- Effective communication, with closed-loop communication and consistent routines, is foundational to team performance.
- Strong teams require intentional investment in every member, including understanding individual strengths, delegating appropriately, teaching skills, and maintaining regular feedback.
- All contributors—clinical and non-clinical—are essential to patient care.
All surgeons lead teams, and our ability to do this helps ensure effective and safe care for our patients. Maximizing team performance can be one of the more challenging aspects of our specialty, and yet it's something most of us have little or no formal training in.
I think of two key aspects to helping your team function smoothly: effective communication, and investment in each member. The more you invest in your team, the better that team will serve your patients.
First off, let's identify our team members. We typically think of our teams as the professionals we might round with - interns, residents, APPs, and so on - organized in a somewhat pyramidal structure under us. Nursing staff are a critical component of our care teams and ought to be thought of as core team members. Office staff play a key role in facilitating care and need to be considered as well.
Good communication with these team members is the foundation of effective teams and safe care. Nothing is accomplished without it. Other professions, like airline pilots or the military, have long understood this. It's not difficult to do. Communication should be closed loop: when data is communicated or directives are given, receipt and understanding should be confirmed.
Newer team members will need to be taught this explicitly. Often, simple breakdowns in communication are the specific difference between highly effective teams and dysfunctional ones. I have yet to find there is such a thing as too much communication when it comes to collaborating with others for patient care.
An element of routine goes hand in hand with effective communication. Put another way, there should be specific and discrete times designated for good communication. Obviously, morning rounds or a morning team meeting are most common examples of this.
At the end of the day, when we're all scattered to the ORs and other places, teams can find a way to share information. Even a five-minute huddle in the hallway or OR can help keep the team on track with patient care issues overnight and make the next day run a bit smoother.
As surgeons, we're taught that independence and self-sufficiency are virtues, but when it comes to team leadership, we must invest in others. Specifically, this requires learning to organize and delegate, and then to give feedback. To do this effectively, it helps to understand your team members' comfort zones and capabilities. This is an often-neglected aspect of good communication.
For example, at the beginning of a rotation with a new team, it helps to discuss strengths and weaknesses. Abilities vary dramatically on July 1 versus the late spring of an academic year, or when new hires come on board. Once you have a feel for team members' abilities, it's easier to delegate tasks appropriately.
It's important to invest in teaching and training for basic things we often forget. New interns or APPs might need basic pointers on how best to prioritize tasks and be efficient. Teaching more experienced residents more complex tasks also makes for time well spent. Frequent check-ins to see how team members are feeling about their skills are a good idea. These may also discover gaps in care, or team members who feel stretched too thin, and so on. These "feedback loops" are a critical part of performance improvement.
Finally, a special note about the office staff we all know is critical to our practices. Not all front office staff are clinical, and there can be frequent turnover. These team members in particular need time and teaching to understand how to best interface with our clinical needs so scheduling and outpatient issues are effectively and efficiently coordinated.
Time spent explaining subtleties of the care process -- tests a new referral might need, what's concerning and what's not for outpatient phone calls, or even details of how you like patients scheduled -- yield huge benefits and helps prevent problems.
In short, we’re all placed in leadership roles by the nature of our profession with little or no leadership training. I know this is something that I’ve struggled to do well. A bit of effort towards good communication and investment in team members really helps to develop a team that provides safe, effective, efficient patient care.