Bringing Value:  Build a Functional Leadership Team

Putting together an effective team of physicians can be a challenge for any physician leader, but using the right rules and tools to create the right mix of participants can be highly rewarding.

The ability to build and sustain a well-functioning physician leadership team is a key attribute of a successful physician leader. A physician leader cannot know all the information needed to manage all processes, nor can the physician leader perform all the necessary operational tasks alone. Building a successful leadership team to help carry the load is an essential first step in the career of a new physician leader. Successful health care organizations — such as Mayo Clinic and Cleveland Clinic — rely upon physician-led teams at many levels.

As the health care industry continues to change rapidly, becoming more unstable and dynamic, meeting the challenge of creating a highly reliable, patient-centered organization requires processes and tools that allow physician leaders to drive the organization forward. Physician leaders should consider physician-led teams as one of the most important tools in their management kit. Organizations that have a strong emphasis on teams have high reliability.1

Building strong physician-led teams begins with a recruiting process that selects members who are well-trained, have a positive attitude and are enterprise-oriented. This means bringing into the organization physicians who are not only scientifically and clinically superior, but also have constructive attitudes toward team interaction.2

The primary type of physician-led team is your management team, which might consist of four to six physicians who hold key leadership positions in the organization and report directly to you. The second type is a committee chaired by a physician with physician members. The third type is a team formed to address specific process or technical challenges. Different teams will challenge you in different ways because of their unique purposes.

When you consider putting together a physician-led team, remember that physician teams are no different from any other management or clinical team. For the team members to work effectively together, they must have the specific knowledge, skills and attitudes necessary to accomplish the assigned task.3 The job of a physician leader is to understand his/her constituency and effectively assign physicians to specific projects. If members of the team do not have the specific knowledge or skills for a given project or responsibility, additional training might be required.4

However, for a team to function in a sustainable, constructive way, each team member not only must have the necessary knowledge, skills and attitudes, but also share the same commitment to the assigned task, anticipate the needs of the others, and have a shared understanding of the project.2 Sometimes, physicians enter a team environment with some bias or personal agenda that can disrupt team harmony. Physician leaders should be attentive to such a possibility and rectify these issues before the team begins its work.

Picking Properly

How do you go about assembling an effective physician team? The first step, after understanding the required knowledge, skills and attitudes needed for the team, is to measure the competencies of each of the selected team members. We suggest tabulating the desired competencies for individual physicians. Rank each competency for each physician on a scale of zero, 1, 3 and 9. Such a scale will mathematically spread the final result so that small differences will become more evident. You should then be able to comfortably select the top physicians to become team members.

For teams where voting might occur, selecting an odd number of team members will help reduce tied votes and allow the team process to move more quickly.5 In addition, keeping the team size to a manageable number will make it more efficient. If the team desires additional individuals to be contributors because of their specialized knowledge or experience, the team leader may bring these individuals in as subject-matter experts (SMEs) without voting rights. Once they have contributed to a project, they should be dismissed.

Once a physician team is appointed, time should be allocated for team training, which is important for enhancing team performance.4 Many institutions, for example, after appointing new members to the medical executive committee, take the group on a weekend retreat for training. However, annual training is just the beginning. Consider setting up a year-round development program that continually enhances the skill set of your physician leadership team.

A useful way to think about your team is through the lens of the airline industry, which has used crew resource management (CRM) to train cabin crews and promote safety. CRM improves communication skills, coordination and decision-making among the team members, but it also enhances error-management skills — essential for any physician management team.6

Emotional Intelligence

Physician leaders must understand the emotional intelligence of their teams. Like individuals, teams operate with emotional intelligence, and if the team is in harmony, then the power and impact of the team decision-making process will be greater than any one individual on the team can contribute.7

As you embark on developing the physician management team, consider the following as the three most important competencies8 for each team member:

• A commitment to working collaboratively.

• A commitment to high-quality outcomes.

• A commitment to the organization.

Physician team members transitioning from clinical practice to management might find the transition difficult because it requires a significant mental shift: from commitment to individual patients to commitment to the organization and the community as a whole. This can create additional stresses on an individual physician and should be considered as you form your team.

Another issue that must be considered in the early development of your physician team is trust.7 Trust is a foundation of all human interaction, including the relationships we have in our work. With trust, individual members of the team can speak freely without fear of exposing themselves to negative criticism. Trust is important in building an enduring environment in which team members can innovate, share ideas and, most important, believe in the other members of the physician team. Without trust, the team cannot be effective in the long term. Building this trust is the job of the physician leader.

There are a number of practical tools a physician leader can use to begin the process of building trust among the team members.7 One of the most important tools, in our opinion, is the use of a behavioral assessment inventory, such as the Myers-Briggs Type Indicator, to help team members to understand the thought processes and personalities of others on the team. This will improve the level of communication and understanding among the team members. These tools also identify potential conflicts, strengths and weaknesses, thus potentially avoiding team pitfalls going forward.

Elements of High Performance

Four other elements sustain high-performing teams: creative conflict, commitment, accountability and a focus on results.9

Creative conflict is necessary and healthy for any team. It should not be suppressed but, rather, encouraged to achieve the best results.9 Team members should learn what creative conflict is and understand it is expected to occur once the team begins its work.

There are four barriers to team conflict. The first is a lack of information or knowledge for some members of the team. The second is the environment in which team discussions take place — not just the physical environment, but also the cultural environment that shapes the organization and the attitudes and expectations of the physicians. Team members coming from different cultures might find it difficult to function within the confines of the team. The third is the relationships that exist between the team members, including hierarchical positions some participants might have. Finally, individual deficiencies — ranging from a lack of self-esteem to health issues — might keep the team from performing. That’s why it is imperative for a physician leader to fully vet his or her candidates.

Team members, individually, should have commitment to their work on the team. Without it, trust erodes and the team’s work becomes inefficient. Also, team members should be made accountable for their roles. For example, if an individual member is assigned a task to accomplish before the next team meeting, that team member should be made aware of his responsibility to accomplish the task. A good tactic is to create within the minutes of the team meeting an action plan for the next team meeting that clearly lists the accountabilities of the team members. Finally, the team leader should be required to focus on results. A measurement system should be employed for the team to help guide the team members in their decision-making going forward.

It is important for you, as the leader, to be familiar with team development and team dynamics. A team is a living and dynamic organism that goes through various phases of development as it tries to accomplish its work:10

The first is the “forming phase,” which is the initial orientation. It is the time in which the team learns about what it is supposed to accomplish and in which each member of the team begins to become familiar with the other members of the team.

The second is the “storming phase,” when team members begin sorting out their individual positions on the team. Some might begin to challenge the team leader. This is the start of intergroup conflict. The physician leader would be well-suited to have a good understanding of human psychology and human interaction at this point in the team’s development.

The third is the “norming phase,” during which members begin to use their experiences to solve problems and pull the group together into a more-cohesive team. During this period, the team should be encouraged to establish rules and procedures for its activities.

The fourth is the “performing phase,” when team has reached harmony and is producing results.

The final phase is the “dissolution phase,” in which the team process ends because the project or task has been completed.

Two Heads Better Than One?

There is one last consideration regarding team development in a health care organization that a physician leader should consider — the use of management dyads.5

By dyads, we mean a two-person team usually consisting of a physician and an administrator working together to manage a specific department or function within the health care organization. An example might be a physician who is given the position of medical director for quality and paired with a senior-level nonphysician leader. This dyad would manage the quality efforts in the organization. This type of dyad can be quite powerful in moving the organization, because it brings together the medical expertise of the physician and the technical and administrative expertise of the administrator.

Building a successful physician team is not an easy task and requires a significant amount of planning. Successful leaders will account for the key considerations and necessary tools outlined here. Anyone aspiring to be a successful physician leader should develop a deeper understanding of these issues from additional resources.

Eugene Fibuch (1945-2017) was professor emeritus at the School of Medicine and co-director of the physician leadership program in the Henry W. Bloch School of Management at the University of Missouri in Kansas City. This article is part of an ongoing series he submitted in 2016 before his death in August.

Arif Ahmed, BDS, PhD, MSPH, is chair of the public affairs department and an associate professor of health administration in the Henry W. Bloch School of Management at the University of Missouri in Kansas City, where he also is academic director of the physician leadership program.

REFERENCES

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4. Leonard M, Graham S, Bonacum D. “The human factor: The critical importance of effective teamwork and communication providing safe care.” 2004. Quality and Safety in Health Care. Vol. 13, pp. 85-90.

5. Schenke R. “Management Skills for Physician Executives.” 2004. ACPE Summer Institute. Chicago, IL.

6. Helmreich RL, Merritt AC. Culture at work in aviation and medicine: National, Organizational, and Professional Influences. 1998, Ashgate, Brookfield, VT.

7. Goleman D, Boyatzis R, McKee A. Primal Leadership: Realizing the power of emotional intelligence. 2002. Harvard Business School Publishing, Boston, MA.

8. Leggat SG. “Effective healthcare teams require effective team members: defining teamwork competencies.” 2007. BMC Health Serv Res. Vol.7; pp.7-17.

9. Nazier T. “Creating high-functioning leadership teams.” 2015. Becker’s Hospital Review. beckershospitalreview.com/hospital-management-administration/creating-high-functioning-leadership-teams.html . Accessed Jan. 5, 2018.

10. Tuckman, BW. Conducting Educational Research, New York: Harcourt Brace Jovanovich. Fifth edition 1999 by Wadsworth.