team functioning i: introduction & context
TRANSCRIPT
1
Team Functioning I:Introduction & ContextKyle P. Edmonds, MD
Assistant Clinical ProfessorHowell Palliative Care ServiceUC San Diego Health
2
• Vision: Graduating thoroughly self-aware team members.
• Mission: Increasing the self-awareness of HPM fellows over the course of their fellowship.
• Values: • Significant.• Applicable.• Personalized.
Mission, Vision & Values for the Thread
3
• #1: Team Roles with me (Homework: Communication Style Inventory)
• #2: Communication styles with Dr. Ajayi (Homework: Intercultural Conflict Style Inventory)
• #3: Managing conflict with Chris Onderdonk, LCSW (Homework: Parker Team Player Survey)
• #4: Teams in Action with me (Homework: RHETI or MBTI)
• #5: The Role of Personality Type with Kathryn Thornberry, LCSW (Homework: Develop Professional Mission/Vision/Values Statement)
• #6: Personal Team Style with Dr. Ajayi
The Arc of the Team Functioning Thread
4
Tuckman’s Stages of Group Development
Forming
Storming
Norming
Performing
Adjourning
5
• Questioning
• Socializing
• Displaying eagerness
• Focus on group identity / purpose
• Sticking to safe topics
Group Development: Forming
6
• Resistance
• Lack of participation
• Conflict
• Competition
• High emotions
• Moving toward group norms
Group Development: Storming
7
Argyris’s Ladder of Inference The magic spot to short-circuit conflict
8
• Reconciliation
• Relief, lowered anxiety
• Members are engaged & supportive
• Developing cohesion
Group Development: Norming
9
• Demonstrations of independence
• Healthy system
• Ability to deliver as a team
• Balance of task & process orientation
Group Development: Performing
10
Exercise on Teams & You
CAPC. 2012.
11
For each of us, it’s all about the messages sent at that table
12
• THE Leader?• Autocratic theory• Human relations theories• Situational leadership theories• Emotional intelligence theory• Adaptive leadership theory
The Palliative Physician Role on A Clinical Team
13
Physician Culture: Hidden Curriculum• Hierarchy: strict, linear
• Ego: well above average their whole lives
• Damaged ego: medical training is demeaning
• Hazing: “I survived residency. You didn’t”
• Comfort just diving in: see one, do one, teach one
• Really busy: efficiency and brevity
• Medico-legal risk aversion
• Disease and problem-focused
• “Fix it”
• If the patient is unhappy, somebody is to blameThornberry & Mitchell, 2014.
14
Messages Premise• You do not make mistakes.• You can know everything if you try hard
enough
Doctors must be perfect.
• There is always one right answer.• Social / personal problems are someone
else’s problem.
Uncertainty & complexity are to be avoided.
• You can be rude if you are doing something important.
• Communication skills are nice but not essential.
Outcome is more important than process.
• Medicine is a higher calling.• Caring for oneself is a sign of weakness.
Medicine takes priority.
• More senior doctors cannot be questioned.• Subspecialists are better than generalists.
Hierarchy is necessary.
Physician Culture: Hidden Curriculum
Adapted from: Heidet & Stein, 2006.
15
Physician Behaviors
• Assuming a dominant position on the team
• Dictating treatment plans to the team
• Assigning specific patient-care tasks to team members
• Failure to properly delegate tasks best done by other team members
• Willingness to proceed with non-medical interventions based on limited information or training
• Medicalizing everything, including emotions
Thornberry & Mitchell, 2014.
16
A Shared Leadership Model: Trans-Disciplinary Teams
• Commonly treated as a peer• High knowledge deficit• Highly dependent on the other
members
Appointed leader
• Features of the situation• Individual skills & expertise• Individual ability to influence
Actual situational leadership
Pearce et al., 2009.
17
Shared Leadership: Not EasyKyle pretending to be a social worker. Kyle pretending to
be a chaplain.
18
Pharmacist
Clinical Social Worker
Nurse PractionerPhysician
Others
Shared Leadership: Not Easy
19
Leadership
Authority
Dominant behavior
• Values, skills & behaviors• Mobilize people to action• Disrupt the norm
• The power vested in a formal role
• Maintain equilibrium• Provide direction
• Product of political alliances• Limit setting & control
Leadership Skills
Adapted from: Flower, 1995.
20
Leadership Skills
Adapted from: Serio & Epperly, 2006.
• Awareness of emotions• Knowledge of strengths /
weaknesses• Confidence in abilities
Self-awareness
• Emotional self-control• Honesty & integrity• Flexibility• Initiative & optimism
Self-management
21
• Empathy• Awareness of team’s needs
Social awareness
• Mentoring & inspiring others• Building bonds• Managing conflict
Relationship management
Leadership Skills
Adapted from: Serio & Epperly, 2006.
22
Strategic Leadership PrinciplesIdentify the challenge
Keep the level of distress tolerable
Focus attention on the evolving issues
Give the work back
Protect voices of leadership
Leadership Skills
Adapted from: Chaudry et al., 2008.
23
This Lecture Series
24
• Are you a• Director?• Expresser?• Thinker?• Harmonizer?
Homework ( ! ) – Communication Style Inventory
25
• Vision: Graduating thoroughly self-aware team members.
• Mission: Increasing the self-awareness of HPM fellows over the course of their fellowship.
• Values: • Significant.• Applicable.• Personalized.
Mission, Vision & Values for the Thread
26
• CAPC (2012). Strategies for maximizing the health/function of palliative care teams.
• Chaudry et al. (2007). Physician leadership: The competencies of change. doi: 10.1016/j.jsurg.2007.11.014
• Flower, J (1995). A conversation with Ronal Heifetz: Leadership without easy answers. The Healthcare Forum Journal. 38(4).
• Haidet P & HF Stein (2006). The role of the student-teacher relationship in the formation of physicians: The hdden curriculum as process. doi: 10.111/j.1525-1497.2006.00304.x
• Pearce CL, Manz, CC & HP Sims (2009). Is shared leadership to key to team success? doi: 10.1016/j.orgdyn.2009.04.008
• Serio & Epperly (2006). Physician leadership: A new model for a new generation. PMID: 16512590
• Thornberry KT & WM Mitchell (2014). SWHPN Presentation on team culture. Personal communication received 09.11.2015.
References