In this chapter we will explore: ‘The veterinary team’, ‘What a great team’, ‘I feel such a part of the team’, ‘It was a team effort’. So much of what we do and achieve is not an individual, but a collective, effort. We are fascinated by what makes a good team and desperate to be part of one, because we recognise the deep sense of worth that brings. The story of the lone, heroic veterinary professional striding out across the landscape to perform acts of greatness is steadily being rewritten, rightly, as the multidisciplinary group, acting as an interdisciplinary team, with each part contributing uniquely to a goal which no one part alone could achieve. Understanding the importance of teamwork and its components, including leadership becomes then, an essential professional competence. A team is a social construct of multiple individuals, with interdependency, mutual responsibility, a shared purpose, and co‐ordination (Kimble 2011; Kogler‐Hill, S in Northouse 2019). Although we typically think of teams as human–human, there are good examples of teams that are human–animal (e.g. shepherd and sheepdog), or even animal–animal (e.g. a herd of wild horses). This interdependence makes for complexity, purpose, and impact that is in the relationships, more than the individual parts. A team can achieve, together, what would not be possible alone. There is much debate about the magic of creating the effective (winning) team, and many popular books have been written on the subject. Several factors are important in making effective teams and are outlined (Figure 9.1) and discussed below. Although it is argued that the how is much more important than the who of teams and their effectiveness, the professional context of veterinary medicine determines that certain skills and knowledge functions will have to be performed by regulated professionals (Collins 2015). This is an inevitable constraint that means multidisciplinary, cross‐functional professional teams bring their own challenges for formation, development, and leadership. Purpose (see below) and team composition must, therefore, go hand in hand. The necessary skills for effective cross‐functional teams can be outlined (Yukl 2008): In small teams, of course, many of these functions may be shared across the team, and individuals may have to take up multiple roles. Within the professional constraints, teams that are diverse and inclusive are more effective, with broader perspective, greater creativity, and a wider collective intelligence (Syed 2019). Given that no one situation, patient, challenge, or client is the same, even for ‘routine’ professional work, teams that are flexible, reactive, innovative, and aware are less likely to fall into the trap of collective situational blindness (groupthink) and will more likely recognise and pre‐emptively manage potentially disastrous developments. Taking a ‘nature‐and‐nurture’ perspective, we construct our own view of the world, and develop our various intelligences according to both our biology and our experiences; therefore, diversity and inclusivity might be expected to add to team performance. Diversities include: There are powerful societal, cultural, and systemic constraints which must be recognised, faced, and overcome to generate true diversity and inclusivity (Eddo‐Lodge 2017). As individuals we should be brave enough to face up to the reality and accept that we can all carry conscious and unconscious bias that can be explored using tools such as the Harvard Implicit Association Test. When exercising leadership, it is both morally and functionally appropriate to maximise team diversity, manage our tendencies to gravitate to those with shared points of reference (homophily), and attend to the complex relational needs of those teams. We have considered explored the darker side of some of the motivational drivers that might lead us to veterinary professional work, and which are expressed when competing for, and through, professional training (Chapter 5). These traits need to be considered in teaming. ‘Failure’ carries significant jeopardy for many individuals, both caregiver and patient. Whilst failure is often framed in organisational life as a learning opportunity, when animal welfare might be compromised, and one’s professional standards and identity are at risk, ‘failure’ can be a concept laden with fear and shame. Some veterinary professionals can drive themselves and others hard and, where the shame of a mistake is too painful to bear, deflect blame onto others without asking for forgiveness or saying, ‘I am sorry’. Re‐framing failure as humanity combined with systemic factors, encouraging, and allowing self‐forgiveness is a leadership challenge. This is linked to the anxieties induced by failure, and to imposter syndrome, where only by being perfect (compared to an idealised other) is one defended from (self‐)criticism. Perfectionism, if expressed as overwork, overcriticism, and a lack of acknowledgement of the genuine efforts of others, can challenge team relations. The team member who works fast, is experienced and intuitive, and thinks quickly and (they believe) clearly can be inspiring but also intimidating and frustrating. Where others have something important that they need to consider and share, the fast worker can be rushing on and ignoring both the individual and wider team needs. In doing so, they run the risk of missing vital information. The individuals are easily bored and, when bored, can create disruption and crises (de Rond and Hedges 2018). Although I suspect this is less an issue in the ‘caring’ professions than others, it is undoubtedly present and may be more likely in those attracted to task‐focussed roles. On the other hand, overly empathetic, socially motivated individuals might be a frustration in task‐focussed scenarios where getting the job done is deemed more immediately important than attending to the longer‐term relational needs of the team. Individuals who self‐sacrifice their needs for others are at risk of burn‐out and compassion fatigue (Cohen 2007). The highly qualified professional who has sacrificed so much of themselves to their professional identity may be apt to view their role as critical to the team’s overall effectiveness, and that of others less so. Whilst, of course, professional knowledge and skills are all important to delivery of excellent care and welfare, each individual in a multidisciplinary team is, firstly, a human being and, secondly, playing a valuable role. Perfectionism, which focusses on constant improvement, fast acting and thinking, a future, task focus, and, perhaps, challenges with empathy, can combine to make it unusual for some professionals to say, ‘Thank you’, acknowledge the efforts and contributions of others, and give positive feedback. Finding, defining, and codifying a shared purpose is what makes a team more than a working group of individuals (Bevan and Henriks 2021). In the veterinary context, if animal welfare is, broadly, what is shared in any given team, by definition, that care team includes not just the veterinary professionals but the animal owner/client and any associated business or organisation (Figure 9.2). Together, and whether they recognise it or not, this group, for a given period of time, has a shared purpose. Theoretically, defining and agreeing on the exact nature of that purpose, clarifying and naming it, and identifying the relevance of each individual to the achievement of the overriding purpose will determine whether a real team is assembled and can create something more than the sum of its parts. Practically, whilst there should be meaningful overlap, for teams in complex healthcare environments, it is not realistic to expect complete coherence on shared purpose. Even the definition of animal welfare will vary according to personal experience, values, and professional archetype (Table 2.1). Exploration of, and broad agreement on, the shared purpose is one of the key objectives of team leadership. For a team to stick together, there has to be sufficient individual benefit to justify the associated commitment. Rock (2009) proposes the SCARF model as a way of examining the requirements of team members from a team: It is valuable to put yourself in the shoes of the other sub‐groups in a veterinary team, to understand, and empathise with, their point‐of‐view: Whilst different components of a veterinary team might have different, paradoxical, or even apparently conflicting needs, finding the shared purpose is key to creating a functional group. A failure to do so leads to conflict and/or stress. For veterinary professionals, defining a shared challenge to be solved, rather than a diagnosis to be made, seems to be one important factor in maintain a sense of mental well‐being (Armitage‐Chan and May 2018). Agreeing on the shared purpose might be as simple as asking ‘Do we all agree we need to fix Tibby’s broken leg?’ Fixing the leg, with subordinate aims of doing so elegantly, cost‐effectively, with appropriate pain relief, profitably and efficiently, is an agreed on, and shared, purpose. More complex problems may require group negotiation and open communication. Agreeing a plan for the management of an infectious disease outbreak in both wildlife and farmed populations, for example, might bring in multi‐agency involvement and a varied set of needs. In circumstances such as this, where effective teamwork is essential for production of satisfactory outcomes, agreement of the shared purpose at the outset creates a frame of reference within which delegated and autonomous decision‐making can be applied to the common end. When developing the shared purpose (Figure 9.3), it is important that all members of a team have a voice and that discussions are not dominated by the loudest voices, the most highly regarded, or the HIPPOs (Highest Paid Person In the Organisation) (Bevan and Henriks 2021). Leadership must be careful to maximise and leverage diversity of thought, opinion, and experience. Specific aims for a team derive from, and contribute to, the shared purpose. As these aims crystallise, it may become apparent that the membership of the team needs to be modified accordingly. As this happens, additional needs have to be factored into the shared purpose. When further change is no longer required, so the shared unifying purpose can be agreed and communicated internally and externally. The team aims and objectives, and from them, the specific expectations of individual team members, cascade from the shared purpose. Clarity of role is one of the SCARF factors (above) that ensure members are motivated and incentivised to be part of a team. Any ambiguity (‘I assumed that was your job’) at this stage leads to mistrust and, potentially, direct harm, or at least a sub‐optimal result. Leadership should ensure that aims and objectives are agreed, defined and assigned. In small, close‐knit, familiar teams, this may be communicated verbally (or even nonverbally), but it will be communicated. In newer teams, where familiarity and trust are still developing, sharing what is agreed widely and inclusively is advisable. Shared leadership is a dynamic, interactive influencing process among peers, with the objective of achieving personal, team, and/or organisational goals (Hoch and Dulebohn 2017; Singh et al. 2019). It is facilitated by teams where communication is strong, there is a shared purpose, social support, voice, and team trust (Carson et al. 2007). Whilst there is evidence, including from healthcare settings, that shared leadership is beneficial, there may also be resistance, with different groups, e.g. human physicians being more resistant than nurses (De Brún et al. 2019). Mason and Forsyth (2017) studying multidisciplinary teams in human healthcare suggest that strategies which promote both strong professional and team identifications in interprofessional teams are likely to be conducive to clinicians supporting principles of shared leadership. As veterinary professionals find themselves needing to work, and cede leadership, within interprofessional teams, the concept of shared leadership is likely to gain in relevance and importance. Veterinary teams are typically complex and dynamic. They may be short‐ or long‐lived but there is usually an important ‘shared purpose’ with potentially significant jeopardy and a risk of significant negative impacts on animal, and human, welfare. Second victim syndrome, where there is psychological trauma in caregivers following a medical error, is a recognised risk, and it feeds, in part at least, into some of the significant concerns around mental health and well‐being in the veterinary professions (Wu 2000; Scott et al. 2009; Luu et al. 2012). With this firmly in mind, it is right to see the relational aspects of team leadership, attending to the human interactions, emotions, and responses, as of utmost importance. The concept of relational leadership sees the unit of action not as the individuals in a team but the relationships between them (Uhl‐Bien 2006). The aim, therefore, is to contribute to a team where the task is performed with the minimum reasonable short‐ and long‐term risk, where the potential for unexpected and adverse events is accepted and catered for, where there is trust, respect, psychological safety, and mutual support, where all parts of a diverse team are effectively incorporated and where the leadership function can be shared and distributed effectively and appropriately. If, when exercising leadership, we attend to the relations within and without the team, we can hold the space for emergent performance and shared leadership. Leadership then becomes about embodying and enacting a culture where hierarchies are diminished, voices are heard, decisions are made with collective intelligence, and leadership is both a formal and informal role. Professor Amy Edmondson, author of ‘The Fearless Organisation’ writes: Psychological safety is broadly defined as a climate in which people are comfortable expressing and being themselves. More specifically, when people have psychological safety at work, they feel comfortable sharing concerns and mistakes without fear of embarrassment or retribution. They are confident that they can speak up and won’t be humiliated, ignored, or blamed. They know they can ask questions when they are unsure about something. They tend to trust and respect their colleagues. When a work environment has reasonably high psychological safety, good things happen: mistakes are reported quickly so that prompt corrective action can be taken; seamless coordination across groups or departments is enabled, and potentially game‐changing ideas for innovation are shared. (Edmondson 2019) Psychological safety has been proposed one of the most important determinants of team effectiveness (Rozovsky 2015). It seems paradoxical, until one examines the detail, that psychologically safe healthcare teams report more, not fewer, errors (Edmondson 1996). In unsafe teams, however, errors are not reported, alternatives are not discussed, there is not a culture of learning from mistakes, and concerns are not raised before problems become critical. Psychological safety, where relationships are associated with positive regard and mutuality, is associated with improved workplace learning, engagement, information sharing, and improved satisfaction and commitment (Carmeli et al. 2009; Frazier et al. 2017). How do you know a group is psychologically safe? Where there is respect, trust, compassion, honesty, an ability to disagree without fear of being attacked, where the hierarchy is low and where everyone is listened to and included. And where individuals feel safe to express, not impose, their preferences, personalities and vulnerabilities, and cared for and supported when they do so (Edmondson 2019). Team members should belong for who they truly are, not have to pretend to be someone they are not to fit in. Reluctantly, but honestly, we should also consider what a psychologically unsafe, or toxic team or workplace might look and feel like (Table 9.1). There is a negative impact from psychologically unsafe teams. Workplace bullying, for example, has been associated with post‐traumatic stress disorder (PTSD) in human nurses (Spence Laschinger and Nosko 2015). Leadership in psychologically safe teams is relatively easy; moving with a team from toxicity to safety is much more challenging. Realistically, the perfectly safe team or workplace may not be an achievable ideal, for prolonged periods at least, not least because they are not hermetically sealed, and humans are wonderfully messy, complex, emotional, and ever‐changing. Table 9.1 Behavioural indicators of a psychologically unsafe team; a lack of safety triggers threat responses (attack‐defend‐withdraw). In healthcare, including (I assume) veterinary medicine, cross‐professional boundaries, status hierarchy, a culture of autonomous authority (the veterinary professional as ‘expert’), and practical challenges associated with creating collaborative teams make the ideal difficult to achieve, although it should remain an ongoing aspiration (Nembhard and Edmondson 2006). Psychological safety is experienced in small groups and can be distributed unevenly across an organisation; it is shaped by local leadership (Edmondson 2019). Leadership inclusivity, and reduced power distance, are associated with greater psychological safety and greater error reporting in healthcare teams (Nembhard and Edmondson 2006; Appelbaum et al. 2016). Model leadership behaviours that improve psychological safety and show confidence and trust in the team include: What are our expectations? What do we need to know? What have I missed? What is our purpose here? What can I do to help? Note that when ‘I’ is used, it is to reduce power distance, and when ‘we’ or ‘our’ are used, they emphasise shared purpose. The psychologically safe team might feel a bit strange to new members, and teams and individuals might need to pass through some stages before they can reach a point of confident comfort where difference, disagreement, and messiness are not intimidating. These have been outlined as Inclusion, where you are accepted for who and what you are and bring to the team, Learner, where you are developing an understanding of the dynamics at play through observation of the behaviours around you and relational interactions, Contributor, where you begin to make suggestions and your voice is heard, through to Challenger, where you feel confident to say your own view, even if it differs from others, or even the rest of the team and its leadership (Clark 2020). Development of psychological safety can be helped with reporting systems representing a continuous improvement and safety culture, suggesting that interventions such morbidity and mortality rounds or adverse event reporting systems (e.g. the VetSafe initiative from the Veterinary Defence Society in the UK) might act as positive feedback mechanisms (O’Donovan and McAuliffe 2020). Psychological safety, and inter‐team trust, may be fundamental to performance, but other relational factors inter‐digitate and are worthy of attention in team dynamics:
9
Creating Effective Teams
9.1 Introduction
9.2 Who Is the Team?
9.2.1 The Power of Diversity
9.2.2 The Challenge of High Performers in Teams
9.2.2.1 Fear of Failure
9.2.2.2 Perfectionism
9.2.2.3 Intuition
9.2.2.4 Lack of Empathy
9.2.2.5 Excess Empathy
9.2.2.6 Self‐Importance
9.2.2.7 Difficulty Saying ‘Thank You’
9.3 What Is the Shared Purpose?
9.3.1 What Do Team Members Want in Exchange?
9.3.2 What Do Different Sub‐Groups Want?
9.3.3 How to Agree on the Shared Purpose
9.3.4 Defining Aims and Objectives
9.4 Shared Leadership
9.5 Relational Team Leadership
9.5.1 Psychological Safety
Attacking
Defending
Withdrawing
Ridiculing
Bantering
Imposing power hierarchy
Harassing
Being indiscreet
Hiding self‐identity
Bullying
Gossiping
Being silent
Being rude or insolent
Being cynical
Serving time
Dictating
Controlling
Focussing on task
Blaming
Appeasing
Avoiding conflict
Ignoring
9.5.2 Other Relational Leadership Functions