Teams are key to solving the American health care crisis

Solving the American health care system crisis is among the most complex and important challenges facing this generation. Is it possible to provide high quality care with better access at a more affordable cost? Is this problem solvable or simply to complicated?  Though that answer is not yet clear, what is increasingly apparent is that a new type leadership is needed if there is any hope in achieving this goal.

Professor Amy Edmondson of Harvard Business school has crafted a practical evidenced based book on how leaders and organizations must approach the increasing complexity of problems they face. Unlike the mindset of execution, which was successful in the past, Professor Edmondson demonstrates that in an increasingly competitive global economy a different approach is needed.

Organizations must learn by teaming.

It is a must read for physician leaders or other leaders in health care.

She provides leaders a clear understanding of how individual and organizational psychology, the reality of hierarchical status, cultural differences, and distance can and do separate team members which can prevent successful teaming. Leaders can close these gaps by understanding the existence of these obstacles and by adapting their leadership style to support and facilitate teaming successfully. She demonstrates the challenges as well as the solutions where teaming has gone well and not so well (the “impossible” rescue of miners in Chile and space shuttle Columbia tragedy) with numerous case studies and insights.

Professor Edmondson also notes that leaders must also thoughtfully identify where the challenges they face fit on the Process Knowledge Spectrum (routine, complex, or innovation). Routine operations could be a car manufacturing plant where outcomes and certainty are known. At the other extreme, innovation operations, like an academic research lab, the outcomes and certainty are quite unknown. Hospitals are considered complex operations. Although the teaming framework applies in each of these three cases, the leader’s specific behaviors and actions change. Having excellent outcomes and teaming necessitates matching the right approach to the correct operation.

Interestingly to maximize learning, conflict and failure are necessary for teaming to be successful. These can only occur if leaders create an environment of psychological safety. Learning thoughtfully from these failures and framing them as essential for continuous improvement and innovation is key for organizations to benefit from teaming.

Most importantly, the learning never stops.

Professor Edmondson provides many examples from health care as she has “spent an inordinate amount of time studying people in hospitals.” In one example, she notes how two of four cardiovascular surgical teams studied successfully implemented Minimally Invasive Cardiac Surgery (MICS) because of how the leader framed the challenge. It was a shared learning experience. The other two teams failed because they focused on the individual surgeon rather than on the team. For doctors, being able to ask others for help is culturally difficult and yet vitally important given the increasingly complexity of hospitals and medical knowledge. She notes that the “single most powerful factor explaining success” among the the four teams was how the leader framed the challenge.

She notes that for 23 hospital ICU improvement teams, those most successful in changing were those “who engaged in the interpersonal learning behaviors crucial to teaming.”

One of the three case studies is about leading teaming in a complex operations at Children’s Hospital. The goal of Julie Morath, the chief operating officer, was to harm no patients and achieve a 100 percent in patient safety. She engaged her staff to solve the problems. She eliminated the tendency of the medical culture to view and blame a medical error as the fault of the individual. Instead via “blameless reporting”, observers merely communicated what they saw and analysis followed. aBy creating a culture of psychological safety, the hospital learned from their “accident” and explored ways to improve the their care. As a result, the hospital became nationally recognized as a leader in patient safety.

“For over a century, we’ve focused too much on relentless execution and depended too much on fear to get things done. That era is over … human and organizational obstacles to teaming and learning can be overcome … Few of today’s most pressing social problems can be solved within the four walls of any organization, no matter how enlightened or extraordinary … Generating ideas to solve problems is the currency of the future; teaming is the way to develop, implement, and improve those ideas.”

Although at times, the conclusions from her twenty years of research and observation seem counterintuitive, her findings and stories woven into a actionable framework and structure makes Teaming–How Organizations Learn, Innovate, and Compete in the Knowledge Economy compelling. It is destined to be a classic reference for leaders today and in the foreseeable future as they lead their colleagues and organizations into confronting and solving increasingly complex problems and challenges.

Professor Edmondson hopes that her book will enable organizations to execute at a higher level only “when leaders empower, rather than control; when they ask the right questions, rather than provide the right answers; and when they focus on flexibility, rather than insistent on adherence … When people know their ideas are welcome, they will offer innovative ways to lower costs and improve quality, thus laying a more solid foundation for meaningful work and organizational success.”

She succeeds at every level.

Davis Liu is a family physician who blogs at Saving Money and Surviving the Healthcare Crisis and is the author of The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy and Stay Healthy, Live Longer, Spend Wisely.

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  • Barry Davolt

    The article is based on an assumption that our health care system is broken but I would challenge this assumption.  I think the only broken part of our health care is the uneven distribution of costs which eschews personal responsibility and in some socialist fashion spreads it around.  We have the finest health care system with respect to cutting edge life saving medical advances but our costs are astronomical in relation to the percentage of GDP we waste vs other countries especially when one considers the bulk of those costs are due to highly preventable chronic conditions.

    • davisliumd

      Agree that the US as a very advanced health care system.

      However, we are not as good as we could be in preventing medical errors, wrong site surgeries, and implementing new surgical techniques (see reply to buzzkillersmith).  Even if we solved the highly preventable chronic conditions, there are still things we can do better.

  • buzzkillersmith

    Davis, where do you come up with this utter nonsense?  Stop smoking the MBA drugs!  The problem is not leadership or lack thereof, the problem is that our HC system  has strong financial incentives for medical students not to go into primary care!  Hence the shortage.  Hence poor coordination and poor outcomes given the money spent. 
    Get more docs on the line and things will get better. We don’t need “visionary leaders”, most of whom could not diagnose and treat their way out of paper sack.  We need doctors and NPs and PAs on the front lines.  Pay them and they will come.

    • davisliumd

      I agree that payment reform is part of the answer and especially in improving the primary care workforce. However, alone it won’t solve the challenges facing health care.

      It doesn’t solve wrong site surgery, medical errors (wrong medication, wrong drug administered, failure to do surgical checklists), etc.  Financial incentives in this area hasn’t worked.

      As doctors, are we too rigid and inflexible that we can’t consider the points of views of other disciplines like business school thinking? Processes that are highly reliable have been implemented in various hospitals including Virginia Mason as well as Intermountain Healthcare. As Professor Edmondson noted even implementation of minimally invasive cardiac surgery depending on teaming.  Only half of the teams successfully did it. The other half abandoned it. If we can’t implement a better surgical method which is better for the patient in terms of recovery and better for the health care system as a whole (fewer hospital days), then simply shifting money to primary care alone won’t fix our crisis.


  • southerndoc1

    Does anyone know where I could find an English translation of the original post?

  • acaffaratti

    Buzzkillersmith is right. We need to be paid for time like lawyers. We need to be freed from the bondage of administrative burdens. The system makes it hard to do the right thing. We need payment reform more than visionary leaders. We need robust primary care for all. We think we need the highest tech care because of marketing, but conservative care is better. When conservative measures fail, we proceed to more testing/ procedures with their given risks. We need to make better choices.But…. a lot of people are making a killing on ill-timed emergent and high risk care and there is no incentive to change this because Washington is lead by lobbyists. Follow the money. We need to address the problems- not kick the can down the road like Medicare Part D and Obamacare. Real reform-cut the fat.

  • davemills555

    Teams? Uh, like our Republican team in Congress? The Death Panel Party? Do you actually believe Republicans want to solve America’s health care crisis? Is this some sort of joke? Republicans view our broken health care system as their version of an economic stimulus. Since when has a Republican ever been an advocate for the health care consumer? 

  • ejunge

    It’s so interesting that the discussion of “teaming” and “psychological safety” makes no mention of the clear contstruction of such safety and interaction provided by a unionized workforce. As Kaiser demonstrates, the teamwork of the front line employees (involved through their union) not only guarantees free interaction and problem-solving, but also ensures better patient outcomes.

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