Autocracy or Teamwork

I recently found this in the MGMA Knowledge Center Forum from a member: “I recently ran across an implementation where the practice administrator threatened to charge each staff member $1.00 for every registration error they out in the system. She was serious about this and the staff became terrified of making a mistake. It also was mistake in interpretation of how required fields needed to be entered. This is akin to a swear jar. How enforceable is this and how legal is it? Just curious of HR repercussions with this concept.”

Retha Reeves, a consulting administrator in Houston, Texas and a frequent contributor to MGMA forums, replied with “I’ll leave the legal question for a lawyer. As for HR, didn’t we all learn a very long time ago that management by fear and intimidation is, at best, a disaster? The only successful management style is to work every day toward creating and maintaining a team. A team that believes in the mission of the practice, respects and feels respected by management, and takes great pride in accomplishments. I’ve always counseled that an important part of management is to help your staff be successful in their roles. With a manager such as you described, (s)he totally misunderstands that critical piece and will only breed poor morale, paranoia, and minimal production.”

I completely support Retha’s point of view. I have been a member of teams with autocratic leaders and those who listen to and support the team members. My own experience is that those teams who meet Ms. Reeve’s criteria function best and achieve the best outcomes for patients and clients. I am presently a member of a team that is building a program to prevent falls in elderly people in the community. This team is a part of the Calvin College Rehabilitation Services in Grand Rapids, MI. Recently the team met to fill in a work plan template that included the key activities and how to measure them. Each team member freely contributed ideas for the plan and asked questions to clarify an idea if needed. A great deal of planning was accomplished and I left feeling like my contributions were valuable and welcomed.

The American Medical Association also sees teamwork as benefitting practices by increasing productivity and patient satisfaction as well as employee satisfaction. The success or failure of a practice depends upon the practice’s culture. The AMA believes that practices should focus on improving team culture continuously. They have rolled out on their web site a free online module as part of its STEPS Forward collection that can help practices build a positive team culture. You can find it at by clicking this link.

In the module the AMA lists ten steps for building a strong team culture:

1. Diagnose the current state of your team culture

2. Discuss the results and brainstorm possible improvements

3. Create a staff compact as a group

4. Create opportunities for team communication throughout the day

5. Meet regularly

6. Strengthen the team by focusing on individual development

7. Get to know your team members

8. Teach leaders to be mentors, not managers

9. Create an environment that supports continual learning

10. Engage patients

The module begins by asking practice administrators to assess the culture of their practice by having each team member take an anonymous survey that is provided online. A couple of the questions are (1) Team members say what they really think and (2) All team members participate in making decisions about the work of the team. The module begins with this assessment because it is understood that “you can’t move forward unless you know where you have been”, a common wisdom.

After the staff takes the survey and the results are analyzed by a trusted staff member or a third party quality expert, leaders of the practice should have team meetings that discuss how to move forward. The first thing task for the team meeting should be to write a goal that states the purpose of the meeting and future meetings. It should center on building a culture that values teamwork.

The ‘culture team’ in the first meeting can brainstorm ideas of how to improve the culture of the practice in concrete ways that can be implemented by the leaders and the rest of the staff. I believe that it would be a good idea to use the survey again in the future to see what growth has occurred and to make adjustments that will lead to even better teamwork.

One of the benefits of improving teamwork is that the team can work together more effectively to improve the practice’s processes. Team members can meet to focus on processes that effect patient outcomes, such as processes that improve patient satisfaction and patient engagement. Having practice staff involved in improving processes such as these will lead to markedly better results than if only one or two people are involved. Team members can generate ideas, for instance, in improving patient engagement, and then designate a team member to own the process of implementing their ideas. The outcomes should be measured and reported back to the team.

The development of teamwork among clinicians is taking place in colleges across the U.S. Colleges have created courses that support interprofessional practices. This is the IPE movement. In September 2017 Grand Valley State University in Michigan is hosting a two day conference devoted to Interprofessional Practice, Education and Research. One of the focuses this year of the conference will be telehealth. John Scott, Medical Director and Telehealth Associate Director of the Harborview Medial Center at the University of Washington will be a keynote speaker. One of the breakout sessions at the conference will focus on the collaboration of graduate students in healthcare with Answer Health on Demand, a local telehealth provider in Grand Rapids.

As you can see there are many supporters of the development of teamwork in the healthcare field. The benefits of developing a strong team culture are many, including hitting the Triple Aim of healthcare-better care at a lower cost with improved patient satisfaction. Focusing on teamwork at a practice site will help in the transition to value-based care.