Highland Leadership Chronicles: On Team Resilience

Like many hospitalist teams across the country, the #Highland hospitalist team was one of the more diverse groups within the hospital community. The team has had “representation” from all continents at some point; either as a full-time hospitalist or locum tenens provider if one was to appraise diversity just from the lens of geographic origin. One can readily imagine the potential challenge of “keeping it together” with such a diverse group of individuals, all well accomplished. What I met when I joined the team in July 2018 was a very cohesive team that already had a strong culture! And I quickly learned why – there was Linchpin! A remarkable informal leader on the team that was deeply invested in every member of the team, the team operations as well as the hospital community. If you are at #Highland or have ever interacted with the team in some capacity, you know exactly who I am talking about! Little did I know that I was about to embark on a journey of “learning by doing” and the key role of a “Linchpin” on team performance and especially team resilience when crisis hits! ??????

In their Harvard Business Review article, “The 4 things Resilient Teams Do”, Kirkman et al. (2019) discussed the differentiating factors that their research underscored among resilient teams as follows:

1.????They believe they can effectively complete tasks together.

2.????They share a common mental model of teamwork.

3.????They are able to improvise.

4.????They trust one another and feel safe.

The #Highland team with all its imperfections like many teams, did live up to these 4 precepts in my humble estimation as I share below. ?

The team effectively functioned as a single unit! From the daytime rounding team taking over admissions left overnight seamlessly when the night team is not able to get to a number of patients when overwhelmed by the intermittent explosion of night time patient numbers – a?rather frequent occurrence in the COVID-19 surge era – to taking care of patients on behalf of colleagues to allow them to attend to recurring personal obligations that foster work-life integration and personal resilience and importantly, #LeadingFromWithin when the situation demanded, knowing that everyone was acting in the best interest of the team including non-physician colleagues, patients and their families.

Kirkman et al. (2019) wrote about the idea of a common mental model; “All team members must be on the same page about their roles, responsibilities, and the ways they interact with one another during adversity. This is their mental model of teamwork, and it helps them coordinate effectively, predict one another’s behavior, and make decisions collectively on the fly. These mental models have to be both accurate?(Are we doing the right thing at the right time?) and shared (Do we all agree on what we’re supposed to do?) in order to be effective.”

Decisions taken at the monthly hospitalist team meetings, as well as on-the-go, in response to an unfolding crisis and the subsequent team response and follow through reflect the team operating from a shared mental model of teamwork. Patient volumes and optimal staffing were a major challenge of the COVID-19 surge era experienced by many similar hospital medicine programs across the country. Not infrequently, my team had to promptly reorganize its workflows to accommodate changes to patient volume situations while additionally leveraging relationships across the local provider network to optimize staffing for patient volumes with leadership support to remain effective through a challenging pandemic…And often, my team responded with grace against all odds!

Constant communication and the presence of an effective linchpin with significant social capital within the team and the larger hospital and local community were key stabilizing factors for this shared mental model of teamwork for the #Highland team.

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Improvisation and team agility in response to constant change and crisis is a direct fallout of the common mental model for the #Highland team. The team enjoys free flow of information fostered by high levels of trust and low political stakes which in turn sets the tone for proactive sharing of ideas that helped the whole team navigate uncertainty.

Prior to the COVID-19, my inexperienced self, had been “lured” to experiment with different rounding models as we worked together to manage a difficult staffing hiatus with growing patient numbers. These experiments were, in fact, great preparation for what was to come – COVID-19 – and the degree of improvisation and agility that we would need to manage the ambiguity and to survive those very challenging early days of the COVID-19 Pandemic!

This, in turn, encouraged experimenting with different approaches to optimizing internal workflows that leveraged the strengths of different members of the team to augment internal workflows specifically with regards to the clinician rounding model and patient cross coverage. ?These shared experiences as a team had turned the #Highland team to what Mannucci et al. (2021) described as “capable improvisers!” in their HBR article, “Improvisation Takes Practice”. We had, in essence, #LearnedByDoing, at least to some degree, the “Improv Skills” that have their origins in theatre but have found significant applicability in social and professional spaces. The Pandemic area with unprecedented uncertainty and full-on crises mode for most, if not, all of us. ?

Kirkman et al. (2019) wrote aptly that: “Teams must be able to improvise and develop new ideas or ways of handling adversity. Improvisation is really about the deliberate process of adjusting to changing circumstances in real time. To do so effectively, teams need to be able to access existing knowledge from past experiences and creatively reconfigure it to develop new and novel ideas when facing a setback. Resilient teams are intimately familiar with one another’s knowledge, skills, and abilities so that they can draw upon the right expertise at just the right time”

The #Highland team is fortunate to have a team of providers with very diverse backgrounds and hospital medicine practice history with an equally rich professional network, the sum total of which feeds into the team’s ability to improvise and the courage to experiment with different approaches during challenging situations.

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The last factor described by Kirkman et al. (2019) was Trust! I like the term “vulnerability-based trust” as explained by Patrick Lencioni in his book, “The Five Dysfunctions of a Team”. The idea is simple – for the team to function at a high level, vulnerability modeled by leaders and established team members is key to fostering a culture of psychological safety that provides a strong foundation for the free flow ideas in a non-judgmental manner. I was challenged on many occasions to be vulnerable – not necessarily my default style outside of my closed circles but I learnt from some of the best people around me and many mentors, the immense value of this practice of vulnerability even outside of the obvious boundaries. One incident stands out for me; I lost a dear friend in the middle of the COVID-19 pandemic and was distraught by the many challenges surrounding the unique situation of my friend’s family. My own vulnerability with my team around the scenario and how it impacted many aspects of my day-to-day business of seeing patients and leading on the front lines was welcomed with much support from my team as is the prevailing culture. It helped my recover much faster, and it reminded me of the value of connections that we make as colleagues, especially on teams with high stakes missions as pertains in healthcare settings, and how much it builds overall team resilience.

Of all the 4 characteristics discussed by Kirkman et al. (2019), the “trust” factor I believe is a non-negotiable ingredient and the foundational precept for a culture of resilience on teams.

References

1.????Kirkman, B. et al. (2019) “The 4 things Resilient Teams Do,” Harvard Business Review, 19 July. Available at: https://hbr.org/2019/07/the-4-things-resilient-teams-do.

2.????Lencioni, P. (2005) “Understanding and Overcoming the Five Dysfunctions,” in The Five Dysfunctions of a Team: A leadership fable. San Francisco, CA: Jossey-Bass A Wiley Imprint, pp. 195–201.

3.????Pasulka, A. (2022) Everything You Need to Know About Improv, www.backstage.com. Backstage. Available at: https://www.backstage.com/magazine/article/everything-know-improv-3218/ ?

4.????Schwabel, D. (2017) “Brené Brown: Why Human Connection Will Bring Us Closer Together,” Forbes.com, 12 September. Available at: https://www.forbes.com/sites/danschawbel/2017/09/12/brene-brown-why-human-connection-will-bring-us-closer-together/?sh=3ed600242f06

5.????Vittorio Mannucci, P., Orazi, D.C. and de Valck, K. (2021) Improvisation takes practice, Harvard Business Review. Harvard Business Publishing. Available at: https://hbr.org/2021/03/improvisation-takes-practice?