Building relationships and achieving results by nyut545e2


									                  It takes a
                  T E AM
                Building relationships and achieving results

                                     By William F. Moskal, Ed.D.

Without question healthcare delivery can be            linear structures often defeat the change they
improved. In fact, much attention has been given       seek. Instead of becoming new, cross-functional
in recent years to developing new payment              teams of empowered professionals, leaders often
systems, uniting care across the continuum,            remain locked in affiliational allegiances.
building new partnerships with physicians, and
other initiatives designed to improve patient out-     As a result, many change initiatives that start
comes and customer satisfaction. Despite these         with enthusiasm quickly sink beneath the weight
positive changes there remains one obstacle that is    of conflict. This occurs for two basic reasons.
often overlooked: the way traditional                  First, many leaders fail to understand the social
relationships can hinder meaningful change.            dynamics behind change and why, on a human
                                                       level, change initiatives fail. Second, many
Most healthcare organizations, especially those that   organizations focus almost exclusively on the soft,
are hospital-based, were organized years ago.          relationship-building aspect of change
Consequently, they are structured as departments or    management, or on the hard, business aspect. They
functional units, where conflict frequently results    are unaware that successful change initiatives
over turf. Even when organizations try to improve      must incorporate both-through an emphasis on
quality through such change initiatives as patient-    team-based problem-solving that, in turn,
focused care and reengineering, the traditional        focuses on achieving tangible results.
Moving Toward 'Yes'                                     structure the discussion and decisionmaking
How do you create a team-based environment              process so it most effectively uses the skills of
that encourages all players to work together to         all team members, especially as the team
achieve real results? You follow a four-step            moves through the three stages of decision-
sequence that requires a problem-solving team to        making: data-sharing, discussion, and decision.
1) communicate effectively; 2) resolve conflict;        Identify those team members with strong
3) solve problems; and then, 4) make decisions.         analytical skills (the analytical and the amiable
Ironically, the reverse typically happens, with         in the Merrill and Reid model) and use them
decisions being made before discussions take            to lead the datagathering and data-sharing
place and problems are solved. As a result, the         processes; invite those with strong people skills
process often goes awry and expected results do         (the amiables and expressives) to lead the
not materialize.                                        discussion phase of the process; and involve
                                                        the more result-oriented team members (the
To ensure that teams work together and in the           drivers) in the final, decision-making, phase.
correct order, you must become aware of each
participant's typology and then apply that              To get solid results, you should not try to
awareness to group interaction. In working with         accomplish more than two of the three tasks
teams, I like to start off by having individuals fill   (e.g., data-sharing, discussion, and decision-
out a "styles" questionnaire. Each group member         making) in any single meeting. Encourage
must answer a series of questions to identify one       your team to structure its deliberative process
anthers' leadership styles. Through this exercise,      so that it steadily, but not coercively, moves
group members gain an awareness of how they             toward positive, consensual decisions. One
are perceived by others and they begin to               way to accomplish this is to require the team
understand how, when combined, their                    to develop and adhere to a schedule of rotating
individual styles can lead to the development of        leadership and meeting facilitators. That way,
shared goals, vision, and mission.                      everyone is represented equally in the process
                                                        and each viewpoint is more likely to be
Team members also learn that it is acceptable to        expressed.
be different-that diversity of style is not an
obstacle but an opportunity for change. After           Not only does this process work, it leads to
all, bringing people with different styles together     results that don''t break down under the natural
allows a greater number of perspectives to be           pressures of conflicting styles. Everyone
present during decision-making. As a result,            involved-the analyticals, drivers, amiables, and
deliberations have a better chance of succeeding        expressives-gets the satisfaction they seek from
and producing a positive outcome (see sidebar).         deliberations. They are also able to contribute in a
                                                        way that genuinely enriches, rather than short-
The next step, depending on the type of group           circuits, the process.
and project involved, is to focus on how you can
best use team members' styles to overcome               While this methodology may be different from
obstacles and achieve your goals. To accomplish         the more traditional team-based decision-
this, you should ask team members to set                making process employed in many
expectations for one another and for the team as        organizations, it has proven successful. Not
a whole. You should also require the team to            only does it establish team performance
develop accountability-to determine who will be         expectations, it builds performance guidelines
responsible for what, to establish a timeline, and      for team maintenance over time and supports
to allocate necessary resources.The next step is to     the development of a strong team culture.

                                                                                            Healthcare Executive
                                                                                                NOV/DEC 1997
 Personal Styles
 In their book personal Styles and Effective performance, David W. Merrill and Roger H. Reid
 examine team-building and the effects different leadership styles can have on team dynamics.
 The authors identify four core leadership styles-the analytical, the driver, the amiable, and the
 expressive-and explore the impact each style has on how discussions and decisions are shaped.

   The Analytical                                              The Driver

   The analytical leader is focused on thinking,               Drivers share a few traits with analytical
   analyzing, gathering evidence, and planning.                leaders. Both are task-oriented and prefer to
   Analytical people prefer to work alone, to study            work alone. They differ in their tolerance for
   and restudy data, and then to present that data in          risk, however. Unlike analytical leaders,
   final form to decision-makers. Analyticals are              drivers are the most risk-favorable and action-
   very slow to sign off on anything. The most                 oriented of all four leadership types. Drivers
   risk-averse of all four leadership types, they are          have no patience for slogging through
   easily flustered by the faster – or, as they see it,        ponderous reports; they want to get to the
   hastier – decision-makers. In fact, analytical              bottom line as fast as possible. And, if there is
   leaders may try to stop a change initiative                 a preponderance of evidence, they will make
   because they are obsessed with planning. To                 decisions quickly.
   their credit, however, good analytical leaders
   will spot faulty analysis or planning that others
   may overlook.

   The Amiable                                                 The Expressive

   While analytical leaders and drivers are job-               Like amiable leaders, expressive are focused on
   oriented, amiable leaders are more focused on               people, but they are much more action-oriented
   relationships. Amiable leaders are most focused             than amiable leaders. In fact, they are more like
   on collaborative decision-making, resolving                 drivers. Their focus is on the big picture and
   conflicts, and building individual and team                 their interest is in moving toward the future.
   relationships. Like analytical leaders, amiable             Expressive leaders like to tie people into the
   leaders like to collect data. But while analytical          company vision and are often guided by their
   people collect data from studies and statistical            intuition. Because they have a strong need for
   sources, amiable people prefer to work with                 personal approval and recognition, they are also
   focus groups. That’s because they are natural               very responsive to incentives.
   born people leaders, intent on ensuring that any
   change initiative respects and recognizes the
   needs of people as individuals. While analyticals
   may balk at quick action because “the data isn’t
   there,” amiables will only act once they’re
   certain that everybody involved is “on board.”

Given the distinctions of each of these groups, it is easy to see how each seeks something different from the change
process. Consequently, all four types must be present at the problem-solving table if a change initiative is to be successful.
The critical challenge for healthcare leaders is to ensure that everyone is moving in the same direction and that the special
genius of each type is used to make change possible

Healthcare Executive
NOV/DEC 1997
More importantly, because the process is conscious and     have showcased team accomplishments by allowing
balanced, it makes real progress possible. It moves the    team members to share their innovations on local
team toward definable goals and fosters real ownership     radio and television programs.
on the part of all team members.
                                                           Can it be challenging to realign the patterns of
Group Genius                                               interaction in your organization and foster the
Another advantage of this process is that teams such as    incentives that will lead to sustainable change? It
these achieve high levels of "group genius"-they           certainly can. But that does not mean you should not
harness individual creativity into a larger, more          try. You really have no alternative if you are going to
productive whole. Given the market dynamics and            create the changes (e.g., quality improvements, cost-
operational pressures facing healthcare organizations      effectiveness, and outcomes accountability) that
today, there is a strong need for this kind of group       customers are demanding. Clearly, the time to set your
genius-this innovation. And this need will only            organization on the path toward progress is now.
increase as healthcare organizations are pressured to
continue to improve quality and reduce costs in the        William F Moskal, Ed. D., is partner at Industrial
future.                                                    Relations Inc., a consulting firm in Detroit. Several
                                                           assessment tools are available to help executives
Once your teams are up and running, it is vital to keep    identify team members' strengths, development
the momentum going. One way to support continued           needs, and preferred working styles, including the
activity is to provide for team rewards and recognition.   Myers-Briggs Type Indicator® and the FIRO-B.- Both
In addition to providing incentive pay when                of these assessments are available to executives
appropriate, make it a priority to personally recognize    through the ACHE Healthcare Executive Career
high-achieving teams by thanking them for their            Resource Center. For more information contact Reed
contributions and providing opportunities for them to      L. Morton, Ph.D., FACHE, HE CRC director. FIRO-B
showcase their achievements. Some healthcare orga-         is a trademark and MyersBriggs Type Indicator a
nizations have published advertisements recognizing        registered trademark of Consulting Psychologists
high performing teams in their local newspapers. Others    Press, Inc.

                                                                                              Healthcare Executive
                                                                                                  NOV/DEC 1997

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