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Curbside Consult with Dr. Jayne 6/22/15

June 22, 2015 Dr. Jayne 4 Comments

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A reader commented on last week’s Curbside Consult asking about effective leadership teams:

I would love to hear about effective leadership teams and how they become that way. I am not part of our organization’s leadership, but occasionally interact with them and also hear info from people who more frequently interact with them), and it just seems that the more layers we add – VP, SVP, EVP – the more work is created without true hierarchy and responsibility. We don’t even have a clear IT leader. Is it our VP of IT? Our Chief Innovation Officer, who replaced our Chief Information Officer, but she seems to have limited interest in core IT functions? Our new EVP of “peripheral” services like IT, Finance, Pharmacy, etc.? God only knows. And yet even with an expanded leadership “team,” they all give the impression of having too much on their plate to concentrate at the issue at hand or even, yes, show up for meetings (much less on time!)

There are plenty of books out there about building effective leadership teams. Although they may have good information from an academic standpoint, it’s often hard to put those theories into practice, especially in an environment as chaotic as healthcare.

Most of my early experience in leadership was not on the IT side but rather the operational side of an employed medical group. As I moved through the ranks to CMIO, I was exposed to a lot of different leadership structures within my own health system and was a member of several highly functional teams. Unfortunately, I was also a member of several highly dysfunctional teams. Through interacting with other customers sharing our core vendors I’ve been exposed to even more teams all across the spectrum. Those experiences have given me a lot to consider in answering the question.

Now that I’m in consulting, I’ve had to put together my own methodology for helping people move in the right direction. There’s no one answer for how to get a team to be effective, but there are some key characteristics that have to be present.

First, the group has to communicate effectively to lead effectively. Although some people are naturally strong communicators, most aren’t. In order to drive people in the right direction, I’m a huge fan of applying a great deal of structure regarding communication. All of my clients have to sit through a communication skills for leaders class with me and do a communication matrix exercise where the team decides and documents how they’re going to communicate, at what points in the project/initiative, with what methodology, to what audience, and by whom. Once they put pen to paper, I ride herd on them to make sure they’re sticking with the program. A successful team will realize that they don’t need a consultant to keep them in line and will take on the tasks themselves. I continue to prod them a little to make sure it’s sustainable.

Communication isn’t just how they report things out — it’s how they document things day to day and operate when they’re communicating (for example, in meetings). Do they have written (and time-boxed) agendas before the meeting? Does someone facilitate the meeting, allowing people to participate without worrying about minutes or timekeeping? Does someone take good minutes and get them out the same day? Are meetings halted when key people are missing rather than wasting everyone’s time because topics will have to be revisited with the appropriate people in the room? Are there ground rules for meetings to make sure everyone plays nice with the other kids? Making sure the answer to all those questions is “yes” helps a leadership team become more effective.

Second, effective teams have buy-in to their project. Ideally the team has been together since the project’s inception, participating in charter creation, writing a mission statement, etc. That’s usually not the case for most organizations, where people come and go or restructuring seems like its own constant. Teams that actually understand and agree to try to deliver the mission do much better than those with only a loose understanding. For people who don’t natively buy-in, an organization needs strategies to either coach them to arrive at that point or employ incentives (or penalties) to elicit the desired behavior.

Even people who may not agree with a given mission tend to be motivated by financial or other incentives. Consider Meaningful Use: whether it was the carrot or the stick, it sure got a lot of physicians who didn’t natively give a hoot about EHRs to actually install them in their practices and start using them. In working with end users, recognition and small rewards (giveaways, raffling off gift cards, etc.) can make a huge difference in aligning people’s actions with the end goals. Teams that either have buy-in or are otherwise motivated tend to show up on time and ready to participate.

Third, effective teams have to have clear leadership. I sympathize with your comment that the more leadership layers that are present, the less effective the leadership is. I recently worked with an organization that suffered from what I can only call “title bloat.” Their VP level people were what would have been considered directors at best in my former health system. Did I mention they had assistant VPs, associate VPs, VPs, senior VPs, executive VPs, system VPs, and more? Many of the titles had no discernible meaning, but were used as ways to try to elevate people or reward performance without giving raises. It led to an arms race where they had to keep promoting others to keep parity among the ranks.

Regardless of what people are called, someone has to be in charge. There has to be, in the words of one of my favorite executives of all time, a “single neck to choke.” That person should come into the office every day asking, “What’s at risk today, this week, this month” and address the issues when his or her team answers the questions. In shared initiatives, there have to be clear leaders for operational, technical, and clinical pillars. For those types of shared structures, I like to add additional necks to choke in the form of a steering committee that meets regularly and addresses a standard list of project metrics (budget, timeline, risks and mitigation strategies, etc.) People always ask me who is best to own a project. Operations? IT? Clinical leadership? I’ve seen them all work, provided the structures are in place to ensure accountability. I’d rather have a well-organized leader from an “underdog” part of the organization than a disorganized alpha dog.

The leader has to have skin in the game. They should feel personally responsible if their project is not meeting expectations. The right person will have this quality intrinsically. Others can be motivated (again, think bonus goals or incentives) to put it on the line. The leader also has to have dedicated time and resources to lead the project. In a stakeholder assessment I did recently, the designated IT leader was overseeing hospital revenue cycle and ambulatory EHR implementations, both at the same time. The projects were headquartered on opposite sides of town and both were billed as “highest priority” for the health system. The sheer logistics made it almost impossible for her to be hands-on in the way needed for success because she always seemed to be driving to one location or another for a meeting, while taking another meeting in the car. It was no surprise that both projects were failing.

In my opinion, these three elements are key. When they’re not well defined or executed, things can very quickly fall apart. Of course there are dozens of other “essential” facets of effective teams, but these are the ones I see malfunctioning the most often. Sometimes they’re easy to fix and sometimes you scratch your head figuring out how in the world you’re going to patch things together enough to get the job done. Sometimes it takes an outsider to figure out which person is the square peg in the round hole and how to rearrange them. Sometimes it takes a major project failure to get people to wake up and pay attention. I’d be interested to hear what others think.

Have an opinion on what it takes to build an effective team? Email me.

Email Dr. Jayne.

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Currently there are "4 comments" on this Article:

  1. While elements one, two, and three are all valid points, the larger issue of “what makes an effective team?” needs to be addressed. One of my favorite executives used to say “you knew when a team was working out because they were having fun. Why were they having fun? Because they were winning and winning is fun.” The point is people know when they’re on a good team. I contend an effective leadership team is aligned with an organizations goals, meets commitments to those goals, and promotes that organization’s mission into the future.

    An effective leadership team has to be progressing on the mission / goals of the organization. An organization could easily do #1, #2, and #3 really well and completely miss the boat of the organization. Let’s say for example you’re at a health care system that has committed to being the low cost leader in their area. Luxury amenities would certainly be out. If the IT leadership team pursues a strategy of being an innovative leader, they’re not going to be in alignment with the organizations goals. They may be able to communicate this well and hopefully their CEO would re-direct them, but if not they’re going to be so out of alignment with the needs of the organization they’re not going to be an effective leadership team.

    The first most important factor for an effective leadership team is also the most important attribute of an effective employee. Every leader on the team needs three qualities. Buffet says it better than anyone else.

    “Somebody once said that in looking for people to hire, you look for three qualities: integrity, intelligence, and energy. And if you don’t have the first, the other two will kill you. You think about it; it’s true. If you hire somebody without [integrity], you really want them to be dumb and lazy.”
    ― Warren Buffett

    The second factor for an effective leadership team is a commitment to the people the organization serves. This will in turn lead to a commitment to the organization’s mission. Often times I hear of ridiculous health care system board member salaries. In almost every case, it’s because they have no connection to the people they serve and no connection to the organization’s mission.

    The third relates to factors one and two. If you have one and two, the team will commit to an organizational structure that promotes and aligns with the overall organization’s mission and strategy. One and two also have this other nice side effect that if an organizational structure isn’t working they have the integrity, grit, and determination to change it.

    I was once asked by a major CEO given the options of Connection, Communication, and Collaboration, which is the most difficult? Everyone wants to say communication is vitally critical to a leadership team and I agree BAD communication is bad, but when you think about the hardest part is actually collaboration. In the example above the IT leader could probably communicate effectively with both major projects, but the challenge the IT leader had was they couldn’t collaborate effectively. Collaboration takes engagement which takes listening and sharing. Effective communication is important, but the most successful executives I’ve worked with have an eye toward collaboration. Seasoned pros like Dr. Jayne do this instinctively (so much so they don’t talk about it). They have “get-along” ties and an awareness of how groups are working together.

    Usually when I see questions asked about leadership teams it’s in the context of how to get promoted or improve one’s career. My career advice is work on collaboration. Be the person people want to work with and deliver results. It’s amazing how far that will take you. I once had a very complex time-critical project completely blow up in my face with some less than honest individuals. My phone didn’t stop ringing when I reached out to former colleagues and people that I had even briefly worked with because I had a reputation of the being the person people wanted on their team. The other advice I have is to be very selective about the teams you join. Your personal brand is greatly impacted by the teams you join.







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