Essential Skills for Managing in Healthcare

Andrew Price, Andrew Scowcroft

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315357355
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Health professionals often take on managerial roles at short notice and with little or no preparation. Although they may be highly clinically qualified and accomplished, the practicalities and relationships involved in management - helping staff to feel motivated and valued, building and leading teams, managing meetings and presentations, writing reports and managing change, to name but a few - present new challenges and pitfalls for which they are unprepared. This book is for managers and prospective managers who want to approach their new responsibilities professionally from the very beginning. Based on the authors' successful "Vital Signs" education programme, it identifies the critical skills needed to hit the ground running as a manager. It is an accessible, easily comprehensible guide to gaining the self-confidence and the respect of staff, and to creating a steady platform for acquiring and mastering a wide range of skills in the future. 'This book is dedicated to helping leaders and managers prepare for people responsibilities. It also addresses three areas which usually make leaders and managers uncomfortable - running meetings successfully, making presentations and writing reports. [It] gives accessible and practical examples and I have no hesitation in commending it to a wide readership.' - From the Foreword by John Edmonstone

PART 1

Dealing with people

CHAPTER 1

Dealing with people

TEAMS: THEY ARE CENTRAL TO OUR EXPERIENCE OF WORK BUT SO LITTLE UNDERSTOOD

The existence of any organisation of a size greater than one person is proof of our persistent belief that we can achieve more by working together than we can on our own. Michael West from Aston University points out that it is our ability to work cooperatively that has enabled humans to make such remarkable progress, and that our extraordinary achievements in science or exploration have been largely made by teams.¹ Teams have conquered Everest, mapped the human genome and produced the Authorised version of the Bible. Teams have put men on the moon and split the atom. But despite all the evidence of the creative potential of teams, we keep finding organisations who begrudge the time and effort needed to develop them. In this chapter we’ll underline the importance of teams, set out the foundations of effective teamwork and look at the different ways people contribute to team success. At the end of the chapter we’ll give you a simple framework to use in reviewing your team.

HOW DO TEAMS AFFECT US?

We’ve often asked people about their experiences in teams.

‘Think of the worst teams you’ve been in,’ we say, ‘and tell us what characterised them and what impact they had on you.’ Regardless of their profession or organisation, people tend to say the same things. The worst teams they’ve been in were characterised by:

➤ poor communication

➤ unclear roles

➤ unhappiness and even bullying

➤ members ‘watching their back’

➤ cliques and politics

➤ poor leadership – either oppressive or non-existent.

People in these teams:

➤ dreaded going into work

➤ experienced fear, sickness and stress

➤ wanted to leave the organisation

➤ did just enough to get by.

THE LEGACY OF TEAMS

When we ask people about their experiences in teams we are often taken aback by the stories we are told of victimisation, humiliation and conflict, often involving senior professional staff, and by how long the memories of such experiences persist. Although many years may have passed, anger or resentment about being part of a dysfunctional team is not far below the surface and, therefore, liable to still influence the way such people currently behave in teams. We have also often noticed a change in the mood of these groups when they think about their best teams. Body language and the tone of the discussion reflect pleasure or excitement. The legacy of teams is, for good or ill, very long-lived.

We then ask people to think of the characteristics of the best teams they have been in, and what impact these teams had on them and their work. Again, people tend to say the same sorts of things. Good teams:

➤ work towards a common purpose

➤ give every member a part to play

➤ work flexibly

➤ have a sense of identity.

The impact of these teams on their members was, not surprisingly, very positive. They tended to experience:

➤ enjoyment

➤ a sense of achievement

➤ high levels of commitment

➤ support from other team members

➤ less stress and sick leave.

The comments made by the groups we have worked with are echoed in research into teams. It seems we have the very best and very worst of our work experience in team settings.

THE INVISIBLE LEADER

We’ve noticed that people seem to mention leadership more often when they are talking about bad teams than when they are talking about good teams. When describing poor teams they often identify defective leadership as a cause, but when they describe their best teams they tend to talk about things that are the results of good leadership – purpose, role clarity, flexibility – rather than about leadership itself. It reminds us of the saying attributed to Lao Tzu (600–531BC): ‘A leader is best when people barely know he exists, when his work is done, his aim fulfilled, they will say: we did it ourselves.’

GOOD TEAMS: JUST A BONUS?

But does any of this really matter? If people feel fear, stress and confusion, or alternatively a sense of purpose and commitment, does this significantly affect their work? If the answer is no, hard-pressed bosses might be forgiven for neglecting the development of their teams. But if the answer is yes, we should make a conscious effort to create and maintain good teams.

So let’s consider the evidence. First subjectively. Imagine you visit two hospital departments as a patient. In one the staff seem happy, purposeful and flexible. In the other they seem stressed and defensive. Assuming that each department is staffed by fully qualified professionals, in which department would you expect to receive the better care?

Second, an example from recent history. In 1998 the Government set up an inquiry into children’s heart surgery at the Bristol Royal Infirmary. Public concern about the deaths of children followed by disciplinary action against several medical staff indicated that something had gone wrong. The inquiry was chaired by Professor Ian Kennedy and considered evidence from nearly 600 witnesses. The report of the inquiry included the following observation:

There was poor teamwork and this had implications for performance and outcome. The crucial importance of effective teamwork in this complex area of surgery was very widely recognized. Effective teamwork did not always exist at the BRI. There were logistical reasons for this: for example the cardiologists could not be everywhere. The point is that everyone just carried on.²

So, while other factors were involved, poor teamwork had influenced the standard of care given to children. What is more, despite widespread recognition of the importance of teamwork ‘everyone just carried on’. The cost of this unwillingness to tackle poor teamwork was high.

Again, in 2010, another inquiry into the deaths of babies following heart surgery, this time at the Oxford Radcliffe NHS Trust, found that the lack of teamwork between the surgeons adversely affected the work of the unit.⁶

Finally, research with 400 teams and 7000 staff in the NHS showed that the benefits of effective teams include higher-quality care, more innovations and lower levels of stress among team members. The research also highlighted a significant statistical relationship between the percentage of hospital staff working in effective teams and patient mortality.³

So it seems that not only are effective teams healthier, more enjoyable contexts to work in, they are also more productive and innovative, contributing to higher quality services.

TEAMS AND GROUPS

There is a tendency in organisations to call any grouping of staff a team. This can lead to confusion and even conflict as the ‘team’ searches for a purpose and function to justify its existence. We find it is helpful to distinguish between groups and teams. The main difference is that members of teams have to work together closely and supportively to achieve a shared goal. For some purposes, a group is the best solution. For many years a number of training managers from separate health organisations used to meet together. Functioning as a group – exchanging information and enabling smaller interest groups to form – the gatherings worked well. But when some members tried to make the group behave like a team and establish a unique shared purpose and collaborative working, it became apparent that something artificial was being created. Most group members, whose first loyalty was to their organisation, resisted being tied into a team. Moreover there was no clear team task. The result was misunderstanding and ill feeling.

BUILDING A GOOD TEAM: YOUR MOST IMPORTANT TASK

There is plenty of evidence that the quality of teamwork is a major influence on the service an organisation provides. On top of this, being in a good team makes us less stressed, more innovative and more committed. For all these reasons we believe that developing an effective team is perhaps the most important task of any manager. But if this is true, why are there so many ineffective teams and why, like at the Bristol Royal Infirmary, when teamwork is poor, do we just carry on? It is as if we see being in a well-managed team as a bonus or an act of God, whereas we should see it as a basic right of every employee.

REASONS FOR INEFFECTIVE TEAMS

1 Great teams don’t happen by accident.

Effective teams don’t just happen, they have to be shaped and developed. Even where you have a group of committed, flexible and competent people, you will still have to put thought and effort into developing a team.

2 Building teams is simple … but not easy.

The elements of successful team leadership are not complicated or extremely intellectually challenging. You do not need to be a genius to master what causes teams to flourish and what makes them flounder. But you do need character. You will need to persevere in the face of misunderstanding or opposition. No wonder many managers prefer to focus on the technical parts of their job because they are less demanding. We suspect that when managers claim to be too busy to develop their team, it is often a justification for avoiding issues that demand character as well as skill.

3 Delayed impact.

It seems that the closer an action is to its consequences, the easier it is to learn from that action. Touching something hot is immediately painful so we learn not to do it. The impact of either developing or ignoring your team is less immediate. There is no instant and obvious ‘bottom-line’ result of carrying out a good appraisal, clarifying team roles or agreeing objectives, so it is tempting to neglect team development for more pressing but in the end less-important tasks.

THE FOUNDATIONS OF EFFECTIVE TEAMWORK

Regardless of what sector you work in or what type of staff make up the team, we suggest that there are five foundations for effective working that all teams need.

1 Purpose: clear, shared and worthwhile.

Teams must have a common purpose. This should explain the reason for the existence of the team and it should be something worth working towards. However, we have learned never to assume that teams are clear about their purpose. In one team we worked with, our question about purpose was greeted with amusement if not derision: ‘We’re the top management team. Its obvious what we do!’ As we interviewed the members though, we found a variety of ideas about team purpose. For some the team’s role was to focus on the big picture and give overall vision and direction for the organisation. Others insisted that their role was to be the operational decision-making hub of the company. Both were valid purposes, but as we watched the team we could see how differing ideas about their purpose pulled the agenda in different directions, leaving all the members frustrated.

Teams often confuse their purpose with their day-to-day activity but there is an important difference; activity is what you do, purpose is why you do it. Having a clear shared purpose enables each team member to see their role in the context of something greater than themselves. For example, take two clerical staff working in a hospital. One has simply been asked to collect certain pieces of information from medical records and send them to someone else. The other has exactly the same task, but understands their role to be part of a team who are studying different ways of treating a particular illness so that patients can be treated more safely and more effectively. While the task is identical, one sees the greater purpose and understands why it is important to have accurate and timely information. For the other it is simply a chore, with no sense of rhyme or reason. Which one is likely to do a better job?

We suggest two ways of getting to the real purpose of your team. First, think about what you do and then ask yourself why you do it. If your team runs a clinic, why does that clinic exist? Your first answer might be ‘to treat patients’. If so, keep asking why. What does that treatment enable? A team who provided mobility aids to patients realised that their purpose was not to provide wheelchairs or electric scooters but to enable their patients to live full and unrestricted lives. This is a good example of purpose because it is clear, motivational and, importantly, hard to achieve. The other way to get to your purpose is to ask yourself what bad things would happen if your team and the service it provides did not exist. What impact on people would this have?

Distinguishing purpose from activity is so important. Not only does it motivate the team and guide decisions but, it also helps it to innovate and change, to seize new opportunities. The mobility-aids team we mentioned above are more li...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• About the authors
• Acknowledgements
• Introduction
• Part 1: Dealing with people
• Part 2: Management disciplines
• Selected reading list
• Index