Leadership and Just Culture in Health Care Teams

by Mark Hughes, MD, MA

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    00:00 So let's talk a little bit about leadership in healthcare and having effective teams means having effective leaders.

    00:10 So the leader has to do a variety of things. They have to set priorities.

    00:14 They have to make decisions and once they make the decisions the rest of the team has to agree to those.

    00:21 They have to check in with the team members and making sure the workload is, you know, relatively fair in terms of how it's being shared.

    00:31 So there's a bouncing of that workload within the team.

    00:36 There may be team members that are monitoring the situation, but the leader is also responsible for that and always checking in and making sure that things are working smoothly.

    00:45 They need to know how to utilize resources.

    00:48 So, some teams are going to be with limited resources, others will have more resources.

    00:54 The leader has to figure out a way to bring in resources to maximize performance.

    01:00 And there may be times where the leader needs to call on, you know, for help.

    01:04 Need to go to others within the organization or maybe, you know, work with other teams to get the help that they need so that their particular team can function effectively.

    01:17 And as I mentioned already, the idea of resolving team conflicts.

    01:21 We're human beings, there is going to be possibility of having conflict, but having someone that can be there to help resolve those things work out the differences.

    01:33 So these are the things that an effective team leader will have to do.

    01:36 They have to coordinate and facilitate the teamwork. So that means delegating task or assignments.

    01:43 It means conducting meetings or huddles or debriefs.

    01:46 There may be pre-meetings before you start the work.

    01:49 There may be huddles as you're doing the work to check in how things are going.

    01:53 After our task has been accomplished, there might be a debrief of how did we do.

    01:59 There's a need for a team leader to empower team members to speak freely and ask questions so that openness to communication is going to be very necessary for there to be an effective team.

    02:12 So, making sure the leader says "Yes, I want you to speak up if you have concerns." As I mentioned, there should be quality improvement activities.

    02:21 There should be training of the teams.

    02:23 So if they see that there are deficiencies in any kind of skill or task performance that there's a training opportunity to get that quality improvement.

    02:34 And lastly, there has to be a vision by the leader.

    02:36 So inspiring the team members, making sure there is a positive group culture, really making sure that everyone is committed to the same goal.

    02:48 There are going to be teams that fail. Why can that happen? Well, one reason is unclear definition of roles.

    02:55 If people really aren't sure what they're supposed to be doing, there hasn't been that, you know, forming approach and, you know, getting to a stage where you understand your responsibilities, that might mean that the team fails.

    03:11 There may not be someone that is exquisitely coordinating the team.

    03:14 So that checking in whether it's a particular leader or all members being responsive for this coordination, another reason why teams might fail.

    03:24 And then the biggest, you know, which we see in healthcare is inadequate communication.

    03:29 People don't talk to each other.

    03:31 If people aren't listening to each other, that can be a reason that teams fail.

    03:39 This brings us to the question of well "What if there's a medical mistake or a medical error? How should the team approach that?" In the old days, it might be blame the person that had the error," blame the individual.

    03:57 But it's really been recognized that that's not a good approach.

    04:00 It makes people more defensive and not going to be open to sharing when things haven't gone right or there's been an actual mistake.

    04:08 So, this idea of a just culture means everyone is committed to learning, everyone is committed to open and honest reporting, and everyone is going to work towards improving the system so that the error mistake doesn't happen in the future to another patient.

    04:27 And really the focus comes not on the individual, but on the system.

    04:31 So how can you design the system to prevent the human errors that are just naturally going to happen? How do you set up a system that has accountability when the error does occur? How do you figure out, you know, how to work with team members to shape the behavior so that when they have choices to make, the easy way or the harder way but what's the safest way that they figure out a way to accomplish the task? The just culture mentality also means that there's mindfulness of team members towards making a culture that is focused on safety.

    05:12 So it says that there may not be this hierarchy that we often talk about in healthcare that really it's not deference to a rank or status, but more deference to expertise.

    05:22 If there is a team member that has the more salient expertise for a particular task, you rely on that person.

    05:32 It's also a way to flatten the hierarchy.

    05:34 So, you know, when there are concerns about, you know, things being dictated from above, maybe there's an opportunity say "Well, we have to alter or flatten the hierarchy to fit the specific situation so that there can be this openness of team members to talk." There also has to be adaptability.

    05:55 So, when the unexpected occurs, when things you didn't anticipate happened that you're able to adjust and adapt to respond to the new situation.

    06:07 And always, you know, if it's you know safety or patient well-being, whatever the core goal is, that that sense of the big picture is always kept in mind as you're completing each individual task as a team member.

    06:23 And also when we're thinking about the system as a whole, this is an opportunity to promote innovation.

    06:29 So team members that are always doing the same thing and it always, you know, is a hard task, if they can innovate and figure out ways to make it a simple task or less prone to error, they share that and then that gets moved up into, you know, the administration and others in the institution to make sure that the just culture has that learning opportunity and innovation is foster.

    About the Lecture

    The lecture Leadership and Just Culture in Health Care Teams by Mark Hughes, MD, MA is from the course Communication with Patients and within the Health Care Team.

    Included Quiz Questions

    1. Balancing workload within a team
    2. Avoiding monitoring a situation
    3. Leaving it to the employees to maximize performance
    4. Not showing weakness
    5. Avoiding asking for help
    1. Inadequate communication
    2. Goal-setting
    3. Emphasis on culture
    4. Employee monitoring
    5. Leadership change
    1. Hierarchy flattening
    2. Focusing on rank when appreciating expertise
    3. Focusing on status when appreciating expertise
    4. Free snacks
    5. Early dismissal for good employees

    Author of lecture Leadership and Just Culture in Health Care Teams

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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