Show Notes
Description
Dr Daniel Eiferman visits the FAMEcast Studio as we consider high-functioning teams in medicine. Discover how trust and psychological safety protect against frustration, burnout, and missed opportunities. We hope you can join us!
Topic
High-Functioning Teams in Medicine
Learning Objectives
At the end of this activity, participants should be able to:
- Identify common causes of team dysfunction in academic medicine.
- Explain the role of trust and psychological safety in building a strong team.
- Apply strategies that foster vulnerability, trust, and psychological safety in a medical team.
- Evaluate approaches for strengthening accountability and encouraging discretionary effort.
Guest
Dr Daniel Eiferman
Professor of Surgery
The Ohio State University College of Medicine
Links
The Five Dysfunctions of a Team (Table Group)
Yerkes-Dodson Law of Arousal and Performance (SimplyPsychology)
What Google Learned From Its Quest to Build the Perfect Team (NY Times)
How Google Builds the Perfect Team (YouTube)
Episode Transcript
[Dr Mike Patrick]
This episode of FAMEcast is brought to you by the Center for Faculty Advancement, Mentoring, and Engagement at the Ohio State University College of Medicine.
[Music]
[Dr Mike Patrick]
Hello, everyone, and welcome once again to another episode of FAMEcast. We are a faculty development podcast from the Ohio State University College of Medicine.
This is Dr. Mike coming to you from the campus of Ohio State. It’s episode 13. We’re calling this one the secret sauce of high functioning teams.
I want to welcome all of you to the program. We are so happy to have you with us. As you know, strong teams are really essential in academic medicine, whether we’re in the clinic or the hospital, a classroom, administration, or a research lab, wherever we are, teamwork is really important.
However, dysfunction often creeps in leading to frustration, burnout, and missed opportunities. So, in today’s episode, we will explore the foundations of teamwork. And along the way, we’re going to consider trust and psychological safety.
And we’ll attempt to identify the secret sauce that leads to strong, high performing teams in medicine. Of course, in our usual FAMEcast fashion, we have a terrific guest joining us in the studio to discuss the topic. Dr. Daniel Eiferman is a professor of surgery at Ohio State. Before we get to him, I do want to remind you very quickly that the information presented in our podcast is for general educational purposes only your use of this audio program is subject to the FAMEcast terms of use agreement, which you can find at FameCast.org. So, we’ll take a quick break. We’ll get Dr. Daniel Eiferman settled into the studio, and then we will be back to talk about high functioning teams. It’s coming up right after this.
[Music]
[Dr Mike Patrick]
Dr. Daniel Eiferman is a professor of surgery at the Ohio State University College of Medicine. He has a passion for helping medical teams, not only succeed, but achieve a strong, high level of function.
That is what he is here to talk about. High functioning teams in academic medicine. Before we dive into our topic, let’s offer a warm FAMEcast welcome to our guest, Dr. Daniel Eiferman. Thank you so much for visiting the studio today.
[Dr Daniel Eiferman]
Hey, my pleasure. Thanks for having me, Mike. Really appreciate it.
[Dr Mike Patrick]
Yeah, I am really excited for this conversation because over the last, I would say 20 years and maybe even more so in the last 10 years, this idea of teamwork in medicine has really come to the forefront and it sure makes sense because especially as medicine has become so specialized and there’s so many different areas, it’s really tough to be an expert in all things. And so, we come together as a team to provide the best care for our patients or to do the best research or to lead a hospital through administration.
So, teams are really, really important. However, they oftentimes are a little disappointing when you’re actually a part of a team. So, what, what are the main reasons why teams in academic medicine sort of have a tendency to fail if just left to their own devices?
[Dr Daniel Eiferman]
Yeah, it’s a great question. And I think that my answer goes to all teams, not just that our teams in academic medicine, but one of the main tenants that I talk about when we’re talking about why teams don’t function at a high level is there’s a great book out there called the five dysfunctions of a team and it describes it as a pyramid in there. And I usually focus on the bottom two aspects of the pyramid of what it is that don’t allow teams to function at a high level because the bottom of the pyramid is, you know, that’s the base that contributes the most to it.
So, the number one thing that goes on the bottom and it’s true of any relationship that you’re in and that is when there’s an absence of trust, teams do not function at a high level. So that is the biggest base of the pyramid that you have down there. The next biggest contributor to that, because the teams don’t trust each other, there’s a fear of conflict and conflict has this negative connotation to it that conflict should be avoided.
But conflict actually is a good thing if it’s handled healthy. Healthy conflict is actually when, Hey Mike, you’re pretty smart. You’ve got some good ideas.
Maybe I’ve got some good ideas. If we put them together, we’re going to get better results. And that can only happen if we can have healthy conflict between the two of us.
So those are really the main two things that when I give a talk on teamwork is absence of trust, fear of conflict.
[Dr Mike Patrick]
Yeah, a really good point. And in the book that you mentioned, the five dysfunctions of a team, we are going to put a link in the show notes for folks if they want to take a look at that and sort of take a deeper dive into this. That’ll be in the show notes over at famecast.org.
This is episode 13. So, you’ll be able to find a quick and easy link to the book there. So, we have this pyramid, we have trust at the bottom.
How do we begin building trust on a team? So that’s not just something that happens organically, does it? Like we have to actually be intentional about building trust.
Completely.
[Dr Daniel Eiferman]
And I always say whenever I give a talk or give a class, like I want to give tangible take home messages that you can impart versus just, you know, when people say, you know, whatever happens here stays here, things like that. There are actually things that you can do. And here’s the number one thing that I tell people that I think is somewhat counterintuitive and that is show your vulnerability upfront to build trust in your team.
So, when we don’t have trust in a team that leads to invulnerability, I’m not going to drop my guard with you and let you know what my concerns are or any insecurities that I may have. However, if I’m willing to come in and show that I am human, a regular person and say, listen, I’ve had issues with this before or I’ve had trouble with this or, and I show my vulnerability upfront, I will actually build trust with my team.
[Dr Mike Patrick]
Yeah. How do you do that? Let’s say in the operating room.
So, since you’re in surgery, how do you show vulnerability when people are looking to you and trusting you to sort of lead this thing and have a successful outcome? That’s a fine line to walk, right?
[Dr Daniel Eiferman]
It is. But I will tell you, I think that people have the notion in their head that the surgeon should be this, you know, almost dictatorial for like, we’re doing it this way. And this is the way that they want confidence.
And I don’t care if you’re a nice guy or not. I just want you to have good hands and good. And I actually don’t think that that’s accurate.
I think that’s more of a, more of a stereotype. And specifically, for something like in the OR and even outside of that, I actually find like the, the self-deprecating is probably the best way to go about it. So, I’m doing a difficult case, or I have somebody who’s new or a trainee that hasn’t done something before.
It’s just something else. And I was like, listen, you can’t screw this up any more than I have previously. You know, the only reason that I got here is because I have, you know, good judgment comes from experience.
Experience comes from bad judgment. So, I share something like that. So now they see me as a human, somebody who has been in their shoes before.
And instead of just coming to say, hey, the first time I ever did this, you know, I was God’s gift to surgery. I never made a mistake. And that’s what I expect of you.
It’s listen, this is tough. I’ve been there before. I know what you’re going through now.
I am a human that they can relate to, and they are much more likely to share their vulnerabilities with me and us form a connection together.
[Dr Mike Patrick]
And I think that they’re able to better perform actually when you lower that stress level of, I have to be absolutely perfect. A hundred percent of the time when you give them permission not to be perfect, then they don’t have to worry about it. And they’re actually less likely to make a mistake.
[Dr Daniel Eiferman]
There’s actually science behind this and it’s something that you could certainly put a link to at the end. But for those who want to put graphs and figures, just things, I don’t know, Mike, have you ever heard of the Yerkes-Dodson curve? I have not.
No. Y-E-R-K-E-S hyphen D-O-D-S-O-N. But they put a curve together where on the X axis is your level of stress or anxiety.
And on the Y axis is your performance. And it looks to be a bell-shaped curve where if there’s no stress and no anxiety, then your performance is actually low. And I make that akin to when the cat’s away, the mice will play.
Nobody’s working, nobody’s looking, you know. Then on the other end of the bell-shaped curve, that’s when you’re just worried about getting berated and yelled at and any little thing you do. And it shows that if you’re at that level of stress or anxiety, you’re going to perform at a worse level.
In the middle where you perform at your highest, they use the term like productive anxiety. That’s where I try to be with teams, trainees and all that stuff. That’s the level of; I don’t want to disappoint you.
And you’re so if you have a little bit of anxiety, that’s actually a good thing. You’ll actually perform it a little bit better, but you have to be able to draw that line to either not be too far to the left of the curve or not too far to the right of the curve.
[Dr Mike Patrick]
Yeah. Yeah. And that, that vulnerability, you give that example of in the operating room, but really, we can take any situation, whether you’re teaching, maybe you’re on rounds, you’re doing administrative work for your institution.
There’s really, you know, all the different hats that we wear in medicine. Really, you can still do that. And you may need to be creative in finding a way to show your vulnerability, but it’s an important thing.
[Dr Daniel Eiferman]
Very much so. I mean, listen, our brains are wired. We tend to remember our failures more than our successes.
Our failures hurt us more than our successes do. So, any situation that you come in, and somebody asks you for some story or some recollection, it’s actually usually easier to pull out things that you have screwed up than it is things that you knocked out of the park. So, whether I’m on rounds or I’m in a meeting or anything like that, you can always like, let me tell you how I screwed this up before, or let me tell you about some bad ideas that I’ve, that I’ve tried and not failed.
So, I’m glad you guys are here to maybe bring new blood in or tell me what you think, or is there something new out there? And again, that invites in conversation, and you know, that is one of the main tenets of getting your team to function at a high level is if you can get everybody to contribute about an equal amount, that’s when your team actually functions at the highest level.
[Dr Mike Patrick]
And as the leader of a team, it’s going to be important to have an understanding of what individual team members, what their strengths and their weaknesses are. So that you can kind of push the work that that’s going to be satisfying to them and that they have talent and passion for. And there’s, there’s a definitely an art to that.
I would imagine.
[Dr Daniel Eiferman]
There is, if you, if you want to kind of dive into that topic of how it is that you can find out, you know, where it is that people thrive and things like that. They say that there’s really three, three main things that contribute to you and I having a relationship where you’re going to accept feedback from me and I’m going to receive feedback from you. And those three things are, number one is a connection.
Do you and I have a connection between each other? We tend to listen to the people that we feel like we have a connection with. So that’s number one.
Number two is trust. We only are going to listen to people and take feedback from people that we trust. And we can only number one and two go together.
I’m only going to form a connection with you if I trust you. And I’m only going to trust you if I have a connection with you. Then number three is one that people don’t think about as much.
And that is noticing. And that is I have to have enough points on the curve between my connection and trust with you to notice things and be able to say to you, Hey Mike, I noticed when you were on rounds and you give your differential diagnosis that it’s X, Y, or Z or this technique that you use in the operating room to hear somebody say, well, I’m hearing from the staff or I’ve heard from other people that doesn’t count. I need to do the noticing myself so that I know what it is that it’s going to make you feel comfortable and how I’m going to get you to perform at your highest level.
So, connection, trust, and noticing.
[Dr Mike Patrick]
Yeah. All really important. And, and it, it really does begin with that the trust and that vulnerability showing it.
Can you give an example of a trust building just from your own practice?
[Dr Daniel Eiferman]
Well, I would probably say the biggest thing that I’ve seen in trust building is the minute that I drop my guard and show my vulnerability is that met with a you dropping your guard and you showing your vulnerability to me or B was that a major turnoff for you or you’re going to use that against me in some way that you know, what you usually find I would say 90% of the time is when I say something like God, the first time I did this procedure, you know, I didn’t sleep for a week and I checked the patient’s chart every five minutes to make sure that they’re okay. That’s almost always met with or thank God, or you know, something like that. You can usually tell it in their body language more than anything where they relax and things like that.
You’re very likely going to have trusting relationship with there and that’s usually met with them sharing some sort of vulnerable. I am nervous about this. I haven’t done this.
I don’t want to screw up. I don’t want to hurt the patient. I don’t want to sound stupid, whatever that thing is.
If when that happens, when that happens, they would say that what you’re about to engage in is what’s known as a deep conversation and that you and I are actually going to get closer when that happens. And when we have those, we build trust.
[Dr Mike Patrick]
Yeah. So, so important. Do you find that that some folks, this is a process that takes some time.
So, you know, that would, if so, then that would mean that the teams that we have, you know, if you can have longevity of the people in your team and there’s more time to build trust as opposed to teams that may have new people coming in and out all the time, which in academics, especially as we have learners, if they’re a part of the team that becomes, you know, you don’t have as much time to build trust. Are there any tricks to building trust more quickly? Probably not.
[Dr Daniel Eiferman]
Not that I know of. That’s why, like I say, you know, I go into an operating room with a trainee, a circulator, a scrub tech and who hasn’t done it before. I go straight for, for the I’m human and I’m happy that you guys are, are all here.
We’re going to treat everybody. You know, I have realistic expectations of everybody here. That’s really the only way that I know.
And having done a decent amount of reading on the subject in a fast environment. The other thing I guess that I would say, and I mentioned one of the, the elements before is very hot topic or keyword right now is the term psychological safety. And how can you build that?
Because when you have psychological safety in a group, whether it’s a new group, that’s formed an old group of more, that’s when people are willing to ask questions, ask for help, offer up their own things, admit that they were wrong, disagree with you. That’s wrong. And so, you then say, okay, your natural next question is a great podcast host would be, gee, Danny, how do you build psychological safety?
And so, whether we ask about a new team, there’s been two things that have actually been shown to build psychological safety. And this came out of studies actually out of Google. And number one is a term called ostentatious listening.
And listening is a skill that most of us are not very good at. And learning to be a great listener is a great skill that we should all try to master because that listening is willing to build is the number one component of psychological safety. And it’s not just listening, but it’s, it’s mastering.
Like they talk about communication, Mike, as, as having three parts to it, the words that you say, the tone of voice that you use and your body language while you’re here. And they break, if you break that down to a hundred percent, Mike, do you know which of those three things actually has the lowest impact on your communication?
[Dr Mike Patrick]
I am going to guess words. I’m only going to say that though, because I have studied a contextual intelligence, which we had a podcast on recently and emotional intelligence. Like this is all really important in terms of forming relationships so that we can work well together.
[Dr Daniel Eiferman]
Yeah. So, they say out of a hundred, 8% is the words that you actually say. So that leaves us with body language and tone of voice.
So, I’ll give you a second chance of the two, which do you think is a bigger player, the body language or the tone of voice?
[Dr Mike Patrick]
I’m going to go with body language and, but I could be wrong, but I think that because, you know, if you are closed off and you’re not making eye contact and you’re across the room, you just get that vibe that things are off. But when I lean in and I really pay attention and I’m shaking my head and asking follow-up questions, then it would seem that, that it’s easier to make a connection. But like I said, I could be wrong.
[Dr Daniel Eiferman]
No, you should, you should look up podcasting as a, as a, as a, as a job, my friend. So that is, yeah, that’s great. So, they say that body language is about 60% and then the other 30% is your tone of voice that you use.
So, you’re asking me, how do I build trust quickly in a team? Sometimes in a team that I can do a lot, just with my body language, you know, and making and listening, they talk about things like mirroring, like saying back to you, maybe the last two or three things that you said that shows that I am listening to you, nodding in agreement, words of encouragement, uh-huh. Tell me more, things like that.
All those little things that you can do with somebody that I just met make a huge difference in building that trust, having the psychological safety, which they say is the secret sauce of getting your team to function at a high level. Yeah.
[Dr Mike Patrick]
You know, as I think about engaging in teams and psychological safety and building trust and all of these things, that active listening part becomes so important and it’s also counter to the fast pace of medicine today. Like we’re, we’re anticipating things, we’re trying to get people through, we may have a busy clinic, we may have more patients than we want on our rounds and we’re just trying to move the needle. And so that means when someone’s talking, often we’re thinking about what our response is going to be while they’re talking.
And we can really miss out on what they’re saying when we’re thinking about what our response is going to be rather than really listening to what they’re saying. And if you’re going to do some thinking, maybe think about why they’re saying what they’re saying or sort of, you know, that’s where empathy comes in. Why do they have this perspective?
And once I understand them as a person better, I may understand their perspective better. And so, in that case, then I’m not looking at like, if I do have feedback to give, I’m not necessarily looking at them as a bad person because I understand why they’re doing what they’re doing or saying what they’re saying. And I can then give feedback without making it about them as a person.
[Dr Daniel Eiferman]
So, I’m not totally sure you need me as a guest on this podcast because you, you, you said exactly what I was going to say when I’ve tried to do a lot of reading and learning about how to become a better listener. And if you ever go through learning to become a coach and all that stuff, they spend a lot of time talking to you about listening. And what you said is the number one thing that we, we healthcare workers, humans, I think don’t do well.
We listen to respond. We don’t listen to hear what the other person is saying. We’re constantly, and this happens all the time in rounds and the OR and all that stuff.
You’re telling me why you don’t think the patient needs an operation. Instead of listening to you, I’m just formulating in my head, all the reasons why I think my side is the correct one. And if I was a better listener to you and why you feel that way, we’re going to have a more productive conversation.
Say, okay, Mike, I hear you. You’re concerned about X. Okay.
Here’s my concerns about Y and all that stuff. But if all I’m doing is thinking of why your concerns about X are wrong, I’m not being a great listener to you.
[Dr Mike Patrick]
And so, this is the interpersonal relationships within the team and feeling psychological safety. As you said, that’s really the secret sauce in all of this. Is there a way to actually name these things for what they are within the team?
So, in other words, like being so intentional that you’re actually talking about psychological safety or does it just, or does it just have to happen?
[Dr Daniel Eiferman]
So, I have not seen that be successful to be honest. That’s the what happens in Vegas stays in Vegas. Uh, but like, well, you just can’t say that, you know, I’ve been in rooms, meetings, discussions that people just say, this is a safe place.
You know, you could say whatever you want. And the whole reason you’re there is because you didn’t feel safe in the first place. So, I don’t know if naming it, I don’t know if naming it or calling it out makes a difference to be completely honest.
I do know that if you’re leading the team, the, I said the first thing was the ostentatious listening. The second thing you can do is what is known as a quality and conversational turn taking, which is a very long way of saying making sure that certain people don’t always dominate the conversation. There are good studies out there about groups, teams, and committees that like 75 to 80% of the communication comes from like two to three people groups where everybody feels it shares equally tend to be the ones that have psychological safety in them.
And so, if you’re leading the team or, and you’re seeing that you’re not getting input from person A, B, and C and person X, Y, and Z are always interjecting and all that stuff. That is one thing that you do, you know, thank you very much for sharing. You know, we haven’t heard from Mike yet, you know, and Mike, can you share your thoughts in there?
That’s one thing you can do to try to say it. But again, if you’re not feeling it, you’re not going to come out and share your vulnerability. And then you have to take a look and say, is this, is this team going to function at a high level?
And then one thing that people don’t talk about enough at all is some teams should disband. Okay. Not every team can function at a high level and that’s okay, but we do a poor job of talking about that, but not every team can be successful.
[Dr Mike Patrick]
Yeah. That comes back to noticing, right? Like noticing who’s participating at what levels and the folks who may be quiet have great things to say, but they may be a bit more introverted or think like this isn’t the right time to say it, but without them talking, you’re not going to know what they are passionate about and what tasks that they might be really ideally suited for because you’ve not engaged with them enough.
So, I guess that noticing thing, it becomes really important.
[Dr Daniel Eiferman]
And that’s where I talked about asking, you know, deep questions earlier. If you, and usually non-public, it’s like, tell me what you’re scared of. I mean, I do this with patients all the time.
You know what I’m saying? You’re scared of dying. Okay.
Like, let’s just talk about it. Let’s get it, let’s get it out on the, you know, scared of being stuck on a bed. Let’s just get it out.
And when people don’t feel comfortable sharing, you know, try to get to that root cause. And then also identify, I may not be the person that they feel comfortable sharing with. And you can ask who would, you know, who would help you get better in this arena or who is somebody that you look up to?
And let’s see if we can get them involved so that you get more comfortable. And that also, again, shows a little bit of my own, you know, vulnerability. I may not be the best person for this.
I recognize that and hopefully that will help build some trust with that person as well.
[Dr Mike Patrick]
Yeah. Yeah. You talked about Google’s project Aristotle and there were five traits of high performing teams.
We’ve talked about psychological safety, some other traits, dependability is one of them. Why is that important within a team?
[Dr Daniel Eiferman]
So, if you, if you keep going up that, that pyramid that we talked about earlier, a lot of people I’m going to, if with permission, Mike, I’m going to, I’m going to change your word from dependability to accountability. And that is a major issue that comes up in teams that, that fail is when things aren’t going the way that they should be going, who’s there to put the stop gap in and say, hey, this isn’t going well, and we need to pause or look for a new strategy in there. If that doesn’t happen, the group, the team, whatever term you want to use in there really begins to question their commitment to the team.
And that’s in the middle of the pyramid that we, that we talk about, why teams are. So now if I’m all in, but Mike, you’re not all in and the other person is like, now we’re not all moving in lockstep together in that team is going to struggle significantly. So, I hate to switch words on you there, but that’s the dependability.
It’s really more about accountability. How are we going to hold ourselves accountable? Is the team going to hold itself accountable to each other?
And if we don’t, then we’re going to have commitment to the team issues.
[Dr Mike Patrick]
Yeah. Yeah, no, that totally makes sense. And so, you can have like the best people in an organization on the, on the team.
And so, you would think, oh, I’ve got all the best people. Like this is a team. This is going to work.
But if they aren’t holding each other accountable and being vulnerable with each other and not avoiding conflict, but sort of embracing conflict as long as we’re not making it personal, you know, we’re, we’re trying to, to be the best team that we can be. That’s going to be better than having just the, the 18 players, right? Like you can have, they don’t need to all be 18 players.
They just have to be able to work well together.
[Dr Daniel Eiferman]
I would agree with that. And what I would say is when you get a team together, you know, you’ve got your all-stars, whatever you want to call it, but you don’t have that trust and then you have your fear of conflict. What they talk about is that you actually have what’s known as artificial harmony.
So, if an outsider came in and saw the group and saw us all sitting around the boardroom together and Mike, you bring up an idea, I think we should go with strategy B and I’m fearful of conflict. You and I don’t really have trust. My, even though I think strategy B is a bad idea and isn’t going to work, I withhold that information.
But because I don’t say anything, it would look like, well, if nobody objects to strategy B, then strategy B it is. And that’s false or artificial. I don’t actually agree with strategy B.
The team doesn’t think strategy B, but if somebody were to come in and observe our group, it’s like, these guys function at a great level, you know, nobody, you know, everybody’s, you know, in lock step with, with one another and, and, and in harmony. And that’s what I think you see a decent amount of is, well, I don’t want to speak up and say anything. So, we’ll just go with that and say, Hey, this team’s working great.
You know, we don’t fight, you know, we don’t have disagreements and all that stuff. And that’s where I went back in the very beginning when I talked about healthy conflict, where you can have candid debate with each other, where I respect your opinion, where there’s a mutual purpose and a mutual respect, which is the two ingredients of having what the term called rapport. And if we have a rapport with each other, going back to, you know, we’ll develop that rapport.
If we have connection, trust, and noticing when people have rapport with each other, that’s when the free flow of ideas is going to happen. And everybody has seen this before to give you kind of a, a comical view of this. One of my best friends, one of those partners with here, we just loved each other.
And when we used to present to patients at morning report, and he would do something that I didn’t agree with. Did you ever see scrubs Mike, the best medical show ever? Oh, loved it.
And there’s a reboot coming. I saw that and I cannot wait. Do you, did you ever see the episode of my mistake guy?
I don’t, that does not ring a bell. So, JD wishes in his mind that he had a guy when he was about to make a big mistake that would sing in an opera voice behind him. So, I used to have that on my phone and when my buddy would do something that I disagreed with, I would play that under the table and, you know, make care.
And then when it was time to be serious, we, you know, so got everybody to laugh and all that stuff because we had rapport, you know, we could disagree with each other and say, okay, now that we all laughed and all that stuff, why’d you think that, you know, this technique was the right one to do and all that stuff. Everybody’s guards lower, no, he’s on edge. And now we can have candid discussion back and forth between each other.
[Dr Mike Patrick]
Yeah. Yeah, absolutely. Going back to your example on let’s do plan A or let’s do plan B.
And I think plan B is not right, but I’m not going to say anything. If you approach it with just, you know, vulnerability there, like, you know, I may be wrong about this, but this is what I’m seeing about plan B, but then that gives the plan B people a chance to help you buy in, maybe to explain why they think a certain way. And then you explaining may help them see, oh, we actually need to meet somewhere in the middle, like a point B 8.5, like somewhere in the middle. And, but having that rapport, even though you may have a different lens, a different outlook, different experiences, that’s going to give you the best outcome.
[Dr Daniel Eiferman]
What I would say to that is when you want strategy A and I want strategy B, the only, the best way to go with that is to ask you open-ended questions, not yes, no. So, Mike, you think that’s the best plan? Yes.
We think we should start antibiotics. Yes. Tell me more about why you think that antibiotic therapy alone here is the best plan.
Another open, you know, do you have any concerns about X, Y, Z? When I ask you open-ended questions, it allows me to hear your rationale, and it also makes you have a rationale for why you feel that way. And again, if we have rapport with each other, I’ll be able to call out, ah, yeah, see that’s Mike.
I think that’s where we disagree right now. You know, I, I don’t think that the patient has, you know, this or that, but even when you don’t agree by just getting you to explain your rationale, then I could say it back to you. So, when I’m hearing you say, and then I’m demonstrating my ostentatious listening with you, what I’m hearing you say is this, you know, that’s one of the ways even if we may not have rapport together, that we could at least have a meaningful conversation and get to the best outcome.
[Dr Mike Patrick]
Yeah. Yeah, absolutely. If you’re leading a team and you want it to be really high level of function, how do you get a commitment or buy-in from the team?
How do you get every team member sort of putting their best foot forward and looking out not for themselves, but for the team?
[Dr Daniel Eiferman]
So, my answer to that is I think I used the word secret sauce already once already in this podcast, but maybe you can edit it out, so it doesn’t sound like I’m saying the same thing over and over again. And that is the idea of discretionary effort. If you want your team to function at the highest level and getting everybody in there, you need to get people to give discretionary effort.
That is my job is here’s what I have to do discretionary. Here’s what I’m willing to do. And they say, you know, for me, I give examples like, you know, that’s going back and seeing the patient one more time or reaching out on the phone to a consultant to make sure that we have the best, best plan for them or checking in on somebody when they tell me that they’re, that they’re struggling.
The best way I know how to do that. Well, I used to give out written expectations when people rotated on service with me that I expected that from them. I don’t do that anymore.
People tell me they didn’t like it, but that one to me is I actually try to demonstrate that the best that I can and saying, you know, this is how you take great care. This is how you take great care of patients. And we could stop here, but we’re going to keep going because we’re going to be internally motivated and I want to be, we want to be great.
And I’m not doing this so that everybody notices I’m doing this so that I can hold my, be proud of myself. And what I would say is, and this may not be the most popular thing that people want to hear. If when you find those people that are internally motivated, that want to be great, that want to give discretionary effort, you put those people on your team and you never let them leave.
Here’s the flip side. Here’s the flip side of that. If you have your people on your team that aren’t like that, this is a job, not a career.
They’re in it for money or titles or recognition. I’ll be honest with you; there’s probably people you don’t want on your team. I don’t think you’re going to get there.
And as I said earlier, that’s where something we’re very hesitant to do, but you know, sometimes that’s what’s best for the team.
[Dr Mike Patrick]
Yeah. Yeah, absolutely. We’ve talked about forming a team and sort of, you know, the secret sauce of it and the triangle and having trust at the, at the base.
So, it would seem that it’s easy to build a high functioning team from the ground up. Are there ways other than disbanding a struggling team to try to get the ball rolling in a better direction? Because I think a lot of folks find themselves in that situation where like we know it’s dysfunctional, we want to do better, but where do we start if we don’t also want to disband?
[Dr Daniel Eiferman]
Yeah, that’s a great, it’s a great question. And I’m going to answer it with the following kind of statistic where, so what you’re talking about is an intervention, right? Person X on your team is dragging the team down or isn’t functioning at the level that you want them to.
How can you get them to, to come up? This is something I’ve done a decent amount of, of reading on and talking to different coaches about how you do this. The answer is that you, you can get a poor performer up to better performance.
The cost, the cost is usually a phenomenal amount of time. It does not happen quickly. And the statistic that is out there for every 10 interventions that you try to help somebody, three are going to be successful and seven are going to fail.
And so, you have to know, now in baseball, that puts you in the hall of fame, right?
[Dr Mike Patrick]
Mike Perry, you know. That’s right. Yeah.
[Dr Daniel Eiferman]
You know, in surgery or in medicine, you know, that’s, that’s not so great, but yes, there are tips and tricks, and you know, how to give people coaching feedback, how to frame things in a positive way. I always tell them my class is the number one best way to do that, to keep people positive instead of putting them on the defensive is asking a question like, what would be the benefit to you if you got better in this area? So, it’s, so it’s not, we’re throwing you off the team or that crap doesn’t fly here or anything like that, but how can I make it positive?
Hey, what would be the benefit to you if you got a little bit better in this area? That’s the best way I know to try to bring somebody up if you don’t want to, if, if cutting them loose or, or, you know, disbanding the team isn’t an option, it takes a lot of time. It takes a lot of hard work.
It’s very slow. Yeah.
[Dr Mike Patrick]
Yeah. And that’s why it is, it’s, if you can build it from the ground up and sometimes maybe just a change in leadership, you know, cause now you have a reason to do things a little bit differently. And so that can be a way to, to restart things if you, if you needed to, you know, if like, there’s no, there’s no option for disbanding.
[Dr Daniel Eiferman]
But I mean, think about sports teams. What happens when the new coach gets, get the new head coach gets hired? Well, there’s usually resistance at first.
Right. But then that coach, he or she brings in all the assistance that he or she wants, right? They want their team because they know that I can, I can trust Mike and Danny are going to work.
We’re going to work well together. That’s very common. That’s what they’re doing, right?
They’re, they’re, they’re trying to form that team from the top. I’m going to lead this way, and I know that I’ve got these people that are, that are going to follow in my footsteps right here and we’re going to build the culture here that I want. That’s the most common thing that happens like when sports teams change.
Yeah. Change leadership.
[Dr Mike Patrick]
And that, and that goes back to when you find someone with that internal motivation and who’s willing to go above and beyond and put the team effort head of individual efforts, you keep them. And if you go, if you go lead a different team than a, you know, hey, come over here, come join my team.
[Dr Daniel Eiferman]
I just, uh, I’ll go once a, not just keep them, tell them how much you appreciate them because even though that they’re doing it because they, they just want to be great at what they do. When you go in and say, listen, you know, this good outcome that I had and say is partly because of you. I know that you’ve got my back and that you’re always going to do whatever.
And then that usually will encourage the behavior anymore. So, I would, I would encourage not just keep them on their team, but tell them, you know, it doesn’t necessarily need to come with a raise or a new title or anything like that. But I’ll give you an example.
One time, I wrote handwritten notes to the team in the OR for the people that were functioning at a really high level. People come back and tell you; they put it on their fridge and how much it meant to them, things like that, that stuff makes it. You don’t think that those people are going to continue that behavior and continue being great and that they’re going to, we’re going to have a great relationship together.
We absolutely are.
[Dr Mike Patrick]
Yeah. Yeah. Before we go, can you sum up again the secret sauce of high performing teams?
What’s the, what is at the very base level? What do we need to know?
[Dr Daniel Eiferman]
Okay. Your team will not function at a high level if there is no trust in your team. So, the next logical question would be, how do I build trust and how can I do it? Do it quickly.
The first thing that I would say is the fastest way to build trust is actually to show your vulnerability first. First, go in there and admit that you’re human, that you have realistic expectations, that you’ve made mistakes before. If you do that, you will build trust.
When you start building trust, then you could start getting into things like building other aspects of psychological safety on your team. Remembering that the two main components of that are learning to be a great listener, what’s known as ostentatious listening, and then the equality and conversational turn taking, making sure that everybody has a voice and a seat at the table. Once you get psychological safety and then you learn to be a great listener, okay, you will have rapport.
And that rapport will allow you to have connection, trust, and noticing, which is going to allow for free flow of information back and forth.
[Dr Mike Patrick]
And our team’s going to function at the highest level. Yeah, that is, that’s really fantastic. This has been a wonderful conversation, and I feel like I have learned a lot actually in terms of, I kind of have now, of course, like many of us, I’m involved in several teams, but I’ve, I have this like newfound motivation to be my best, the best version of myself as I’ve functioned within teams.
So, this has really been great. Again, we’re going to have the text, the book, The Five Dysfunctions of a Team. We’ll have a link to that in the show notes over at famecast.org.
Also, a link to a New York Times article, What Google Learned from its Quest to Build the Perfect Team. And there’s also a great YouTube video out there on how Google builds the perfect team. We’ll put links to all of those things in the show notes.
Again, this is episode 13 over at famecast.org. So once again, Dr. Daniel Eiferman, Professor of Surgery at The Ohio State University College of Medicine. Thank you so much for stopping by and chatting with us today.
[Dr Daniel Eiferman]
Mike, thank you so much for having me. So enjoyable.
[Music]
[Dr Mike Patrick]
We are back with just enough time to talk a little bit more about our team. It’s time to say thanks once again to all of you for taking time out of your day and making FAMEcast a part of it. We really do appreciate your listening and support.
And of course, thanks again to our guest this week, Dr. Daniel Eiferman, Professor of Surgery at The Ohio State University College of Medicine. Don’t forget you can find our podcast really wherever podcasts are found. We’re in the Apple podcast app, Spotify, iHeartRadio, Amazon Music, Audible, and most other podcast apps for iOS and Android.
Our landing site is famecast.org. You’ll find our entire archive of past programs there. Show notes for each of the episodes are terms of use agreement and a handy contact page.
If you would like to suggest a future topic for the program, or if you just want to say hi, I like getting those messages too. Don’t forget reviews are helpful really wherever you get your podcasts. We always appreciate when you share your thoughts about the show.
Just takes a couple of minutes. And then we do have some additional resources I want you to know about. If you go over to the website, so famecast.org, there is a resources tab up at the top of the page. There are two important links there to faculty development modules on what’s called Scarlet Canvas. One set of modules is on advancing your clinical teaching. And the other set is a faculty development for medical educators or FD for me.
And there are scores of learning modules in these two areas. So be sure to follow those links. You’ll find lots more useful information specifically targeting academic medical faculty.
Also want to remind you of a couple of other podcasts that I host. If you happen to be a pediatric healthcare provider, we do have a podcast for you called PediaCast CME. So, we offer free continuing medical education credit for those who listen.
And it is category one credit, by the way, chosen details are available at the landing site for that program. PediaCast CME.org. You can also listen wherever podcasts are found.
Simply search for PediaCast CME. And if you’re not in pediatrics, but you have kids at home, you know, maybe you know a lot about ophthalmology or pathology, but maybe not so much about child physiology. We do have a podcast for moms and dads and actually lots of pediatricians and other medical providers also tune in.
As we cover pediatric news, we answer listener questions and interview pediatric and parenting experts. Shows are available at the landing site for that one. PediaCast.org also available wherever podcasts are found. Just search for PediaCast. Thanks again for stopping by. And until next time, this is Dr. Mike saying, stay focused, stay balanced, and keep reaching for the stars. So long, everybody.
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