October 25, 2016

How to build a better care team, according to Google

Daily Briefing

The key to creating high-performance teams— in medicine and elsewhere—is to create a cultural of psychological safety, two Google researchers write in NEJM Catalyst.

To learn what makes effective teams tick, Google conducted more than 200 interviews with its employees over two years and identified more than 250 attributes that can drive team performance. In NEJM Catalyst, Jessica Wisdom, a people analytics manager at Google, and Henry Wei, a benefits medical director, condensed those findings and shared how Google's best practices can be transferred to a health care setting.

A key takeaway, Wisdom and Wei write, is that good teams are defined more by how they work together than by who is on the team. In successful teams: 

  • There is a climate of psychological safety: Team members feel that they can take risks without feeling insecure and embarrassed.

  • Team members are dependable: Members of the team can be counted on to perform their job tasks effectively and can rely on one another for help.

  • The team is well-structured: The team has well-defined roles and responsibilities—and people are held accountable.

  • Team members find meaning in their work: Team members feel they are working toward a goal that is both professionally and personally fulfilling.

  • The team is making an impact: Team members feels that their work "matters" and is helping achieve a "higher-order" goal.

The most important of these dynamics is creating a climate of psychological safety. "In fact, it's the underpinning of the other four," Wisdom and Wei write.

For instance, Google found that sales teams that feel a high degree of psychological safety exceed their targets by 17 percent, on average. In contrast, sales teams that have low psychological safety fall short of their goals by an average of 19 percent. The takeaway, according to Wisdom and Wei, is that psychological safety boosts effectiveness because it creates a "learning culture."

Google has launched several efforts to improve psychological safety on its team, such as providing a quick survey to help teams understand their internal dynamics. The tool, called gTeams, generates discussion among teams, as well as suggestions and resources to improve performance.

Google's research in the health care context

In health care, Wisdom and Wei suggest ways teams can set themselves up for success.

  • Ask 'are we really a team?': Teams generally should not exceed 15 people. They must be well-integrated, mutually accountable for performance, and united around common goals. "If these aspects don't describe your team, then you might actually have a working group or a collection of individuals who report to the same manager," Wisdom and Wei write. "It's important to not force team-building if you're not actually dealing with a team."

  • Observe team meetings: In some cases, it can be helpful to record and review your team meetings for performance-limiting behaviors. Keep a close eye for factors that influence psychological safety, Wisdom and Wei suggest, and then brainstorm ways to improve.

  • Stay focused on psychological safety: Watch for "warning signs" that team members don't feel psychologically safe, such as gossip, hesitance to ask "silly" questions, fear of requesting feedback, or having team members who dominate the conversation.

The science—and strategy—behind having a 'great meeting'

  • Get feedback on psychological safety: Wisdom and Wei suggest gathering anonymous feedback about how psychologically safe team members feel, such as whether they feel comfortable brainstorming in front of each other, whether mistakes can be discussed openly, and how the team manages conflict.

  • Take action: Find opportunities to praise team members' work publicly, foster an inclusive team atmosphere, and express disagreement respectfully.

  • Rethink your meetings: "Consider the use of huddles, or daily clinical team meetings," Wisdom and Wei write. A 2015 study in Health Care Management Review of six Veterans Affairs primary care practices found that team huddles increased feelings of psychological safety.

Confronting the unique challenges of a health care setting

Unfortunately, the culture of medicine may make it difficult to achieve high levels of psychological safety.

Many doctors "tacitly assume" that their opinions valued more highly than those of nurses, Wisdom and Wei observe. That can reduce the perception of psychological safety on a care team. Also, a 2008 study published in Joint Commission Journal on Quality and Patient Safety found that 71 percent of doctors and nurses identified uncivil or disruptive behaviors which led to medical errors. 

Research suggests that the best way to push back against these tendencies in medicine is to provide inclusive leadership that solicits feedback and involves each team member in decision-making. "Thus, it is up to leaders to set the tone for psychological safety," Wisdom and Wei conclude (Wisdom/Wei, NEJM Catalyst, 10/19).

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