Talk is cheap, especially when it comes to teamwork

January 27, 2015 | Posted in Healthcare, Medical Staff, NorthGauge



My years of senior hospital leadership and providing expert physician peer review services to hospitals in every state have helped me to appreciate the astonishing complexity that constantly permeates the lives of healthcare leaders.  There’s not much about it that’s easy; there aren’t many simple problems to solve.  How do we do it?  Not very well, in my opinion.  The evidence speaks for itself.  But my criticism isn’t so much driven by comparing our healthcare to that of other countries, by considering the astronomical costs, by appreciating our unbelievable complication and infection rates, or even by the growing disgust and dissatisfaction among physicians over their chosen profession—you know, the stuff that’s in our faces every day.  I see those more as symptoms than causes.  My criticism is driven largely by how inept we are at working as teams.  The impact of the all too common team failures is devastating.

In his book One Last Strike, Hall of Fame manager Tony La Russa makes it very clear that his primary strategy is to ensure that players, ownership, management and coaches all feel the support of everyone else.  They are more than just another team.  They exude teamwork and benefit from it.  They help each other.  They look out for each other.  They are open and honest in their communication.  They realize that they rise and fall together and that weak links have to be overcome.  No one survives on the team by riding everyone else’s coat tails.  Leadership gets the most out of the team by ensuring maximum contribution to the team by each player.  They teach and lead teamwork.  Yet, astonishingly, when I share my perspective about the lack of teamwork in our hospitals with healthcare leaders around the country, I receive a common response: Caregivers upon whom our patients depend are actually trained to not be team players.  Yes, our patients need well trained, competent individuals.  But more than anything, they need a great team.

In hospitals, we speak a good game, but we don’t play one.  It’s no wonder.  How prevalent is team training in medical school and other the clinical training programs that produce the team members upon whom the patients depend?  How often do we see the word “teamwork” in mission statements with no real, sustained team training or focus on how effective the team is functioning?  How often do we hire money generating physicians without much care about how they might lead or at least contribute to the team?

What’s the cost of our failure?  Lapses in communication; poor service; distraction due to conflict and bruised egos; burn out; complacency; conflict; fear; problem solving efforts that don’t get to the root of the problem; use of quality tools (like peer review) as weapons rather than for the great value they should bring; the right hand often not knowing what the left hand is doing.  The list goes on.  As a result we provide suboptimal care—often with disastrous consequences—while increasing the cost of care.  We too often hurt each other, and worse, in the process, we harm our patients.

Is there hope?  Maybe.  I hate to say it, but our hope rests in leadership’s response to government’s and payers’ carrot and stick incentives.  I applaud new initiatives that demand we work together to improve population health, that hold providers accountable for failure and that reward success.  Might the new financial incentives drive our leaders to realize that we can’t just hire team members without building effective teams and making team skills training an integral part of our organization?  Here’s my fear:  The changes needed take a major shift in paradigm.  We need time and money to bring about the necessary change, yet our provider organizations and legislators are driven towards short term success—this year’s profits and election returns.

It’s a major problem.  Many of our organizations are trying to run when they haven’t yet learned to tie their shoes (or wash their hands).  They will trip and fall unless they come to appreciate what our most successful corporations and sports teams have known for years.  It’s worth the time, money and effort.  It always has been.  The shift toward team education, beginning within our training programs and carried throughout our organizations will come.  I am hopeful!  But why is it that here in America, in 2014, it takes carrots and sticks?

– Jon Moses, President & CEO