Teaming up to deliver integrated care

Teaming expert Professor Amy Edmondson of Harvard Business School talks about her experience of a recent NHS Leadership Academy Masterclass and how her research forms the basis of the resulting report.

I was delighted to recently attend an interactive masterclass session arranged by the NHS Leadership Academy and Novartis UK. Here, I had the chance to meet senior leaders from across the NHS in England. I see the NHS as a shining example that demonstrates how a nation can deliver great healthcare at scale. It’s clear that there are pockets of true excellence within the UK’s healthcare system, but also places where there is an opportunity to learn.

Leaders from the NHS spoke to me about the need for them to build shared ways of working and mutual trust between team members as they establish Integrated Care Systems

I’ve spent many years researching how to build teams among experts coming from diverse organisations and backgrounds, because it’s become crucial to the work we do in today’s world. To work as a team, without being a well-practised or familiar team is challenging. It’s also imperative!  More and more, to deliver success in our increasingly integrated world, especially in healthcare delivery, people are being asked to team up across boundaries of all kinds (specialty, location, ward) to get work done.

During the NHS Leadership Academy Masterclass, I discussed some of my research into teaming and also how leaders can enable the people in their organisations to better learn from and collaborate with each other. These are vital skills to achieve successful performance in a constantly evolving healthcare environment.

We discussed how a four-part approach to teaming can help increase the chances of success:

  1. Aim High. Set a clear, ambitious, and meaningful vision which inspires people by focusing on the humanity of the work – the things that matter to us, not some business process or performance indicator – and aligns their effort around that goal.
  2. Team up. Bring together the right mix of people for your project. A homogenous team may have greater chance of success in routine tasks, but diverse teams have the ability to achieve breakthroughs by creating the synergies to innovate.
  3. Fail well. Identify opportunities for intelligent failures that provide information on how to improve approaches and systems. The point at which the system breaks down will often be the greatest opportunity to learn.
  4. Learn fast. Maximising learning requires focus, discipline and structure when reviewing failures. The US Army uses four simple ‘action review questions’: What did we intend to do? What actually happened? What is the difference and why? What will we do the same and what will we do differently next time?

In addition to building teams, another of my research interests centres on a concept that I introduced following studies of successful behaviours within large organisations: Psychological Safety.

Psychological Safety is a work climate characterised by the sense that ‘I can and must speak up’ with work relevant information, questions concerns and even mistakes – it’s mission critical for quality, safety, and even learning and teamwork. It gives permission for candour.

In a knowledge-intensive workplace, like healthcare or pharmaceuticals, it is crucial that people can bring their full self to work – and this in turn is vital to delivering safe care. Healthcare teams need to feel empowered to raise concerns, share ideas and be able to take responsibility for mistakes without fear.

Psychological safety is not a license to relax, or about sacrificing performance to give people an easier time. On the contrary, high standards coupled with high psychological safety provide the ideal environment in which to learn and develop.

How can leaders encourage a psychologically safe environment within their organisations? We discussed a four-step process:

  1. Framing the work accurately – and in ways that build a shared understanding of the complexity, uncertainty, novelty or ambiguity that lies ahead. This will encourage the right types of behaviours.
  2. Invite engagement – asking good questions focused on what matters broadens the discussion, invites careful thought and gives people a voice. Example questions include: Who has a different perspective? What are we missing? What other options do we consider?
  3. Focus on specific points raised – investigate the evidence or insights behind other perspectives and opinions. Remember that the tone in which a question is asked makes a huge difference to the way it is interpreted.
  4. Respond productively even when the news is bad – receiving honest feedback needs to feel like a positive experience for team members. Responding badly to difficult information will encourage a culture of covering up.

This is just a quick summary of the content we covered in the Masterclass. If this is of interest to you – I hope you will download the report for more details.

Amy Edmondson

Amy C. Edmondson is the Novartis Professor of Leadership and Management at the Harvard Business School, a chair established to support the study of human interactions that lead to the creation of successful enterprises that contribute to the betterment of society.

Edmondson has been recognized by the biannual Thinkers50 global ranking of management thinkers in 2011, 2013, 2015 and 2017 and was honoured with the Talent Award in 2017. She studies teaming, psychological safety, and leadership, and her articles have been published numerous academic and management outlets, including Administrative Science Quarterly, Academy of Management Journal, Harvard Business Review and California Management Review. Her books – Teaming: How organizations learn, innovate and compete in the knowledge economy (Jossey-Bass, 2012), Teaming to Innovate (Jossey-Bass, 2013) and Extreme Teaming (Emerald, 2017) – explore teamwork in dynamic organizational environments. In Building the future: Big teaming for audacious innovation (Berrett-Koehler, 2016), she examines the challenges and opportunities of teaming across industries to build smart cities. Her new book,The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation and Growth (Wiley, 2018), offers a practical guide for organizations serious about success in the modern economy.

Before her academic career, she was Director of Research at Pecos River Learning Centers, where she worked on transformational change in large companies. In the early 1980s, she worked as Chief Engineer for architect/inventor Buckminster Fuller, and her book A Fuller Explanation: The Synergetic Geometry of R. Buckminster Fuller (Birkauser Boston, 1987) clarifies Fuller’s mathematical contributions for a non-technical audience. Edmondson received her PhD in organizational behaviour, AM in psychology, and AB in engineering and design from Harvard University.