Teamwork across boundaries

Health Progress, Sep/Oct 1999 by Deane, Bonnie St John

Teams Involving Different Departments Or Organizations Can Often Lighten the Load

As I travel across the nation, I meet organizational leaders who tell an increasingly familiar story. Whether they head Catholic hospitals or other types of organizations such leaders find themselves carrying out ever broader and more complex missions, even though their resources remain essentially unchanged.

In such a climate, teamwork is vital. But when leaders try to impose a "top-down" leadership style on teams, the usual result is internal disagreements, endless compromises, and a least-commondenominator result that pleases no one. When, on the other hand, leaders transform the old monologue into a shared vision, they often discover an unexpected solution that makes everyone smile.

BENEFITS OF COLLABORATIVE THINKING

I am struck by the apparent universality of these cases. In California, welfare agency leaders now have an expanded mission demanding much broader collaboration than was previously the case. Ten years ago, the main goal of such leaders was reducing welfare fraud. Today they are expected to promote family self-sufficiency. One county welfare director said, "We could write welfare checks on our own, but getting families on their feet requires us to work with other agencies and the community at large. We must actively seek out partnerships for extra funding sources, programs to address family problems ranging from drug abuse to child care, and jobs for welfare recipients."

Everywhere I go, I see organizational leaders tapping into the strengths of "virtual" organizations-teams that cross departmental or organizational boundaries. Sometimes circumstances force leaders to form such teams. "Recently we worked closely with another hospital to provide a safe childbirth for a woman with a severe heart condition," said Brue Chandler, president of Saint Joseph's Hospital, Atlanta. "We are among the top five cardiac hospitals in the nation, but we stopped providing obstetrics care some years back. However, Women's Hospital, which is nearby, has a superior program that delivers more than 10,000 babies annually. Together we decided to bring Women's Hospital's staff and baby care equipment into Saint Joseph's cardiac ward, where we were monitoring the mother-to-be."

After the birth, the baby was returned to Women's Hospital for ongoing care. Both hospitals had been willing to cede some control and stick to the area of their expertise. To do that-to allow the whole to be more than the sum of the parts-the hospitals' leaders had to go beyond their normal rules and procedures, to cut their usual red tape. "It certainly made the paperwork more complicated," says Chandler, "but the result was the best care for mother and child."

The results of collaborative thinking can be equally great in situations involving large numbers of people. "When Saint Joseph's relocated from its former downtown location to one in the suburbs, the move threatened to leave a gap in care for the uninsured and at-risk," Chandler says. "To fill that gap, we created the Mobile Mercy Health Program, mobile clinics that provide healthcare to people in the inner city." (See Nancy Paris and Tim Porter-O'Grady, "Health on Wheels," Health Progress, November 1994, pp. 34-35, 41.) "Each year, 25 percent of our net profits go to support three Mobile Mercy medical outreach buses and related programs that now serve more than 100 locations."

Because of its experience in mobile healthcare, Saint Joseph's was asked by a local Presbyterian church to help operate a clinic in the basement of the church. Community needs had quickly outstripped the church's healthcare resources. At first, church members asked for only a single physician to staff their site part-time. Today, four years later, the Mobile Mercy Health Program provides the clinic with physicians, nurses, and even administrative personnel; the church itself continues to provide equipment and supplies.

The project requires-in addition to cooperation between a Protestant church and a Catholic hospital-that each organization bring to the table its corporate and foundation sponsors, together with their own sets of priorities. A real leader must be willing to listen to others and to let their vision help mold and shape his or her own. Concerning crossboundary teamwork, Chandler says, "You take it one small step at a time. You add partners one at a time, and your partners add partners."

A WILLINGNESS TO LISTEN

The process of enlisting cross-boundary support for a mission automatically changes the way a leader relates to his or her team. It is no longer sufficient simply to communicate a clear vision to the troops. In fact, sticking to an old-fashioned, topdown approach can prevent team members from arriving at the best solution to the problem.

Managers today must be more willing to listen to team members. They must ask others not just for their opinions of the problem, but also for their vision of its solution. "Clear vision reframes the problem as an opportunity," says Sr. Barbara McMullen, CDP ("Celebrating the Mission," Health Progress, July-August 1998, pp. 104-103). Leaders who can draw on the visions of others without losing their own sense of direction will have both more options to choose from and deeper commitment from the members of the team.