Summary
In healthcare it is common practice for multidisciplinary teams to be involved in efforts to improve the quality and safety of patient care. The perioperative period, which encompasses the time before, during, and after a surgical operation, is a prime target for multidisciplinary improvement efforts because of the diversity of professional roles and care delivery settings involved. Failure to achieve improvement targets in this context is often attributed to lack of resources or resistance to change.
A recent study counters this view, suggesting failure is more likely to be due to the way the multidisciplinary improvement team is led and how well it collaborates. Successful improvement projects depend on effective leadership—from designing the team, communicating a shared vision, planning the project, through to creating a collaborative approach to getting work done, and a structured training and feedback process.
A new study distils existing literature and gathers expert opinions on leadership and high-performing teams to offer practical guidance on those factors and behaviors relevant to the delivery of perioperative improvement projects, but also to leading multidisciplinary teams outside of healthcare.
High-performing healthcare services continually seek to improve patient experience and outcomes. One key area of focus for improved performance has been the perioperative period—the time leading up to, during, and after surgery. Unfortunately, perioperative improvement teams often fail to achieve their goals and when this happens the blame is often ascribed to resistance to change or lack of resources.
A recent study highlights that another important – yet overlooked – reason why t improvement projects fail is because of the way multidisciplinary improvement teams are designed, how they are led, and how the multidisciplinary teamwork is managed.
The study, from Christina Yuan and Michael Rosen, Faculty Affiliates at the Center for Innovative Leadership at Johns Hopkins Carey Business School, in collaboration with Tasnuva Liu, Benjamin Eidman, Della M. Lin, and Elizabeth Wick, contends that taking time to pre-plan and continually reflect on how team leadership behaviors are enacted is the best way to ensure team success—yet this is often overlooked.
The researchers surveyed a range of thought leaders and team leaders with deep-rooted experience in perioperative work to discover the leadership behaviors and practices considered to be most relevant to planning and implementing perioperative improvement initiatives.
Based on their findings the researchers recommend the following six key areas leaders should consider when designing and leading teams to deliver perioperative improvement projects—recommendations that carry implications for the management of multidisciplinary and cross-functional teams in a wider context too:
Design and Define
It is important to clearly define the aims of the mission, and to choose a team that includes all stakeholders and the right mix of skills and roles—allowing flexibility and ensuring that roles are not too rigidly defined. It is also wise to include those who are skeptical about improvements, as well as those who are more receptive, so as to understand the scope of the challenge ahead and ideally to bring skeptics on board.
Manage
Leaders should create an environment where collaboration is prioritized and fine-tuned. Through discussion, establish effective processes for getting work done and delegating tasks. With agreement leaders should identify challenging but realistic goals for the team. They should monitor and report on progress and help the team recover from any small set-backs.
Sustain
An environment of psychological safety should be created, where team members feel they have a voice and their opinions are acknowledged. Leaders should communicate regularly to everyone to show how the project is progressing and to build a collective understanding of what is being achieved and what more might be done. This should be framed as a positive way to learn from successes and failures as opposed to seeking compliance.
Train and Feedback
Listening, asking good questions, and soliciting feedback are essential leadership behaviors. In a multidisciplinary team it is important everyone participates and is heard, including less vocal team members. This interaction can be the basis for providing skills training and promoting continuous learning—appreciating that failures can be opportunities for learning.
Manage Team Boundaries
It is a leader’s role to clarify the boundaries between the core project team and other groups and departments, as well as to be a liaison with these entities. It is vital to obtain senior leadership buy-in at the outset of the project and to maintain this throughout with regular reporting on progress, successes, and any potential barriers. Messages should be brief and individualized to address each senior leader’s particular concerns.
Manage Organizational Context
Aligning the team’s efforts with organizational needs is key. Here an important factor is for senior leaders to ensure access to data the team needs to make decisions and do their work. Removing barriers to data sources and providing the team with opportunities to ask senior leaders questions and get information as needed is also the leader’s responsibility.
In a busy healthcare setting, where the delivery of a perioperative improvement project will be one of many priorities for the members of the assigned multidisciplinary team, above all team leadership must be clear and precise. It must ensure all members of the team understand their roles, feel free to participate fully, and are empowered to achieve to the best of their abilities. There are innumerable management theories and practices that might be suggested to accomplish this. The value of Yuan and Rosen’s study is that it helps to distil the essence of what is really required for effective team leadership in this context.
