Conundrum 3
Managing a team

‘Oh not again, not another complaint about the service of the ABC team!’ Sure enough, the next letter in your in-tray is from a parent whose child has been waiting six months for an assessment.

As a director of operations of a busy Trust you have a budget of £30 million and are accountable for services provided by a couple of thousand staff. A challenging role and you know that parts of the service are better than others. However none seems to generate as many complaints as the ABC team.

This is a multi disciplinary team with members from speech and language therapy, OT, physio, dietetics, and nursing. There is also a consultant member and an SHO. Although superficially friendly with each other, you know because you have attended team meetings in the past, several members have let you know informally how unhappy they have become over the last year. The team leader, the more senior nurse, has left, and the team has used the opportunity to ask if they can be ‘self-managing’.

Although described as a team, in practice the individual members operate mostly as independent practitioners, with their own waiting list for patients, their own professional systems for audit and development, and holding their own case notes.

The weekly team meetings can become heated. These are always about individual patients, and some members of the team regularly become irate when other members ( and the consultant is the most frequent ‘offender’) refuse to try and reach a consensus decision, preferring to treat the views of the rest of the team as advisory.

You know that the individual team members are excellent clinicians, each performing well in their own sphere, but you also know that as a team they have never discussed operational processes nor considered how they can offer to their patients the benefits of being seen by a genuine team.

Now they have asked for an additional post, another OT, to reduce the waiting time from six weeks to three.

Desribe some of the problems within the team that are casuing the somplaints you are recieving

What are you going to do about them?

And how?

Commentary 3

Diagnosing problems and addressing them

Any team must be clear about its role and purpose. Here there are two different views within the team about its role. Some members think it is a decision making body in which consensus must be reached. Others believe it to have an advisory role, and that as long as all views are expressed and heard then the decision can be made by an individual within it. Neither of these views is right or wrong per se, and teams can operate with both as long as they are clear which role is appropriate in which circumstances so that at any one time they are clear which role they are fulfilling. The team therefore needs to have a discussion that clarifies their role.

When managing individuals it is important to observe three fundamental rules (see commentary 2), and thesse are just as important when managing teams. So you will need to ensure that the manager agrees with the team what it is expected to achieve; you will need to be confident it has the skills and resources to achieve it ( and that the team members share this confidence); and you will need to ensure they receive feedback on whether they are achieving this. If the team becomes self-managing then these three rules will still need to be observed, but now by the team as a whole.

Once the team is clear about what it is trying to achieve then it will be able to consider the operating processes it needs to employ if it is to achieve it; the assessment processes, cross referrals, collaborative decision making, record keeping arrangements, information sharing, means of challenging the views of others within the team,.... and many more. When these are working well the existence of a team will be apparent to patients and other members of staff in a way it is not currently. Members of the team will themselves find that they lose some autonomy and will be challenged about their priorities and views in a way they are not used to, and this will not always feel comfortable. There therefore need to be very clear means of dealing with differences of view and the team will need to review these regularly to ensure that individual members are experiencing these challenges positively and are growing as a result. Without friction there is unlikely ot be growth but the friction can get out of hand. There will thus need to be some channel of appeal so that if the group develops a set of behaviours that are counterproductive these can be identified and addressed.

Preparation

When dealing with a team it is important to deal with the team and not with individual members of it. Finding a sympathetic member and trying to convey messages through him/her is tempting but, like many short cuts in managment, can lead to more problems than it solves. It is likely to be perceived by the team as uncaring or even cowardly (and indeed it may be!).

The team will know more about their potential, what benefits they can offer their clients, than you will; and similarly you may know very much less about effective operating processes than they can if they think clearly about what they are trying to achieve. Your role will be to ensure they are challenged to think clearly and constructively, avoiding ‘victim’ mode in which they may blame everyone else for the problems they are experiencing. In other words you must be the guardian of the process by which they clarify for themselves their role, implement the three rules, establish clear operational processes, means of dealing with differences of view, and an appeal procedure. You should not step in with solutions you have devised yourself - not if you want the team to accept its proper responsibilities. This does not mean you must sit back and let the team have a cosy chat reaching unthreatening solutions which keep life easy for them and do not take into account the needsof patients. You must ensure an appropriate degree of challenge to their attitudes, and rigour and robustness in their thinking. You must expect that you will not be popular with all of the members all of the time, and indeed be prepared to be unpopular with them all on occasions. This will probably require the kind of visualisation preparation described in commentary 1.

You will find more about managing teams in chapters 1 and 2 of Really Managing Health Care and from our team development activities

model 2, or productive reasoning.

Jo may well start to behave in this different way, but become downhearted when she finds she cannot keep it up. She may find it reassuring to know that all of us will revert to defensive reasoning when we fear embarrassment or threat, so she will inevitably do so, but will find that her ability to reaosn producitvely will improve with practice.

Helen too could initiate the change - but all change requires a source of energy and Jo’s frustration may provide this energy more quickly.

Please send any comments and suggestions to
conundrum@reallylearning.com