In the 1980s, a cardiac surgeon once told Tom Lee that a team is a group of people who do what he wants them to do, even when he’s not there. In the 1990s, Lee’s colleagues talked about multidisciplinary teams, where each member brings a different skill set to the table. The phrase “practicing at the top of your license” for individuals within multidisciplinary teams gained prominence in the early 2000s.
We’re in an age of incredible medical progress, but all these new insights add up to information overload. Plus, patients are coming in with increasingly complex conditions and comorbidities. There is so much to know and to do.
“Every patient has become a big data problem,” Lee says. “As individuals, we’re overwhelmed, and the fact of the matter is, our teams are not up to the challenge, either. We need a new model of teams.”
That model? Teams with grit.
Lee and psychologist Angela Duckworth recently wrote on the nature of grit in health care organizations, and Lee describes some of their insights.
At the individual level, a gritty person has a goal that means something to them. Getting better at and reaching for that goal inspires passion and perseverance in that person over years or even decades.
What does it mean to try to get better in health care today? The industry certainly comprises people who have grit. “Health care has relied upon individuals, doctors with grit, nurses with grit who stay late, get up early, do what it takes to meet their patients’ needs,” says Lee. But in today’s complicated world of health care, individuals alone with grit are not enough.
“We still need those people, but we need organizations and we need teams within those organizations that attract gritty people, that support gritty people, and — here’s the interesting part — that function themselves like macro-chasms of gritty individuals.”
Lee describes four key elements of what it means for a group or an organization to behave like a gritty individual.
A Goal Hierarchy
In a goal hierarchy, the lowest-level tasks are akin to daily to-do lists, with things like going through one’s inbox on the electronic medical record, answering pages, and sending in prescriptions. “Those are tasks that if that was the only thing I focused, on I’d have a burnout issue,” says Lee.
Middle-level goal tasks are designed to help clinicians accomplish things like coordinated care and preventing complications for patients by addressing their current symptoms.
High-level goals are ones that every individual, team, and organization understands and believes in. “That high-level goal should be idealistic and noble, something that makes you proud, something that gives you esprit de corps,” he says.
In isolation, a high-level goal such as reducing patient suffering may sound abstract or naïve. But having a goal hierarchy that clearly articulates how every goal tracks together, without inconsistencies, helps you understand how tasks like answering your inbox do track up to ultimately reducing the suffering of patients.
“Gritty people have goal hierarchies in their minds. They can see the relationship between the bottom-level goal and the high-level goal that gives them pride, and that’s what sustains them,” he says.
A Growth Mindset
A growth mindset is the idea that you can get better and change — even if you are already the best. “That drive for improvement, that restlessness with the status quo, that is part of grit,” says Lee.
Two Types of Resilience
One type of resilience is the willingness and the ability to bounce back from setbacks, acknowledging that things didn’t go right and trying to learn from the experience and be better as a result.
A second type of resilience is the flexibility to deal with the unexpected. When taking care of patients, the unexpected happens all the time — unexpected medical conditions or other circumstances. And if a team member goes on leave for whatever reason, your team can’t fall apart; you must continue to work well in their absence.
Identification with Growth
Individuals must feel pride in being part of the Parkinson’s team or the cancer team, and pride in being part of their institution. “That has to be something that motivates them, gives them pride, makes them feel better about themselves,” Lee says, “so that when the inevitable stresses of the unpredictable come along, they’re ready to shoulder them and not fall apart.”
“These elements of a gritty team are essential competitive differentiators for health care organizations that are going to thrive in the marketplace that lies ahead,” he adds. Grit is strategic and will help organizations thrive in the face of competition.
“If we develop teams like this, the big winners will first be our patients, who will get better care from people who are working better together,” Lee concludes. “The second winners will be the members of the teams themselves, who will feel prouder about their work, and they’ll have esprit de corps.”
From the NEJM Catalyst event Essentials of High-Performing Organizations, held at the University of Michigan’s Institute for Healthcare Policy and Innovation, July 25, 2018.