Accelerate frequently chronicles the hard work of building and nurturing teams because we believe that real teams are the antidote to the chaos of modern medicine (in the words of Dr. Tom Lee). Here, we highlight a necessary ingredient of high-performing teams: compelling vision.
What's Your Compelling Vision?
Delivering and improving care in multidisciplinary (or interprofessional) teams is better for providers and patients, but working in a team doesn’t always feel easy. Goals, personalities, behavior—it can feel challenging to understand what makes a team successful. It turns out that only a few factors largely impact whether a team is successful. Organizational psychologists call these “enabling conditions.” We’re highlighting one enabling condition today—compelling vision. Researchers tells us that “the foundation of every great team is a direction that energizes, orients, and engages its members.” We highlight three compelling visions from Utah’s own improvement teams.
“The patients deserve it.”—Devin Horton, MD
Horton: The patients deserve it. We’re talking about patients with severe sepsis whose cells are dying. One hour, or three hours, is not too much to expect from a system. That first day, when we saw the system could coalesce and respond within an hour, it was like, “See—it can be done.” It was a relief. If you wanted to call something perfect, this was perfect sepsis care...
Graves: Then we went to other floors, we would talk about a case that didn’t go well. Then we would talk about our protocol, and we would talk about our first patient, and say “we’d like to do this for everyone.” Being able to show that we had done it was really powerful motivation to do it again.
Morris: I realized that a surgeon can’t do this (take care of burns), a nurse can’t do this, a social worker can’t do this, a psychologist can’t do this, a mother or father can’t do this; this is something that can be done by all of us together. The whole is much greater than the parts.
“I am surrounded by geniuses.”—Rob Kistler
Rob Kistler leads nearly 1000 people as the senior director of support services, and motivates his team by asking for their perspective.
Kistler: At some point, I realized that there were really smart people around me, and if I could figure out how to leverage their intelligence we could accomplish great things...I am always telling my team “I know there is a million dollar idea out there, who has it? Somebody tell me your best idea. If you aren’t willing to say it right now, then I need you to tell me later.” I know I am surrounded by geniuses.
Trust is important. We know that our custodians are great and ask for their opinions often. We discuss data points in every staff meeting because to be most effective they must understand and connect how we measure the excellence of their work. Custodians are valuable. When we’ve implemented their strategies, our performance has always improved.
Orthopaedics director Ryan VanderWerff led Utah’s first bundled payment by engaging his team to develop a new process.
VanderWerff: I have to credit our great relationship—we have such a good relationship—with our frontline staff. Our nurses know they can speak their minds. That’s what I value about our culture here. They can even speak their minds to the physicians. The medical assistants and nurses have no problems telling us where the flaws are in our thinking and our approach…we developed this system, they were right there with us on the frontlines as we developed this. So we didn’t ever build a system first and then ask, they were part of the build throughout entire process. Not in every single meeting, but operational decisions were not made without them.
“Requires coaching and trust.”—Lawrence Marsco, MSN, OCN, RN
Lawrence Marsco is the nursing clinical operations director at Huntsman Cancer Hospital. He leads by sharing decision-making with staff.
Marsco: In shared governance, the manager’s role shifts from managing to leading the team. Shared governance means having confidence that the staff are experts in the daily operation of the unit. It means providing them with responsibility and ownership of the unit. This is not easy. It’s hard work and requires coaching and trust, but it’s the right thing to do. I’ve empowered my clinical practice council and the rewards have been amazing.
Stein/Neihart: Stein and Neihart, both proponents of the power of appreciation, encouraged the team with positive feedback. But the glow of success was accompanied by daily problems. The team embraced real-time problem solving, making smaller adjustments all along. The team came up with new ideas. “It was fun. We could see it working. What made it fun was understanding the challenge and meeting it. It ended up being easier than we had thought.”