February 12, 2018

Developing a “culture of safety” as a cornerstone of healthcare delivery, including anesthesia care, depends on a commitment from leadership, a climate of trust that stresses learning over blaming—and teamwork to produce results.  As anesthesia providers know, an anesthesia department needs to be a cooperative and collaborative player with other disciplines across the hospital, surgery center or health system in driving the efficiency, quality, safety and cost effectiveness of patient care, including operating room services.  As a major member of the team that makes up the hospital system as a whole, anesthesia departments are finding it increasingly important to work effectively with other departments, disciplines and individuals.

Jeffrey S. Vender, MD, MBA, of North Shore Health System and the University of Chicago’s Pritzker School of Medicine, focused on the role of teams and teamwork in a culture of safety at the American Society of Anesthesiologists’ PRACTICE MANAGEMENT™ 2018 in New Orleans, including high-performing teams in highly reliable organizations.

A group is not necessarily a team, he said.  To function as teams, groups need a culture of collaboration and transparent, closely monitored metrics in which conflict (freedom to speak up and question the status quo) is encouraged and individual members feel empowered to be leaders.

Teams need a common purpose (The Why), shared performance goals, and a common approach to which members hold themselves (not others) accountable.  “We often form teams by title, position, relationships,” Dr. Vender said.  Instead, groups need to consider the mix of skills and traits needed to accomplish the task, whether a person is a good fit for the team, and removing someone who is not a good fit.

Effective team members communicate with one another, share openly, treat each other with respect and listen well.  “We confuse teams of stars with all-star teams,” he added, referring to the defeat of the Dream Team in 1992 by the Collegians, after which Scottie Pippen remarked, “We didn’t know how to play with each other.”

“Stars usually don’t matter if they’re not part of the team,” Dr. Vender said.  “Often, we get people who don’t fit, and then we don’t fix it.  We just have to find the right spot on the team for the skillset that person brings to our department.”

Multidisciplinary teams, common in healthcare, can falter when members bring the different priorities and perspectives of their specialties to the table but lack a shared vision and goals.  For example, a hospice doctor might be focused on palliative care, while an oncologist is focused on a cure regarding the same patient.

Interdisciplinary teams, by contrast, integrate disciplines and work together around a single shared goal, such as a consultation in which all members participate with the patient’s intimate involvement. Dr. Vender cited the historic teamwork of hundreds of Mission Control personnel in guiding the Apollo 13 back to Earth as the pinnacle of this model.

High-performing teams are formed primarily in high-reliability organizations to address specific, critical problems.  Studies show these teams should be small—optimally 6-10 people.  With larger groups, “you can share information, but communication can be difficult,” Dr. Vender said.  Members should have a diverse range of complementary rather than redundant skillsets, and the team should have clear rules and expectations.

A high-performing team typically goes through a four-stage evolution of forming (getting to know each other and forming a commitment to the team), storming (challenging the leader and each other), norming (starting to work together) and performing (moving toward shared goals).  “It’s not an overnight phenomenon.  You’ve got to go through a process,” he said.  Unlike work groups, in which members pursue paths independently, high-performing teams can become multiplying rather than additive because members work together and share in the outcomes.

Other traits of high-performing teams include:

• An aligned vision.  Members understand “the why” of what they are doing.
• Interchangeable skills.  “If someone falls back, somebody else is there.  They know what everyone’s job is,” Dr. Vender explained.
• Achievable goals and metrics that they measure themselves against.  “They don’t sit around and say ‘we’re the best,’” he said.
• Participative leadership in which all members are free to speak up.
• A culture that is transparent, positive and built on trust.  “If you don’t trust somebody on a team, you don’t have a team,” he said.  “You’ve got to be able to fall backwards into somebody’s arms and have that level of confidence that they’ll have your back.”

High-performing teams encourage rather than blame, focus on getting the job done rather than theorizing, and avoid micromanaging and overriding decisions.  And they have a preoccupation with failure.  “You can’t overlook little mistakes,” he said.  “If we overlook those things, bigger things will happen.”

For effective teams of any kind, “the secret sauce is a culture of collaboration with great leadership,” Dr. Vender said.  “Even in great teams, success is never guaranteed, and there’s often failure. But they rebound.”

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With best wishes,

Tony Mira
President and CEO