By Steven Foster, FACHE, President of St. Luke’s Health–Patients Medical Center and Sugar Land Hospital

Constructing effective teams is an obligatory duty for all leaders aiming to influence action and achieve system goals. Strong teams are of particular importance within health care due to the inherent nature of how care is delivered. From the moment you recruit talent for your health care organization, those clinicians and other staff members are surrounded by team members who must rely on each other to deliver care to patients seeking help during their most vulnerable moments. 

Properly developed teams help eliminate any perception that the organization operates with a traditional siloed mentality. Rather, teams reflect the reality that clinical and nonclinical team members and jobs are all interrelated and dependent on others. Health care teams communicate bidirectionally, both horizontally—nursing with physicians, or clinicians with pharmacists—and vertically, from a single departmental unit to middle management to senior management. Anecdotal evidence indicates effective teams are more efficient and less likely to make mistakes, which helps build a lasting culture of patient safety. Research backs this, as a study published in BMC Nursing states, “Teamwork builds on employee cohesion and reduces medical and nursing errors, resulting in greater patient satisfaction and improved health care.”

With teams wielding such potential benefits, health leaders must understand how to build teams that work well together and maintain appropriate levels of autonomy.

Finding Trust in the Process

Trust is important in any relationship and paramount in constructing an effective team. To create empowered teams that improve patient outcomes and team member satisfaction, health leaders must acknowledge the trust meter.

Teams typically form in order to address a specific issue. Initially, most new teams launch with a low level of trust—or at the bottom of the trust meter—which can postpone substantial progress on the issue at hand. Thoughtful leaders can circumnavigate this obstacle by building trust within the team at the earliest opportunity.

Early trust-building efforts team leaders can make include:

• Be transparent and relational. Speak openly and honestly to team members about the goal of the team and get to know team members as people. Health workers share a passion to help others. Use this shared aim to frame the problem in a way that speaks to health workers’ primary purpose.

• Celebrate member diversity. Health care is a team effort dependent upon various skills and strengths. Recognize and celebrate the diversity within your team, as this diversity allows a team to remain flexible and endure inevitable challenges.

• Designate a loyal dissenter. It’s important for team members to get along, but strong teams avoid drifting toward a group-think scenario in which no one is willing to raise valid concerns. Assigning someone the task of loyal dissenter guarantees a dose of constructive criticism, which leads to testing and improving upon potential facility or corporate solutions.

Empowering Teams Through Tier Organization

Teams are built with varying levels of authority, which confers ownership and inspires them to take appropriate actions. This doesn’t empower teams to change policy or make unilateral decisions. It ensures team members understand and follow protocol for elevating recommendations after studying the problem for which the team was created. 

Across St. Luke’s Health, we deployed a multi-tiered management system to guide teams when they’re ready to make suggestions. This system has the following tiers:

• Tier 1: Departmental. At this level, any frontline staff can identify areas with potential for improvement and suggest solutions to realize this potential. Once a suggestion reaches the unit leader, that leader can either resolve this within the department or, if necessary, escalate it to the next tier.

• Tier 2: Multi-departmental. Consulting additional departments helps when a proposed solution requires additional conversation or insight from other stakeholders. The majority of team recommendations find resolution at this level. 

• Tier 3: Senior management. If a decision involves a new piece of equipment, technology, policy change or other change with facility-wide implications, the issue escalates for a final recommendation and decision. 

Organizations previously relied on leadership alone to solve organizational problems, but those days are gone. Our frontline teams are intimately acquainted with daily challenges to improve care. Part of the goal of leadership is to break down communication barriers and drive innovation at the front line, where the work gets completed. Tiers allow for bidirectional, constant communication between teams at all levels of the organization, empowering teams and frontline workers to challenge the status quo. 

Rejecting Traditional Silos Through Teams

This concurrent vertical and horizontal communication and cooperation facilitated by teams has real-world implications. In late 2022, CommonSpirit Health began implementing a new calculator to estimate glomerular filtration rate (eGFR) as recommended by the National Kidney Foundation and American Society of Nephrology. Unlike previous calculators used to estimate kidney function, this one does not include a race variable. As a result, it positively promotes health equity among underserved communities.

The implementation process required substantial communication between leadership, local laboratory staff members and medical staff within each facility. Teams worked vertically and horizontally upon a foundation of trust, breaking through traditional silos to adopt the new recommendations by January 2023—a feat made possible only by strong teams.

Building Forward-Thinking Teams

While some teams necessarily have a short shelf life, others continue to offer benefits for years and even decades. A common thread among teams that pass the test of time is the ability to avoid stagnation. Lasting teams change constantly, adapting to the ever-evolving health care landscape.

Health leaders play a role in the longevity and success of a team. Both at the launch of a new team and as a team ages, leaders should:

• Identify needs and provide resources to increase a team’s likelihood of success

• Celebrate victories and then continue pushing toward innovation

• Reassess team membership to ensure the presence of proper skills and stakeholders

Additionally, even teams built to address a pressing matter should be encouraged to have an eye on the future. When anticipating tomorrow’s challenges and finding solutions to problems yet to arrive, teams are at their most effective and rewarding.