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The way we do things round here: fostering a supportive team culture

Dr Jude Tweedie and Dr Nina Dutta Royal College of Physicians, London 21 November 2017

We have collaborated with the Royal College of Physicians on a set of resources for clinicians to use to improve teamwork in their workplaces.

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Good team working is essential to both the enjoyment we get and the effectiveness of our work. Being part of a good team not only improves the ability to just get stuff done but also makes individuals feel valued, purposeful and adds a sense of belonging. The best teams we have worked in provided a buffer from day to day challenges, a much-needed port in a storm.  This respite can take the form of a sympathetic ear, a helping hand with a difficult job, or sourcing a double espresso in the twilight hours of a night shift.

The culture of a team underpins its ability to succeed and flourish. Culture in this context is taken simply to mean “the way we do things round here” (Reason, 1997). In healthcare we sometimes subscribe to the notion that culture is set by the powers that be.  In reality, the nature of our interactions with those we work with most closely have a much more significant impact on our perception of the working environment.

The Royal College of Physicians has collaborated with the Point of Care Foundation on a series of resources, ‘Improving teams in healthcare’, which clinicians can use to improve teamwork in their workplace. Four key principles were recognised as being fundamental to creating a positive team culture.

Celebrating success and acknowledging contributions

The easiest way to acknowledge the contribution of a team member is to say thank you. Yet in the hustle and bustle of daily clinical practice this simple civility is often lost. For us, it took stepping out of clinical practice and into our respective fellowship years to be reminded of the value of thanking others for their contribution. Still, neither of us gets it right all the time.

Celebrating success is particularly challenging in healthcare, because there is always more work to do. Yet, so many significant achievements occur on a daily basis. This can range from completing a procedures list through to running a successful take, finishing an audit, launching a new admissions pathway, or receiving a complimentary letter or thank you card from a patient or colleague.

Having a clear set of goals or objectives for any team means there are clear times at which to celebrate achievements. Unfortunately, this still seems to be done poorly in healthcare. In the 2015/16 NHS staff survey 28% of staff did not agree that their team had a ‘shared set of objectives`. (NHS Staff survey, 2016) Creating objectives or goals does not need to be overly complicated and any team member can do it.

Encouraging members to seek help when needed

The NHS staff survey demonstrates the incredible dedication of all members of the healthcare team. 72% of staff work extra hours while over half of all employees attended work in the last three months despite feeling unwell. (NHS Staff Survey, 2016)

Good teams will have the systems in place to allow members to ask for help. The best teams actively encourage team members to seek help when needed. Support may be as straightforward as moving work to another part of the team, or it may require more complex, long-term intervention. Discussing issues at an early stage rather than once the situation is out of control will be of benefit to the individual, team and organisation.

Promoting an open and honest culture

We both remember vividly how it feels when you realise you have made or nearly made a mistake. An open and honest culture enables team members to share, learn and receive support when these situations occur.  It makes individuals feel comfortable discussing what matters to them, be it a fledgling idea, a mistake or an achievement they hope to celebrate.  An honest culture is one which embraces different viewpoints, healthy debate and difficult conversations.

We identified two techniques which can be used to create an open and honest culture: flattening the hierarchy and encouraging feedback. Both require all team members to participate. It is not easy to flatten the hierarchy if you are the most junior member of the team. Great team leaders create cultures in which everyone feels confident to speak up and knows their contribution will be valued.

Feedback is a good method to prevent team members having to guess or assume each other’s motivations. It works best when given frequently (definitely more than once a year at an annual appraisal), occurs immediately after an event, is delivered by a supervisor or respected colleague, and when there is scope for improvement.

Challenging unprofessional behaviour

We all have off-moments. But persistent poor behaviours impact on team morale, cohesion and performance. There is no universally accepted definition of what constitutes unprofessional behaviour, but it is likely to include that which impacts negatively on patient safety, disrupts team working or leads to breakdowns in communication.

The culture of the team can be defined by the behaviours it does and does not permit. Encouraging feedback within the team, enabling debate and discussion and agreeing a code of conduct can reduce the impact and frequency of unprofessional behaviour.

It takes time, persistence and tenacity to change the culture. Getting it right at the start can save considerable hassle further down the line, and will have a positive impact on productivity and efficiency. Even more importantly, the right team culture helps to create a pleasant working environment where people derive satisfaction from their work.

In conclusion, culture is “not about offering yoga lessons and interest-free loans for travel cards. It is both hard and soft: the attitude to the way you do work and the structures and processes that surround.” The RCP and Point of Care Foundation will continue to advocate on behalf of all those who work within healthcare.  But it is organisations that have a responsibility to their patients to foster the structures and processes which enable staff to work to the best of their capabilities.