Importance of a Strong
Clinical Team
The Kaiser
Permanente (KP) Georgia Region has been forming clinical teams and working
on team development since 1977. As these teams began to work with their
patient panels, the KP Georgia Region gained the clear understanding
that highly functional medical teams were essential if patients were
to be highly satisfied and bond with their personal care providers (PCPs).
Organizing health care delivery using a team model has generated a sense
of ownership among all the team members, and this sense of ownership
has resulted in greater professional and personal satisfaction in the
clinic.
From their
years of experience assembling clinical teams, team leaders in the KP
Georgia Region have also learned that multiple opportunities exist for
continually infusing "new life" into these teams to keep them
feeling stimulated and creative. The KP Georgia Region has thus been
formulating answers to three major questions: After your team has been
established, how do you keep it creative and energized? How do you manage
a change in team leadership? What keeps highly functioning teams doing
well when major changes take place? The answers are contained in the
six guiding rules outlined here.
Rule 1: Establish Sound
Principles for Team Behavior
Forming
your clinical team is only the first step; ongoing maintenance of the
team is critical to its forward motion and continued success. The KP
Georgia Region learned this lesson in August 2002 after losing our long-established
team leader. At that time, many team members (Table 1) expected that
patient satisfaction would fall as a result of this personnel departure,
which was hastened by conflicts that arose after the team leader's resignation
letter was delivered. While 3000 patients in the departing team member's
panel awaited reassignment to other PCPs, the other team members were
already working nearly to capacity. Moreover, the existing patient panel
had been highly bonded to the team since its earliest days.
How were
these obstacles resolved? Working under a new team leader for 5 of 12
months of the year, we finished in first place for the region. But this
outstanding result did not happen by coincidence. Instead, we had realized
that our fundamental behaviors were the secret to our continued success
and were responsible for our success in the first place. These behaviors
included paying attention to patients' needs; validating patients' concerns;
setting professional examples that we all could be proud of; acknowledging
patients' time constraints and providing convenient service; and interacting
interpersonally with respect, kindness, and compassion.
Rule 2: Emphasize Inclusion
and Open Discussion
Even a
brief examination of group dynamics shows that all team members want
three things: to be included, to be important, and to be listened to.
Boredom in one's profession grows from a sense of isolation and disconnection
from other members of the team. To prevent this boredom, we initiated
a simple program early on to enhance participation at team meetings:
We assigned a "meeting leader," a "timekeeper,"
and a "notetaker" and rotated each position among all team
members throughout the year. This practice led to greater appreciation
for meeting content and for following an agenda while enhancing the
ability of team members to contribute individually at each meeting.
Rule 3: The Team Must
Recruit Members for Itself
Recruiting
for the team is another critical issue. We encourage all team members
to participate whenever we recruit for new or vacant positions. During
the interview, we impress on the applicant the value of intrateam cooperation,
the importance of being honest and straightforward about issues currently
or potentially affecting the team, and our unique team culture of inclusion
that has led to our success. We let interviewees know that we are a
busy team with an interesting and appreciative patient panel.
Our mission statement, developed by the team, also has been important
in our success and is used in recruitment: We make each new team member
aware of this mission before the member joins our team. In particular,
we emphasize a key line in our mission statement: "to treat our
patients as we would want ourselves to be treated." This goal provides
an instant education for each of us, because we all have had the experience
of medical services being impersonal, disrespectful, too costly, or
taking too much of our time. Thus, to meet this aspect of our mission,
our team members discuss waiting times, tone of voice, personal distractions,
and demeanor as these factors relate to patient care. We are pleased
to include members on our team who understand and value these concepts.
We also like to solve problems quickly; therefore, we remain ready to
admit that we have made mistakes and will probably make more mistakes.
We recognize that mistakes can energize the learning process and keep
it active.
Rule 4: Practice Medicine
"The Way We Were Taught"
In developing
our team values, we reflected on our own medical training and realized
that "practicing medicine the way we were taught" needed to
become both our value and our mission. Our vision derives from this
mission and includes working toward success, creating an environment
where our skills help our patients, working to keep our patients satisfied
with their medical care, and keeping ourselves professionally challenged.
The team ends each week with a great sense of accomplishment and renewed
awareness of why we chose to be in health care. Indeed, our team training
brought out the question --"Why are we doing this?", which
we must ask ourselves every day. I believe that our patients can almost
certainly best answer this question, because their needs are what this
business is all about.
Rule 5: Recognize and
Address Boredom, Infighting, and Disrespect
Because
team activities can become mundane, an essential strategy is to look
for ways to breathe new life into every team--especially when extremely
busy days have generated fatigue and frustration. We try to identify
boredom among the professionals in our team, and we make special efforts
to challenge these team members with projects that will reinvigorate
and enhance their interest in better health care delivery:
- We
discuss recent findings learned through continuing medical education
and let our staff come up with investigative projects to improve patient
encounters.
- Team
leaders try to identify interpersonal infighting and bring the issues
to the surface quickly to avoid further deepening the divide between
individuals or groups in the team. Disrespect is not tolerated in
our module.
- We
place a high value on respect for patients and team members alike.
The need for respect in any group is universal and the sting of disrespect
is universal as well. Many problems can be avoided if issues are clearly
and openly discussed and team members are encouraged to talk over
situations that might lead to a perception of disrespect.
Rule 6: Congratulate One
Another for Team Success
After
the departure of our team leader, we had anticipated major difficulties
with our longstanding, highly functioning delivery of service. With
this personnel change, we expected chaos. Looking back, however, we
realized that as a team, we had established all the skills we needed
for moving forward and continuing to take good care of our patients.
We congratulated ourselves for acquiring and developing these skills,
and we were honest and forthcoming with our patients about what was
occurring within our team.
Conclusion
As part
of our team's successful ongoing development, we try to accommodate
both the team and our patients in "above and beyond" ways.
We keep them aware of our team's progress and ongoing PCP assignments
as well as those that may be undergoing change. Throughout it all, we
give our best, and we acknowledge our efforts and successes. Our patients
have told us--and they continue to tell us--that we are doing it right.
