When my mother was dying in a hospital last year, her admitting physician complicated my family’s grief by being an arrogant jerk. He insisted some of her recent symptoms were the result of drug combinations she had been on for many months, and pushed medical procedures that were just stupid for a 90-year-old woman clearly on her way out. We had no idea when we would see him again, yet he ignored repeated messages passed through nursing supervisors that we wanted him off the case. Meanwhile he continued issuing orders regarding Mother. It stopped when I went to the hospital ombuds office and told them I would physically prevent him from entering her room if he showed up.
Once they gain a measure of authority, some people refuse to listen to anyone who questions their expertise. This has been true for a long time. A scholar visited a Zen master supposedly to ask questions. But the scholar kept talking about himself and his own ideas. When tea arrived, the master poured for the scholar—and kept pouring as the cup overflowed. “Stop,” the scholar said. “Can’t you see the cup is full?”
The master responded, “You come and ask for teaching, but your cup is full; I can't put anything in. Before I can teach you, you'll have to empty your cup.”
Managers like this scholar harm team productivity because teams that learn outperform those that don’t. The situation is worse when the teams don’t exist for long. These “action teams” are formed for very short projects and then break apart. Members go on to form new action teams, usually from different combinations of people, as needed. A great example is surgical teams, drawn together from available specialists at the time a surgery is needed. Can an expert-led team like this possibly learn anything from such a short time together that would help a later surgery?
Some Israeli researchers guessed it might be possible if you focused on learning by individuals across multiple team experiences, rather than within a single longer-lived team as in prior studies. University researchers Dana Vashdi, Peter Bamberger, and Miriam Erez created an ambitious field experiment funded by the Israel National Institute for Health Policy Research. They studied 362 short-term surgical teams in a large public hospital over six months. Only 5% of these were repeats of previous teams. The researchers worked with hospital administrators to design two procedures: a pre-surgery briefing and, for learning purposes, a post-surgery debriefing. Their journal article explains:
“The briefing protocol covered (a) the indications leading to an operation, (b) the procedure to be performed, (c) the kind of anesthetic to be used, (d) special equipment needed, (e) possible complications, and (f) protocols to be followed in the event such complications arose. The debriefing protocol included a review and analysis of (a) what happened during the surgery, (b) any problems or complications that arose, (c) the degree to which surgical goals were met, (d) what prevented the achievement of specific goals, and (e) what might be done in the future to avoid such complications and to better assure the meeting of objectives.”
Three surgical wards received training on the protocols, and six others were observed for comparison. Similar surgeries on patients in similar general health were compared for both length and problems that occurred. Written medical records in Israel—that is, after-reports by the people involved—indicated only 3% of surgeries have a single life-threatening problem. Yet neutral observers in this study found at least one problem in 43% of the surgeries, and 4% had three problems. Never trust self-reports from your team members as an accurate measure of how they are doing, or how you are as a leader.
In comparing their hypotheses to the results, the researchers admitted they were only partially right about the impact of the debriefings. Teams whose members had participated in previous teams’ debriefings took less time on average to perform comparable surgeries. There was no average impact on the rate of problems, though there was in some circumstances. The results held true whether or not members’ current team had done a pre-surgery briefing, and regardless of various factors about the surgeons.
Digging into the details, Vashdi and team found the surgeries were shortened partly by increasing the willingness of people to take on tasks outside their job descriptions. However, those behaviors only shortened complex surgeries. The job-sharing behaviors actually slowed things down when the surgery was simple. Of course, simple surgeries are shorter by nature, and thus any training would have less time to impact them. However, such workload sharing “may in fact complicate standardized work processes, thereby offsetting any temporal benefits,” the authors write. They found it interesting that the impact of learning seemed to come through better processes rather than higher levels of medical knowledge imparted by previous debriefings.
This study suggests that even if your teams are very short-lived and include an authority figure like a surgeon, “lessons-learned” meetings can still help your operations. (Pun not intended. And I thought better of using an alternate term for the meetings, “post-mortems.” Oops, I just used it!) Team members can carry those lessons over to the next team. Taking time to reflect on recent work and identify better ways of operating puts the concept of “continuous improvement” into practice and provides measurable benefits for any team. Unlike the talkative scholar’s tea cup, you will find the time poured into retrospectives provides the value of a bottomless cup.
Action Item: If you manage action teams, hold a short meeting before the team breaks up to answer three questions. These are adapted from the set I coach Agile Scrum teams to use after each iteration of work:
- What went well?
- What didn’t go well?
- What will you suggest your next team do differently?
For long-term teams, don’t wait until an annual review or the end of a project to identify lessons learned. Make it a team meeting agenda item at least monthly.
Source: Vashdi, D., P. Bamberger, and M. Erez (2013), “Can Surgical Teams Ever Learn? The Role of Coordination, Complexity, and Transitivity in Action Team Learning.” Academy of Management Journal 56(4):945.
