Curbside Consult with Dr. Jayne 10/17/16

Everyone in informatics circles has been buzzing about the release of the MACRA Final Rule. As is typical for CMS, it came out on a Friday afternoon. I know a lot of people were hunkered down reading it, me included. I did what I could with it Friday, but on Saturday I had a previous commitment to teach some team-building sessions as part of a local outdoor classroom program.

The type of change that MACRA is trying to drive and the stresses it is going to place on healthcare delivery organizations will require that organizations have high-functioning teams. They’re also going to require intense project management and active management of resources and outcomes. Although many organizations have already figured this out and have robust programs in place (or have hired consultants to do the dirty work), there are numerous organizations that are just trying to figure out what their first steps should be.

When you place stress on teams like these MACRA-related projects are certain to do, teams will either rise to the occasion or they will fall apart. Although some people throw their hands up and just watch things devolve, there are active ways to manage team dynamics and to get your people in the right place so they’re well prepared to take on new challenges.

The program I staffed this weekend brought out many of the types of issues that organizations need to be thinking about as they evaluate how they will handle MACRA-related tasks and who will be responsible for executing them.

Our program brings together people from different backgrounds and throws them into a situation that is unfamiliar for most of them. This year’s group had about 50 participants from all different disciplines – healthcare, manufacturing, communications, technology, and a couple of college students. Even if we have participants coming from the same organization, we mix them up so they’re not working together.

They’re placed in group of five to eight with people they’ve never met and they have to handle a variety of objectives. It’s outdoor classroom with camping and survival skills. Some of the participants may not have done so much as roasting a s’more, so we provide several coaches for each group to help them through the process.

The course starts with an indoor session with a few outdoor elements where they practice basic team skills, and then we follow up with the actual outdoor weekend portion. Their first task was to come up with a team name and motto. We use a variety of exercises to work them through the stages of team development – forming, storming, norming, and performing.

My team definitely had some forming issues because only two of them had arrived by the time the session started. The ability to get to meetings on time continues to be a major issue for a lot of people, which makes it challenging to be a high-performing team. Once the rest arrived, we had some rehashing and revising of the team name, but the team was able to eventually move forward once the late arrivals understood that they couldn’t complain about decisions that were made when they failed to perform.

The teams learned some basics of outdoor cooking and assigned members to roles, identifying leaders and supporting members. When you’re headed out into the woods for a weekend, it’s key to know who is responsible for what. Just like complying with federal regulations, if someone drops the ball, everyone suffers, and having clear chain of command and documented responsibilities makes things easier. The teams are provided with a series of tasks that they have to complete prior to the outdoor portion, and I thought I lucked out when I had someone who immediately volunteered to set up conference calls and meetings to get everything taken care of in the interim.

They met once by phone and once in person during the two-week gap, learning some important lessons on logistics when only half the group showed up in person. The other half was at another meeting place, because leadership failed to recognize that “meet at the XX restaurant by the mall” wasn’t specific enough since there were four different locations of the chain in close proximity, including one actually in the mall. How many times do we have situations like this in healthcare IT? The team thinks they have a clear plan and everyone voices understanding, but it turns out there were multiple ideas about how things were actually going to happen. Although it wasn’t that big of a deal when you’re just dealing with a voluntary team-building program, it’s a huge deal when you have miscommunications around federal requirements and regulations.

There was some last-minute planning, but it appeared they had everything figured out prior to their arrival for the weekend. Unfortunately, one-third of their team was late, leading to delayed setup since people were bringing different pieces of equipment. Across the meadow, the other team I was cross-coaching had arrived and began to set up in a disciplined fashion. Their only glitch was not having their team tee shirts done on time, which they remediated with some ad-hoc spray painting. I was doubtful when they pulled out the cans as to how well it would work, but when they pulled out a drop cloth, rubber gloves, and pre-cut stencils, my doubts were laid to rest. It may have been last-minute, but it was well planned and well executed.

In working with both teams, it was clear that one was more successful. In trying to dissect the reasons behind that success, the major factor was that they put the good of the team beyond their individual needs. They were up early each morning to take care of team tasks, where my team had issues getting out of their tents. I definitely earned my coaching stripes this time around since I had to roust grown adults out of their tents two mornings in a row. I also had to pull out some camping magic when my team failed to follow some of the cooking instructions and their dinner was in jeopardy. Luckily my other team had prepared extra charcoal and had extra supplies, which I was able to borrow to bail my team out. Again, in most of our organizations, we’re running so lean we can’t count on a bail-out. We have to be organized and in command of the situation.

I was hoping that my primary team would see what was going on with the other team and rise to the occasion. Although some team members started to get the message and get with the program, others either didn’t see the possibilities in front of them or maybe just didn’t care. Sometimes we see that, when organizations have enrolled wary participants. Hopefully those that didn’t fully embrace the program learned something along the way and can find elements of the program to take back to their home organizations. I know I learn something every time I put on this program and there are always different challenges to be overcome and different personalities to work with. I come back to my work energized with new tricks and techniques to try to motive my teams.

We’re definitely going to need energy and motivation to make it through MACRA-related reforms and all the sub-projects that will entail. Although I was tired from a couple of nights of sleeping on the ground and herding cats, I’m ready to tackle the rest of the Final Rule.

What kinds of strategies do you use for team-building? Email me.

Email Dr. Jayne.