Developing Teamwork Excellence

Strengthening the relationships and improving the performance of the administrative team of a busy medical clinic.

Client

A well established, modern and highly respected medical clinic offering a wide range of general healthcare services as well as specialist treatment and consultancy.

Brief

The clinic was growing and the increased workloads and time pressures had revealed serious issues with the way in which the administrative staff team was working. Relationships had become strained resulting in poor communication and a certain level of unhelpful behaviour. A number of the team had been in place for many years and so the ineffective ways of working had simply become the norm. The team manager needed assistance in relation to addressing issues of performance with different individuals as well as managing the team as a whole. The entire situation had begun to impact negatively on the care patients. Thus the objective was to renew the relationships in the team, eliminate the ineffective work practices and help every individual move forward with a fresh approach to their work, to each other, to every patient and to the clinic as a whole.

Challenges

The team had no unified approach to internal processes and ways of working. Everybody had developed their own way of doing things which was causing daily conflicts. There was a certain sense among some of the team that ‘their way was the right way’ and that newer members of the team should simply conform to their way of doing things. Excellent patient care was in second place on the agenda. In addition, because of the poor economic climate at the time, all personnel had received a reduction in wages which was not helping the atmosphere or the team’s morale.

Insight

Having spoken with the practice manager as well as a number of the senior team, the underlying cause of the difficulties revealed itself to be twofold: 1) The administration team was inward rather than outward looking. Individual team members were much more concerned with their roster and their rewards than with excellent patient care. They had lost sight of their role within the clinic as a whole. 2) The practice manager had not been managing the team with the degree of engagement and operational closeness that was required. The absence of management, albeit unintentional, had allowed the team’s poor performance to become accepted as the norm. It is an observable fact that whatever is not addressed will end up being permitted, and whatever is permitted eventually becomes part of the culture of an organisation. In this case, the unacceptable work practices and behaviour had simply become the ‘way we do things around here’. The key was to bring the team to see that the way they were doing things was not benefitting anyone, not the doctors, not the patients and least of all themselves.

What we did

We conducted a number of group and individual sessions with the administration staff over a period of six months. In parallel with this, we scheduled a monthly coaching series for the team manager. During the group meetings, the team was brought through a step by step process which lead them to appreciate that the poor communications and strained relationships had been created by each and every one of the team without exception.

Setting the Objective

At the outset, we asked the team to agree on the objective, i.e. the type of team they wanted to aspire to. All wanted an open, supportive and united team working in the best interest of the whole clinic. As the programme evolved, we asked the team to create certain team rules that were specific to the issues that they were trying to overcome. The idea was that these rules or guidelines, if adhered to by each team member, would safeguard the team’s objective and eliminate the obstacles. These included:

• Fully accept the differences in my colleagues.
• Fully serve the needs of my colleagues.
• Follow the agreed procedures completely.
• Never criticise each other, even silently in the head.
• Always have open and honest communication.

Highlighting Individual Responsibility

During the group sessions team members were encouraged to take a good look at themselves and their behaviour. To expedite this process, we conducted an exercise which highlighted for each individual the precise and detailed ways in which they were contributing to the difficulties as well as the various negative effects that their behaviour was having on their colleagues. As is often the case with this particular exercise, the results were a surprise for people. One thing that became clear was that each individual’s intentions were quite wholesome and the various displays of unacceptable behaviour were in fact unintentional. This was a real revelation for everyone, i.e. the fact that, in most cases, people were unaware of their unhelpful behaviour and more importantly the impact of it on their colleagues. In addition to this exercise, we brought the team through a parallel process which highlighted each person’s strengths, good qualities and positive attributes. The whole process was transformative for every member of the team and it immediately shifted the morale and the atmosphere in general. Each individual left the session with a new willingness to work on eliminating their unhelpful behaviour and bring their positive attributes more to the fore.

A United Purpose

Through facilitated discussion, the team was eventually able to clarify their uniting purpose which was ‘Service excellence for every patient every time’. This purpose highlights the considerable progress that the team made in relation to their attitude to their work, especially given the inward-looking nature of the team when we first met.

A Team Motto

Throughout the sessions, it became very obvious that a common and constant cause of difficulty was the tendency shared by most to leave things unfinished, an attitude of ‘someone else will pick up the pieces’. To combat this we agreed to adopt a team motto: ‘Nothing Left Undone’. Holding to this new motto singularly resolved so many of the small irritating issues that were previously the source of considerable tension and division.

Addressing the Team's Ways of Working

On the procedural side of things, we selected the 10 key processes in the clinic and sought to agree on the best version of each. The essential element here, and the challenge for most team members, was to avoid pushing for ‘my’ version and simply consider which version, which way of doing things was truly in the best interest of all concerned. Throughout this process, the team was brought to see that, whenever the reference point is the good of the individual and not the good of the team, the situation becomes unworkable and chaos is not far away. The reference point must always be whatever is in the best interest of the whole team, not ‘me and mine’. Not only did we secure agreement on the 10 key processes, we also facilitated the precise wording of the instructions and guidelines for each of the 10 areas. These written guidelines together with the team rules and motto outlined above were compiled into a booklet - the clinic’s first team charter.

Team Management

The individual coaching series with the team manager, which ran in parallel with the group sessions, focused on building the manager’s capacity to address individual needs and issues of performance. In particular we addressed the following essentials:

• The nature of the manager-staff relationship
• Identifying and clarifying the different needs of staff members
• Adjusting management styles to suit different staff profiles
• Shifting the management approach from task-focused to people-focused
• Communication – giving feedback when and where needed.
• Addressing issues of performance with staff in a way that motivates and ensures accountability
• Facilitating effective meetings with both the team and individuals in a one-to-one setting
• Performance management as an ongoing daily affair.

Outcomes

Every team member came out of the process much more aware of their own shortcomings and working to eliminate any unhelpful behaviour on their part. Some of the more established staff members had a number of breakthrough moments and came to appreciate how they were unintentionally causing division and dissent within the team. This was crucial to the shift in the working atmosphere. The team manager gained in confidence and capacity, managing people with a much greater degree of operational closeness. As a whole, the team was more outward looking, harmonious and attentive to the full and proper care of the patients and each other.