October 31, 2018
3 min read

STS News, Fall 2018 -- In the last 10 years, much light has been shed on the function of high-reliability organizations. Most of the research has centered around groups in aviation, the military, and first responders. In this article, Dr. Paul Levy highlights useful ideas applicable in the cardiothoracic surgery arena.
Frank L. Fazzalari, MD, MBA, Chair, Workforce on Practice Management

Paul S. Levy, MD, MBA, Chief of Surgical Services and Physician Operational Lead, Physician/Administrator Dyad
NEA Baptist Memorial Hospital, Jonesboro, Ark.

If you want to go fast, go alone. If you want to go far, go together. – African Proverb

Having very challenging surgical cases is nothing new for cardiothoracic surgeons. We recently had one such case. I say “we” because most surgeons understand that surgery is a team sport. Teamwork is at the core of high performance and consistency. Good teams function as a whole—its members helping out where needed and stepping up when required. In our specialty, this behavior can save lives.

But how are high-functioning teams put together? What role does leadership play in fostering teamwork? Answers to these key questions may depend on market size, program size, and administrative support, but never upon mere chance.

The Importance of Leadership

Team building is predicated upon a common vision. High-fidelity teams possess members that understand the vision, work in a collaborative manner, hold each other accountable, and share a relationship of trust. Leadership is the linchpin to team building.

High-fidelity teams possess members that understand the vision, work in a collaborative manner, hold each other accountable, and share a relationship of trust.

A strong leader encourages point-of-service stakeholder input and adaptation—a “can do” attitude. Ideal heart team members are self-starters, innovators, quick thinkers, and possess thick skin. A traditional command and control leadership style can stifle these important attributes. Strong leaders must be able to clearly articulate important team goals and identify educational gaps in teammates that are preventing them from accomplishing these goals. After filling educational gaps, leaders must trust their people and processes.

Creating an environment promoting team camaraderie is the job of a surgeon leader and cannot be delegated to a manager. High-functioning and reliable teams have to feel that their leaders stand shoulder to shoulder with them.

How to Strengthen Your Team

Building a strong heart team has been a priority at our institution. The importance of teammate engagement has led to some impressive and sustainable dividends. Over the past 5 years, we have not only experienced decreased heart team staff turnover, but we also have cut our production costs significantly while increasing overall case volume. Additionally, our STS performance quality metrics have improved.

How did we do it? We gave each team member a voice and showed them that we cared. Monthly heart team “get-togethers” serve to fill educational gaps and promote camaraderie. We begin each meeting with personal life catch-ups and then follow with talks regarding pertinent surgical topics, discuss the surgical “whats and whys” using videos, identify different surgical instruments, discuss anatomy, and end with an inspirational team-building video. This is our formula, and it works. I encourage you to give it a try at your institution. Alone or together, fast or far—it’s your choice.

To view previous practice management columns, visit sts.org/practicemanagement.