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Dynamic Chiropractic Canada – March 1, 2009, Vol. 02, Issue 02
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Nine Strategies for Building a Cohesive Team

By Shelley Simon, RN, DC, MPH, EdD

In his book Good to Great, Jim Collins uses a bus analogy to make a point about building a great team. Collins says you have to get the wrong people off the bus and the right people on the bus, and then get those right people in the right seats. That's excellent advice, but it's only part of the story. Once you have everyone on board and your bus is motoring down the road, how do you keep from having to pull over every few miles to reassign seats, study the map, settle squabbles and make repairs?

While team-building does require time and effort, the benefits of having a high-functioning team cannot be overstated. Some of these benefits include increased trust, enhanced performance and productivity, job satisfaction and staff retention, shared purpose, and a sense of community. All of this adds up to good traveling companions on a happy bus. The absence of teamwork, in contrast, will show up as unwillingness to engage in honest communication, avoidance of accountability, frustration, resentment, suspicion, and lack of commitment. Who would want to travel on that bus?

This article addresses the fundamentals of building and maintaining a healthy, cohesive team. Something that all healthy teams have in common is an ability to communicate effectively - among themselves, with patients, and with the practitioners in the office. I've coached health care professionals from all around the country over the past several years and have come to realize that almost all staffing problems are related to poor communication. Misunderstandings, assumptions, things left unsaid, and unhealthy or ineffective leadership styles can create chaos within a team. Once chiropractors (and their managers) recognize the value of developing a professional and consistent leadership style, enhance their own emotional intelligence, and model positive communication skills, their staff begins to come together and function at a higher level.

Just because you have a staff does not necessarily mean you have a team. Here are nine strategies to help you develop an effective style of leadership, improve communication in your practice and, as a result, enjoy a more motivated, engaged and cohesive team.

Be clear about purpose, expectations and common goals. This is best achieved through a series of strategic office meetings or during a practice retreat. Once agreed upon, the purpose, expectations and goals of the practice should be documented, updated at least annually, and referenced frequently - especially when there is evidence that the practice bus is weaving dangerously into the wrong lane or is at risk of running off into a ditch.

Develop and use coaching skills. A "top down" management style ("Do what I say because I'm the boss") is outmoded and largely ineffective with today's work force. Communication and collaboration is the name of the game now, and forward-thinking practitioners and their managers are learning and using coaching skills to successfully manage their teams.

Have explicit ground rules about how the team will work together. Again, a group meeting or practice retreat is an ideal setting in which to create and agree upon such a list of rules. Ground rules should be customized to the practice. A four-person office will likely have a list that is quite different from an office with 20 staff members. Ground rules fall into two major categories: task-oriented (how the work gets done) and relational (how we work together). On the task side, consider ground rules about how the workload is shared and how goals are set and measured. On the relational side, personal behavior, fairness, communication, and how to compromise might come into play.

Delegate with clarity. You can help team members avoid boredom and burnout by providing them with new responsibilities and opportunities to grow their skills. When delegating a task or project to an employee, be certain that they understand not only what they are expected to accomplish, but also why. How does this project fit into the bigger picture? What practice goal does this task contribute to? How will the progress of this effort be monitored? What precisely is the desired outcome? Answering these questions will help ensure that the job is done properly and with a high-level of commitment. From the day of delegation until the task or project is complete, check in and coach the responsible individual based on their level of need for support.

Commit resources to staff development. As a practice leader, you no doubt regularly attend continuing education courses as well as professional development and practice management workshops. Savvy practitioners budget for their employees to participate in continuing education directly related to skills they want or need to develop and that will enhance their value to the practice. Seminars on communication, emotional intelligence, team-building, and patient relations are all worthwhile considerations. But don't make the all-too-common mistake of shuttling an employee off to a seminar with the idea that your job is done. Follow up with ongoing support and coaching to ensure that the learning sticks, as demonstrated by the employee utilizing new skills, being more proactive, and implementing effective new policies.

Offer feedback on a regular basis. Both casually and through a formal evaluation process, staff members should always know where they stand. Studies show that feeling valued and being acknowledged at work ranks higher than the paycheck when it comes to job satisfaction. Praise staff members promptly and specifically on a job well-done. For example, if a patient comments on how friendly or efficient your assistant is, relay that information to her before the end of the day. If someone goes out of their way to help you or another team member get through a crazy day in at the office, let that individual know that their efforts were noticed and appreciated. Prompt feedback is also in order when it's less than positive. For example, if you observe an employee being abrupt with a patient, bring it to their attention privately as soon as it's feasible to do so.

Lead with consistency. Whether you have two employees or 22, make every effort to be consistent in your decision-making. Being a consistent leader means applying office policies equally and not "playing favorites." This is easier said than done. When there is inconsistency, it's often unconscious on the part of the practice leader. Let's face it - some employees are just more likable and easier to deal with than others. When making a decision or an assessment about an employee, if you have any doubt about the fairness of your action, pause to ask yourself what you would do in the same situation with a more favored employee. Communicate decisions clearly and to everyone affected, either at the same time or within a short period of time. No one likes to be the last to know about a change in plans or policy.

Plan ahead to resolve conflict. Even with clearly defined shared goals and carefully crafted ground rules, your practice bus will occasionally veer off course, which isn't necessarily a bad thing as long as the bus isn't totaled. When handled in a safe, respectful manner, conflict can be a vehicle to refine views, expand perspectives, and build empathy and respect for diverse opinions. Increased self-awareness and more creative ways to solve problems can also emerge when conflict is managed effectively. Chiropractors in leadership roles should have basic knowledge about how to mediate conflict along with at least basic coaching skills to use when issues arise. Deal with issues that crop up in the office quickly and fairly to demonstrate your commitment to having a harmonious workplace. Ignore conflict and you'll risk rising levels of resentment and tension.

Increase emotional intelligence at all levels in your practice. The eight strategies above will be effective and more likely to "stick" when both chiropractors and practice managers understand the value of leading with a high level of emotional intelligence. In addition, it's possible to raise the level of emotional intelligence among entire teams. You will know if you have an emotionally intelligent team when most of the following elements are in place:

  • strong group identity;
  • effective and efficient individuals functioning as a team;
  • good performance under pressure;
  • high level of trust within the team;
  • good motivation and initiative;
  • team members who proactively and creatively solve problems; and
  • accountability for achieving goals and positive outcomes.

A Process Worth the Effort

It is one thing for a practice leader to have a good working relationship with each individual in the office; it requires different skills altogether to assemble, lead and be a member of a cohesive team. Teams do not spring up magically. Improving communication and building a team involves a dedicated process, but, don't be surprised if you notice a positive change within just weeks or months as a result of implementing even a few of the nine strategies discussed in this article.

Try not to get discouraged if some team members are resistant to change or hold back in their efforts. View this as hidden opportunity to confirm your strong intention to move forward and create a team that is willing to engage honestly, commit to shared goals and achieve results. Even reluctant travelers will come around once they realize they are on a safe and interesting journey with a competent practice leader in the driver's seat.


Click here for more information about Shelley Simon, RN, DC, MPH, EdD.

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