practices. I was fortunate as well to have a highly experienced nurse manager and a seasoned social worker (both of whom are already friends of mine) who helped me to re-direct the conversation during those inevitable moments when it was digressing. You know, human factors fallibility and all…

To prepare for the session, I did a bit of homework, trying to find key points and common themes in the business literature about developing high-functioning teams. Characteristics that are identified in many studies include the following:

  • Common purpose- For the burn team, this is built into why we show up to work every day.  We want to improve the lives of burn patients and their families.  Fin.
  • Clear roles- Who’s on first?  Again, within the burn team, this hopefully comes with the territory.  I’m a terrible bedside nurse and an amateur mental health provider, but I like to believe I’m a good surgeon and physician.  Airing our own dirty laundry, roles have been an issue as we try to move towards a two-attending system in our Unit; we’ve had many questions about who nurses should actually take questions to, and this is understandable for a developing system (and something we are actively working on).
  • Accepted leadership- Lots of subtleties to this one- it’s not just the “who is in charge” issue I take about above, but extends to the leader being perceived as effective by the team members. That trust takes time to build and isn’t guaranteed.  As a leader, there are plenty of things you can do to enhance that trust-building process and to move towards being an accepted leader, but that’s a blog post for another day (and, honestly, it’s a lot of hard work…so be ready!)
  • Effective processes- What I love here is that it’s not just about knowing what works and how to get there from here- it’s also about the constant reassessment of how we are doing things and if we have room for improvement.  If there’s one area in my clinical life I tend to lose sleep over, it’s how we can do things better.  It’s part of our unit culture, and it’s part of why we’re just under a month shy of going 600 days without a CLABSI- we figured out how to do it better!
  • Solid relationships- You don’t have to be BFFs with everyone on the team.  In fact, it might be better if you’re not.  Words that came up frequently in our breakfast discussion included “respect,” “trust,” and “reliability.”  It is entirely possible to respect someone but not be friends with them.  Without respect, though?  Dead in the water.
  • Excellent communication- Again, this was a recurrent theme in our discussion, with an emphasis on the two-way nature of communication between the team and the leader, and the importance of leaders (physicians, in this case) being receptive to communication.  If you question the importance of communication, this 2012 HBR piece shows that the single most predictive factor in team success is communication.  Remember: energy, engagement, exploration are the keys to communication success
    • One of my favorite tricks that I learned from a very wise surgeon (aka Jeffrey R. Saffle, my retired practice partner) is to partake of “bedtime phone rounds” at 10 pm each night with the ICU nurses.  If they have little stuff going on, they’ll hang on to it until you call.  It helps to ward off many things during the night.  And it reinforces that you are there for them and the patient.  

Are there other characteristics that you’ve seen in your work environment that have contributed to an incredibly successful team?  And how sensitive are you to when one of the “secret sauce” ingredients is missing?

More on effective leadership soon…perhaps in a couple of weeks.  I have other ideas stored up from my adventures!