Leadership Series 4: Developing and Leading High-Performing Healthcare Teams

Healthcare leaders are entrusted with setting an inspiring enterprise vision to accelerate medical advances and optimize patient care. This requires that leaders establish an environment and culture of trust, transparency, and shared purpose across the organization. Leaders must also be proficient in developing and building diverse groups of individuals and stakeholders into a cohesive and effective team. Laying this foundation is especially crucial when the vision involves major large-scale change, ambitious institutional priorities, and aspirational goals needed to maintain an institution’s standing in the field.

Based on my own personal experience, acquiring these skills demands continual education, executive coaching, commitment, and humility. Most in medical and scientific leadership roles have typically learned about developing and leading teams by observation, on-the-job experience, and/or informal mentorship. In my case, I was catapulted from my role as a professor running a research laboratory and directing an Institute at Dana-Farber to leading the nation’s largest cancer center, the University of Texas MD Anderson Cancer Center. To me, this represented a once-in-a-lifetime opportunity to harness the talent and resources of one of the world’s great cancer institutions to make a major impact on the cancer problem globally. While I take tremendous pride in the great things our team was able to accomplish during my tenure as president, it was not without challenges. Upon reflection, I walked away with many lessons learned about the ‘team leader’ role. I share here some of the experience gained so that aspiring and established healthcare leaders – particularly those with bold vision – may benefit.

First, my journey. My professional career, spanning 30 years, has focused largely on advancing scientific knowledge, translating discoveries into new medicines, and mentoring the next generation of physician-scientists. This work occurred largely in the setting of my academic research laboratory and the several biotech companies I founded. While never actually seeking traditional leadership positions, I did really enjoy building diverse teams around a common vision.

Second, the context. As I considered joining MD Anderson and, once selected as its fourth president in 2011, I had the opportunity to visit with many of the institution’s leaders, faculty, staff, and key stakeholders in the MD Anderson community. I quickly realized the depth of the institution’s talent, the breadth of its collaborative culture, the enormity of available research and patient care resources, and the institution’s many strengths and opportunities.

Prior to my official start, and even once I arrived, I developed plans for a series of highly ambitious priorities and transformational programs designed to harness the full potential of one of the world’s most impactful cancer institutions. These initiatives touched all mission areas of education, research, and clinical care, and included the following:

  1. Enhancement of research excellence through major investments in graduate and clinical fellows programs, higher standards for tenure renewal, and recruitment of high-quality trainees as well as star faculty. These efforts resulted in a doubling of extramural grant support from CPRIT, our first National Academy of Science members, and our first Nobel Prize.
  2. Optimizing patient care through modernizing our digital infrastructure, accelerating clinical trials, and expanding our national and global network. Our work in these areas earned us continuing #1 status in cancer care and clinical trials, enabled us to implement modern digital systems, and established a collaborative network of academic cancer centers that collectively reached one-third of the human population.
  3. The MD Anderson Cancer Moonshot program, which set aspirational goals for accelerating new standards of care to rapidly and dramatically reduce suffering and improve the survival rate for patients with several major cancers. The program was a new translational paradigm for an academic institution. It embraced a milestone-driven, goal-oriented approach, assembled large multi-disciplinary teams for more deliberate translation of promising breakthroughs, such as immunotherapy, and provided adequate funding to reach goals while demanding results and accountability. To enable translation of new knowledge, professional team platforms were established that consisted of dedicated staff in cancer control, drug development, and big data systems. This program achieved numerous practice-changing advances, created new drugs with licensing revenues reaching $1B, attracted $500M in philanthropic funding, and inspired the National Cancer Moonshot.
  4. The upgrade of our EHR, the largest conducted by EPIC to date. This successful transformation took two years of planning and training and resulted in a modern EHR with return to baseline productivity in less than 18 months.

Based on end results, each of these initiatives could be viewed as a hands-down success. Each achieved its objectives, dramatically enhanced MD Anderson’s excellence in all mission areas, elevated our financial standing, and improved operations.

At the same time, in retrospect, the institution experienced “people-related” and communication challenges. These challenges stemmed from the ambitious scope of multiple change initiatives occurring simultaneously, the speed at which changes were made, and inadequate communication and engagement across diverse individuals and stakeholder groups. These challenges were also partly due to lack of properly developing and cultivating a strong executive leadership team around a shared common purpose – a purpose that everyone understood and bought into.

As the institutional team leader from 2011 to 2017, I learned many lessons and gained a deeper understanding of how high-performing teams function, what high-performing team leaders do, and how high-performing team leaders must behave in leading high-performing organizations. I now understand several critical success factors for leading effective organizational teams.

  1. Team leaders need to inspire more than they drive. Leaders in high-performance teams know how to create and maintain energy and enthusiasm in the team. Team members will want to feel they are on a mission and that what they are doing is of great importance.
  2. Team leaders need to actively resolve conflict and increase cooperation. In high-performance teams, the team leader addresses differences quickly and directly with guidance and counsel. It is typically not prudent to leave it up to team members on their own to work through concerns or differences that can easily escalate. Team leaders set the foundation for building a high level of trust among all team members, who can then be confident that they are trusted and that others have their backs.
  3. Team leaders need to set stretch goals. High-performing team members want to know that they are being challenged to do something extraordinary — and not what any other team or group can accomplish. That sense of shared purpose in meeting a major challenge increases team members’ overall satisfaction level, engagement, and pride with each new accomplishment.
  4. Team leaders must communicate the vision and direction. High-performing team leaders need to craft a clear, concise, and consistent message about both the team’s direction and the expected results. Leaders must work diligently to stay on message and repeat it vigorously and often. This helps to minimize distractions and diversions so everyone stays informed, up-to-date, and on track.
  5. Team leaders need to earn trust and respect. High-performing leaders will earn the trust of team members when they demonstrate confidence in each team member’s capabilities to accomplish something extraordinary. Clear communication instills trust, and enables a team leader to diffuse differences as they arise. A team leader builds trust across the organization by taking the time to build positive, personal relationships with team members, by asking questions and actively listening to input, and by welcoming critical feedback and dissenting opinions.
  6. Team leaders need to understand the four developmental stages that all high-performing teams go through. High-performing teams and high-performing team leaders don’t just happen. All go through the distinct group development stages identified by Bruce Tuckman: forming, storming, norming, and performing. It is the responsibility of the team leader to fully understand each of these stages and how to move team members through them to the next high-performing stage.
  7. Team leaders need to harness the collective capabilities, knowledge, and strengths of diverse team members. High-performing teams are comprised of individuals who are interdependent with one another — where the sum result or output is greater than the parts. Leaders should cultivate teams with diverse backgrounds and experiences . Inviting differing views and perspectives can enrich a team’s conversation and the quality of outcomes. Diverse team members with different perspectives and experience also hold the most promise for leaping past status-quo thinking into innovative creativity.
  8. Team leaders need to help build connections among team members. While team members don’t need to be best friends, they do need to feel positively connected with one another. It is up to the team leader to help each person on the team to know the parts they and others are playing to reach the team’s goal. When people feel a stronger connection to the team, they are more likely to pitch in whenever needed, to help someone on the team who is struggling, and to bring up concerns before they become problems.

Leaders, particularly those in healthcare, need to focus their efforts on fostering high-functioning and high-performing teams. Lives are on the line. Without such focus the team will be subject to dysfunctions that can easily derail the best of intentions. Achieving the highest levels of team performance requires a leader to develop a deep understanding  of how teams work, what causes teams to fail, what contributes to a team’s success, and how to set the example for effective team behaviors.

As I’ve written in prior articles in this Leadership Series, striving for excellence in healthcare leadership is part art and part science, and requires a commitment to continuous learning, a willingness to be open and humble, and the courage to take risks. It also means active involvement in mentorship – both as a mentee learning from other leaders and as a mentor willing to coach and cultivate the people who work for you.

To create excellence in organizations, leaders must all excel in our “people-related” skills and our teamwork. With true teamwork, even the most audacious goals and a truly visionary organization can become reality.

Other Articles in the Leadership Series:

Leadership Series 1:
Striving for Excellence in Healthcare Leadership

Leadership Series 2:
Mentoring Matters

Leadership Series 3:
Achieving Success as a Biotech Leader

Leadership Series 4:
Developing and Leading High-Performing Healthcare Teams

Leadership Series 5:
Leading in a Turbulent Time

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