26th May 2017
This week I had the privilege of working with colleagues in the School of Pharmacy in the Royal College of Surgeons, Ireland (RCSI), the Bill Gatton College of Pharmacy, East Tennessee State University and the Irish Institute of Pharmacy to explore the topic of inter-professional collaboration and team-based approaches to patient care. This involved a day-long masterclass in RCSI on Wednesday and a number of other “fringe events”. As part of the programme of fringe events, I found myself in the studios of Raidió na Life, hosting a podcast where pharmacy and medical practitioners from Ireland and America shared their reflections on the concept of team-based approaches to healthcare (You can hear the recording here). It was a great experience. It was my first time to host such an event, which was a learning experience in itself, but more importantly it resulted in a rich and meaningful discussion which I think will prompt lots of reflection on how we could improve healthcare delivery in Ireland. My thanks to Prof. Reid Blackwelder, Dr. Brian Cross, Dr. McKenzie Calhoun, Mr. Paddy Byrne and Dr. Kieran O’Driscoll for contributing so authentically to the discussion and for sharing their reflections and insights. I believe that more conversations like this, forward-looking and positively-framed, are needed in order to start changing the order of things.
Given that we were considering team-based approaches to healthcare delivery this week, it’s not surprising that the topic of teamwork featured strongly in our discussions. Anybody who knows me knows that I am passionate about this topic! In fact, a number of readers have been specifically asking if I could share reflections on teamwork as part of my blog. It’s impossible to distill my thoughts about teamwork and effective team leadership into one blog-post, so I propose to dip in and out of the topic over time, reflecting on different aspects of teamwork as they arise in my day-to-day life. In light of the discussions about teamwork over the last week, today seems like an opportune time to start that reflection.
I have had the privilege of working with some fantastic teams over my career to date and I am lucky enough to be currently part of one of the best teams in which I have ever worked. Like most people, I have also worked in quite dysfunctional teams. Therefore, it’s easy for me to reflect on what I think differentiates a good team from a not-so-good team. With a great team around you, the impossible becomes possible. It’s where the magic happens.
During the past week, and most notably in the podcast discussion, it is clear that strong relationships are important in teamwork. Whether you are working within a structured and clearly-defined team or you find yourself thrust into situations where you need to collaborate with others informally, relationships are considered a vital ingredient to good teamwork. In my opinion, this can be distilled down even further to one essential ingredient: trust. Without trust, the magic just can’t happen.
The Collins English dictionary states the following in defining trust: “If you trust someone, you believe that they are honest and sincere and will not deliberately do anything to harm you.” Upon reading such a definition, it makes complete sense that you need trust for a team to work well together. The absence of trust would suggest that there are concerns regarding honesty, sincerity or intentions. How could a team perform effectively, let alone flourish, in such an environment? How could any meaningful relationships be established?
The interesting thing about a really powerful team is that you don’t necessarily have to like everyone in the team in order to have trust. In my experience teams are most powerful when they are made up of people who are quite different to each other, each bringing something unique to the table. In a truly effective team there will be potentially opposing views of the world and there will be healthy tension between different perspectives on how things should be done. In a flourishing team there is room for this to happen. Where there is trust, no-one feels threatened.
Patrick Lencioni, author of The Five Dysfunctions of Team, positions trust as the foundation on which all great teams are built. He further differentiates between types of trust: predictive trust and vulnerability-based trust. Predictive trust is where you know someone long enough to be able to predict what they’ll do. You trust that you can anticipate their response to situations. Whilst useful, this isn’t the type of trust that makes teams great. Vulnerability-based trust is, predictably enough, the trust that comes about when people on a team can be vulnerable with each other. When this type of trust is in place, people can ask for help, they can admit their wrong, they’re willing to provide feedback on potentially difficult issues and they’re willing to hear that type of feedback about themselves. Team members are willing to have conversations in a spirit of honesty, sincerity and good intention and are met, in-turn, with reciprocated honesty, sincerity and good intention. When people can be vulnerable, it changes the dynamics of a team completely, making it unstoppable.
Whilst everyone in a great team needs to be willing to be vulnerable, Lencioni maintains that the only way to achieve this is if the leader goes first. If the leader can’t be vulnerable, then the other team members are unlikely to trust that they can be so. Lencioni maintains that leaders have to be willing to show their vulnerability before others will trust that it is safe for them to show theirs. Leaders must be self-aware. They need to understand their strengths and how they use those strengths. They must be insightful about their short-comings and how they address these. They must be capable and willing to admit when they are wrong. They must be open to receiving uncomfortable feedback graciously, before their team will trust that they should do the same.
Once the conditions are set at a leadership level, all team members then have a responsibility to step up and pay their part in cultivating a culture of trust. This means that they too must have self-awareness, they too must have insight into their short-comings and they too must be prepared to put in the effort that is required to maintain a trusting environment. Everyone must believe that all team-mates are acting honestly, sincerely and with good intention. Once the trust is established, it provides a strong foundation for everything else.
Self-awareness is a tricky issue. It makes sense that people should understand themselves and their impact on others, but I often find it lacking. This is often where I focus on efforts when I work with teams, either leading, being part of or coaching them. Once people understand themselves they are better positioned to understand others and this helps to build a culture of respect and trust. I also find it easier for trust to flourish when people are able to have fun together.
Whilst I agree with Lencioni that good leadership is a key ingredient, what about those situations where a clear leadership mandate does not rest with any one individual? In the example of team-based healthcare, where a range of different healthcare professionals may be required to form spontaneous teams to plan the best approach for a particular patient, who is responsible for setting the tone? My answer is that you can wait for someone to come in and set the tone or you can be proactive about playing your part in creating the right environment. This is where you get to see leadership qualities displayed irrespective of rank or whether the individuals concerned have a mandated leadership role. This is where the practicalities of “who is in charge?” become irrelevant and “what needs to be done?” becomes a unifying goal. Once we start asking the right question, everyone can contribute to the leadership of the group by playing their part in creating an environment which will enable the team to flourish. As my American colleagues would say, don’t wait for a memo to instruct you to start creating trust! Just step up and play your part!
Establishing trust, whilst important, is only the first step to creating a great team. There are a further four elements to Lencioni’s model, which proposes that a team will not function optimally if there is a fear of conflict, a lack of commitment, avoidance of accountability and inattention to results. Each of these topics fascinates me, particularly the one relating to the fear of conflict, and I am sure I’ll be reflecting on each of them in future blogs. I’m also interested in exploring the concept of vulnerability because I’ve had some fascinating conversations about this in the last few days and am anticipating a guest blog next week which might stimulate some interesting reflections in this regard! So I know we will re-visit the topic of teams in future blogs. In the meantime, if you want know more about Lencioni’s model of teamwork, take a look at The Five Dysfunctions of a Team.
Are you part of a team? Teams can be found in the workplace, in sports, at home, in communities, in social circles … essentially anywhere you have groups of people working on something together.
Reflect on your team experiences. Think about a time when you have been part of a fabulous team (I am hoping that you have experienced this at some stage!). Compare this to a time when you worked in a poor team environment (I’m assuming most people have experienced this!). Reflect on the differences between these two in the context of trust. Does it hold true, in your experience, that there are low levels of trust in poorly performing teams?
If you are currently working within a team where there is a trusting environment, cherish it and make sure you play your part in keeping it that way. Don’t become complacent and assume trust will just flourish. Like anything worth having, it takes constant work and care to ensure that it is maintained. The effort is worth it when you are part of a team where great things happen.
If you work within a team where there is a lack of trust, it might be worth reflecting on what you could do to start nudging towards a more trusting atmosphere. I’d be interested in any reflections you have on how this can be achieved.
As always, thanks for reading and I’m looking forward to some interesting exchanges over the coming week 🙂
And check here for the latest update from Cicely Roche, who is guest blogging about her Ontario trip!