What Makes Some Health Care Teams More Effective Than Others?

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An effective transition to team-based care improves patient outcomes. | Reuters/Benoit Tessier

Let’s pretend, for a moment, that you’re a primary care physician and you refer one of your patients to another doctor for a colonoscopy.

Will the patient follow through? If not, how will your team know to remind him or her? If the patient does receive a colonoscopy, will your team be alerted so you can evaluate and respond to the exam results?

High-performing health care teams that are organized and trained to do what’s best for the patient can shine in this type of scenario, while low-performing teams can inadvertently let patients fall between the cracks.

The question is: How do you make sure your health care team is one of the effective ones?

New research co-authored by Sara Singer, professor of organizational behavior at Stanford Graduate School of Business and professor of medicine at Stanford University School of Medicine, provides answers.

Teams That Stand Out

Singer and her colleagues analyzed 12 health care teams, all of which had received the same evidence-based training on how to build a high-functioning health care team. This training included full-day learning sessions followed by webinars and site visits to reinforce topics such as: empaneling patients (creating a list of patients seen by a provider in the past three years), population health management (identifying patients with certain conditions, like diabetes, and following up to promote regular evaluations), and patient engagement (eliciting their values, preferences regarding treatment, and capacity for self-care).

The researchers measured each team’s performance over three years using the Primary Care Team Dynamics Survey, developed by Singer and her colleagues, and a work satisfaction rating from all patient-facing staff at each clinic. The survey covered five key aspects of teamwork: skill sets of teams, communication within teams, shared goals, understanding of individual roles, and perceptions of mutual respect and trust.

The teams showed wildly different results. Singer and her colleagues identified six high-performing health care teams with high or rising team dynamics and six low performers with low or declining team dynamics.

Interviews with team members (including physicians, nurses, medical assistants, social workers, and administrative staff) revealed that what distinguished the high-performing teams was their ability to focus on both functional change and cultural change at the same time. The low-performing teams, on the other hand, focused on either functional or cultural change alone.

What Is Functional Change?

The overriding goal with functional change is to improve team communication, track progress, and devise better processes as a group.

What are the tools for getting there? Functional change is the result of collecting data that helps your team understand how it’s doing — and that allows you to identify where there’s room for improvement. For example, this might mean coming up with metrics to measure your success (such as number of patients treated, number of new patients accepted, revenue, etc.). Or it could mean recognizing that you need a new database to store medical records more efficiently or to implement a text-message reminder system for patients — and making sure the entire team has access to these systems.

Effecting functional change might also involve committing to regular, structured meetings so everyone is on the same page, and encouraging smaller, two-to-three-person “teamlets” to gather for a “huddle” at the start of each day or shift. To boost a team’s performance, you might also consider revising people’s roles and responsibilities.

And when teams don’t focus on functional change? A social worker on one of the study’s low-performing teams that failed to incorporate this type of change complained that her group was locked in an unproductive pattern of bursts and lulls of activity. “We have these projects and a lot of energy goes into them, and then they get dropped.”

What Is Cultural Change?

In addition to prioritizing functional change, high-performing teams recognize that cultural change is equally critical to their success.

For starters, this means re-examining who has the authority to take initiative, lead innovation, and contribute to the team. “You need to build trust and mutual respect,” Singer explains.

At one health care center in the study, for instance, a Spanish-speaking patient repeatedly missed appointments. The front desk staff member — a native Spanish speaker — discovered that no one else in the department spoke the language and took it upon herself to help the patient navigate the process. In another situation, one of the medical assistants revealed that patients sometimes share important health information with them, and say, “I never told the doctor, but can you tell them?”

The guiding principle behind cultural change is to ensure that all team members feel valued and empowered to speak up when necessary.

How? Singer suggests that teams consider allowing non-physicians, such as nurses, to handle between-visit calls and to introduce themselves to patients as “your” nurse. “In environments where people often feel overburdened and under-resourced,” she says, “patient relationships enable staff to derive meaning and see the tangible impact of their work. And staff contributions benefit the work of the team.”

Another tactic is reframing how your team views change itself. Rather than reacting to a mistake as a failure, encourage them to approach it with curiosity: Where is the value in this experience? Emphasizing the learning opportunity, rather than assigning blame, will help team members to feel less defensive and skeptical about change. Your objective is to create a culture that’s open to, rather than fearful of, experimentation.

A Message to Managers

Step one in making meaningful change is to leave your ego at the door and embrace delegating tasks. “The care that patients need goes beyond an individual provider. So people must work together in order to deliver the care that patients need,” says Singer. “The ability of one person to handle all the requirements is vastly limited.”

And don’t expect that the process will be easy. Odds are, attempting to tackle not one but two types of change simultaneously will be messy at first. In the beginning, cautions Singer, it’s normal for team members to feel overwhelmed and frustrated, and initial progress may be slow. But in the long term, teams that target both functional and cultural change gain momentum while those that don’t lose speed. The extra effort is worth it, though, because you’ll find that one type of change fuels and reinforces the other.

“We have not attended to management in the way that we have attended to clinical innovation,” says Singer. “And it’s the management innovation that is now holding us back.”

What’s more, she says, even if you manage a team outside the health care industry, these techniques and strategies could help you maximize your results and hit your goals.