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Team Functioning I:Introduction & ContextKyle P. Edmonds, MD

Assistant Clinical ProfessorHowell Palliative Care ServiceUC San Diego Health

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• 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

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• #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

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Tuckman’s Stages of Group Development

Forming

Storming

Norming

Performing

Adjourning

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• Questioning

• Socializing

• Displaying eagerness

• Focus on group identity / purpose

• Sticking to safe topics

Group Development: Forming

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• Resistance

• Lack of participation

• Conflict

• Competition

• High emotions

• Moving toward group norms

Group Development: Storming

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Argyris’s Ladder of Inference The magic spot to short-circuit conflict

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• Reconciliation

• Relief, lowered anxiety

• Members are engaged & supportive

• Developing cohesion

Group Development: Norming

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• Demonstrations of independence

• Healthy system

• Ability to deliver as a team

• Balance of task & process orientation

Group Development: Performing

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Exercise on Teams & You

CAPC. 2012.

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For each of us, it’s all about the messages sent at that table

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• THE Leader?• Autocratic theory• Human relations theories• Situational leadership theories• Emotional intelligence theory• Adaptive leadership theory

The Palliative Physician Role on A Clinical Team

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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.

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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.

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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.

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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.

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Shared Leadership: Not EasyKyle pretending to be a social worker. Kyle pretending to

be a chaplain.

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Pharmacist

Clinical Social Worker

Nurse PractionerPhysician

Others

Shared Leadership: Not Easy

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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.

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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

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• Empathy• Awareness of team’s needs

Social awareness

• Mentoring & inspiring others• Building bonds• Managing conflict

Relationship management

Leadership Skills

Adapted from: Serio & Epperly, 2006.

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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.

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This Lecture Series

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• Are you a• Director?• Expresser?• Thinker?• Harmonizer?

Homework ( ! ) – Communication Style Inventory

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• 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

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• 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