How well does your team work?

May 20, 2005
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Dear Subscriber,

"We've known for more than half a century that engaging people, and relying on self-managed teams, are far more productive than any other form of organizing," says consultant Margaret Wheatley in her essay, "How is Your Leadership Changing?"

In this issue of ISHN's E-Zine, we look at what you can do to make sure your safety teams are clicking and ticking, producing quality safety results.

THE DIRTY DOZEN

"So why then isn't every organization using self-managed teams?" asks Wheatley.

Well, here are a dozen reasons teams fail, based on research from military aviation:

1) Poor leadership / climate — Lack of trust, respect, and problem-solving.

2) Poor grasp of team goals — including poor planning and lack of contingency plans and role definitions.

3) Poor use of available information — instrument read-outs, weather reports, prior records, you name it.

4) Unbalanced workload — In other words, one team member "goes it alone," taking on more than he or she can handle.

5) Diversions / distractions — Poor attention control.

6) Poor communications — Directions or instructions are not clear and direct but vague. Another problem: Excessive chatter.

7) Lack of assertiveness — Junior or less experienced team members fail to speak up and challenge authority when they see something is wrong.

8) Failure to recognize hazards — Teammates fail to note stressors affecting themselves or others such as fatigue, anger or work overload; or environmental distractions.

9) Failure to share information — Team members work with blinders on and focus only on their area of responsibility, neglecting to inform coworkers of changing conditions or new data, or failing to offer assistance.

10) Failure to cross-monitor team actions — Workers "zone out" and miss potential at-risk behaviors and attitudes of team members.

11) Failure to solicit feedback — Another communication breakdown; workers fail to ask for critical information or assistance.

12) Failure to review performance — The team does not look back. Does not critique. And so it does not practice self-improvement.

PAYING THE PRICE

These kinds of mistakes are especially critical — in fact sometimes fatal — when made by teams and crews operating in high-stakes environments, where the pace is fast, risks are high, pressure intense, and time of the essence.

Think of aviation cockpits, space shuttles, operating theatres, emergency rooms, intensive care units, military patrols, emergency response crews, hazmat spill cleanups, construction crews, commercial fishing, logging operations, confined space entries, and lockout-tagout practices.

Each of these activities involve a small group of coworkers, usually operating in close quarters. Fatigue, multi-tasking, communication breakdowns, under-staffing and time pressures can be matters of life or death.

The medical profession has become especially "born again" when it comes to identifying and rectifying problems with teamwork in healthcare settings.

And with good reason. The "Patient Safety in American Hospitals Study" uncovered 1.18 million patient safety incidents occurring among Medicare hospitalizations in 2001-2003.

The medical community is now being graded on its patient safety performance, which ties directly to the ability of doctors, nurses and support personnel to work as a team. HealthGrades (www.healthgrades.com) an organization dedicated to evaluating the quality of hospitals, physicians and nursing homes, uses 13 patient safety indicators to review 37 million patient records and rank the nation's safest and most hazardous hospitals.

BARRIERS TO BETTER TEAMS

But teams in healthcare settings confront many of the same barriers to better safety that teams in industry grapple with. Consider:

  • Command and control cultures are still prevalent in many operating rooms and emergency departments. The core belief: surgeons know best. As leaders, docs are often the strong, aloof type, and not engaging. Subordinates develop an inhibiting "learned helplessness."

  • A similar scenario plays out in many flight cockpits, where the pilot is thought to have "the right stuff" — intangible confidence and skill that distances him or her from the crew.

  • It's all-too-rare for the surgeon / leader to encourage his or her surrounding team to speak out when they see something wrong. "When we investigate medical mishaps," said a cardiologist in an article in Health Leaders magazine, "the healthcare team usually knew something was going wrong and either didn't communicate or really had not been understood."

  • Denial is another problem. In one study, the level of teamwork perceived by attending surgeons compared to other operating room staff differed significantly. Most surgical residents (73 percent) and attending surgeons (64 percent) perceived high levels of teamwork. But only 39 percent of attending anesthesiologists and 28 percent of surgical nurses reported high levels of teamwork.

  • Team leaders often are in denial about their own limitations, too. Seventy percent of attending surgeons agreed with this statement: "Even when fatigued, I perform effectively during critical times." In contrast, only 26 percent of aviation pilots agreed with the statement.

  • Communications, teamwork and other so-called "soft" interpersonal skills are not emphasized in the education and training of physicians, nurses and other medical personnel. A premium is placed on individual technical proficiency, not facilitating human interactions. Many docs are averse to anything that comes close to "psychobabble."

    CREW RESOURCE MANAGEMENT

    One reason pilots are more alert to their own limitations is for years now the Federal Aviation Administration has mandated air carriers conduct Crew Resource Management (CRM) training for all flight crews. Investigations have shown that more than two-thirds of all air crashes involved pilot error — not technical incompetence but a lack of communication and coordination among the crew.

    There is no universal CRM training model. The FAA permits airlines to customize their own programs. Still, many basic principles of CRM apply to workplace efforts to develop effective safety teams.

    CRM's objective is to train team members to detect, prioritize and manage threats, hazards and errors. Leadership, communication, decision-making, and situational awareness are among the skills needed.

    CRM — and really any attempt to improve the efficiency and safety performance of teams — does not lend itself to traditional "chalk and talk" training lectures. Or canned, step-by-step cookbook programs. The dynamics of teams, the interaction of personalities, and the changing conditions they confront require much more flexibility. CRM is usually taught in multi-day workshops, with groups of teams led by a trained facilitator. It's is no two-hour "quick fix" which concludes: "You should speak up more next time."

    If you're a safety pro in industry, you might want to consider adapting some CRM training concepts and techniques to confined safety entry, lockout-tagout, emergency response and other activities requiring communication and coordination among a small group of employees. You can:

    • Use simulations, reenactments and videotapings.
    • Use interactive group debriefings.
    • Educate crews on human limitations (fatigue, workload, etc.), cognitive errors based on misperceptions and the effect of stressors such as multi-tasking, interfacing with lots of technical equipment, and time pressures.
    • Have team members assess personal and peer behavior — openness to feedback, communication styles, reactions to stress and personality types.
    • Have team members monitor and rate critical behaviors affecting team performance, such as the need for high vigilance and not rushing through instructions and directions.
    • Set up peer monitoring and feedback procedures — something familiar to anyone who has implemented behavior-based safety processes.
    • Teach behavioral teamwork skills, such as knowing how to immediately step in and intervene when one team member observes another making a suspected error, taking a risk, or becoming overwhelmed by stressors.
    • This kind of intervention requires teaching communication skills that include inquiry ("Is everything OK? It seems you're falling asleep.)", advocacy and assertion ("Captain, we're losing altitude."), conflict resolution ("Shut up. I know what I'm doing." "No you don't.") and decision-making ("It's time to pull out.")
    • Effective teams also need to be trained in situational awareness — how to process technical data and interpret changing physical conditions; hazard recognition; problems of personal "perception filters" or biases; and awareness of disruptive (intimidating, interfering, deferential, apathetic and risk taking, for example) attitudes and behaviors.

    BENCHMARK YOUR TEAM

    How much your teams might need this sort of training depends on their current effectiveness. How would you rate your teams in these areas:

    TECHNICAL KNOWLEDGE & SKILLS — Team members are competent and understand their roles and assignments.

    SITUATIONAL AWARENESS — Teammates share information and knowledge about working situations. They are alert to distractions, can recognize hazards, and are aware of their own and coworkers' stress levels (fatigue, boredom, overexertion, over-stimulation, etc.).

    PLANNING & DECISION-MAKING — Team goals, directions and instructions are understood. The process of how decisions are arrived at is understood.

    PARTICIPATION IN DECISION-MAKING — Input and feedback are encouraged.

    COMMUNICATIONS — Team members know how to identify problems, alert others, and assist in problem-solving.

    EMOTIONAL CLIMATE — Team members hold positive feelings toward one another. Everyone is clear on job expectations. There is freedom to express oneself, recognition is given for contributions to the team, and involvement and participation is encouraged.

    STRESS — Workload, fear, anxiety, anger, hostility, fatigue, boredom do not reach the boiling point of distress, distraction, and risk.

    ENVIRONMENTAL CONDITIONS — Heat, noise, humidity, vibration, lighting, chemical and mechanical exposures and other physical conditions are at safe levels for team operations.

    LEADERSHIP — Team leaders are proficient in modeling desired attitudes and behaviors, and are open, listening, trusting, and respectful of the team.

    INCIDENT ANALYSIS

    Another way to measure the effectiveness of your teams is to study close calls and reportable incidents. Bring team members together for a post-incident debriefing. Discuss and get their feedback on these CRM markers — factors that the FAA has found to contribute to aviation mishaps:

    • Proficiency training
    • Signs of illness or effects of medication or substance abuse
    • Fatigue
    • Distractions
    • Stress reaching the level of distress
    • Workload
    • Management of tasks
    • Communications
    • Complacency
    • Decision-making
    • Personality traits of team member that might have affect decisions or communications
    • Risk-taking
    • Assertiveness in communicating problems
    • Situational awareness

    NOT FOR THE MEEK

    Organizational consultant Margaret Wheatley says productivity gains in work environments employing self-managed teams are at minimum 35 percent higher than in traditionally managed organizations.

    But Wheatley sees more organizations retreating back to old command and control cultures. Why? Many work cultures never truly embraced participative, empowering, and open work processes to begin with. Some might have dabbled without any real commitment. Keep in mind experts agree if your front line employees perceive that teams are not really valued and supported, any type of CRM-type training will fail.

    "Ideas must be elicited, debated and evaluated without discrimination based on the status of the staff person offering information," states an article in the Academy of Emergency Medicine journal on promoting patient safety and preventing medical error in emergency departments.

    The same bottom line holds true for teams in any work environment.

    Dave Johnson is the ISHN E-News editor. He can be reached at djsafe@bellatlantic.net, (610) 666-0261; fax (610) 666-1906.

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    Are you a safety and health pro or a manufacturer or provider of occupational safety and health products or services who enjoys writing?

    Shakespeare need not apply, but ISHN is looking for authors to publish short articles (1,000 words) in our monthly issues.

    Topics include: safety success stories, close calls and personal experiences, training tips, use of software, engineering controls (machine guards, lockout-tagout), gas detection and air monitoring, confined space safety, personal protective equipment, and OSHA compliance issues.

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