Introduction

We are currently working with several NHS Trusts to develop leadership capability, particularly in helping teams to work effectively together. In some cases, leaders in clinical settings have limited experience of leadership development opportunities and have focused their leadership activity on managing processes and technical aspects of clinical excellence rather than creating a values-based high engagement culture. Now, more than ever, the leader’s role in creating a culture of mutual support, empathy, trust and compassion is essential to sustaining resilience and performance over time. A major focus over the past year has been to help clinical teams to resolve issues that have become entrenched over time but flared particularly over the past 6-12 months.

Repairing a damaged clinical team

In a recent case, the team climate had become particularly toxic, leading to a series of incidents, each involving 2 or more parties that left team members feeling stressed, disengaged and resentful of the way they had been treated by their colleagues and leaders.

The team had begun to fracture into small groups with shared interests together and aligned against other groups and individuals in the team. Formal grievance processes were underway against a number of the team and previous attempts at mediation had been unsuccessful.

A neutral evaluation was undertaken to understand different perspectives of the case. This wasn’t an investigation and there was no specific case to answer but it enabled us to work from a firm foundation of understanding of the situation on which to base a series of recommendations.

Making Resolutions

INDIVIDUAL COACHING for 6 senior team members. AN MBTI WORKSHOP and follow up facilitated programme to develop an understanding of different types and perspectives within the team and how these could give rise to discord and misunderstanding over time. JOINT LEADERSHIP COACHING SESSIONS for senior leaders to create a clear sense of their accountability for a healthy team climate and to help them to develop practical strategies for maintaining this by reinforcing team commitments for behaviour and respect for colleagues. A SERIES OF FACILITATED TEAM MEETINGS with the whole group and with smaller technical specialist groups within that. These were designed to open up conversations around how conflict had arisen in the past, what needed to change to enable effective teamwork in the future and commitment to work in future with a greater degree of mutual support and understanding. DEVELOPMENT OF A TEAM CHARTER of behaviours to respect and account for differences. MEDIATION where some of the parties had experienced a deep and destructive conflict that was unresolved and still an obstacle to effective teamwork. Each element was delivered online and used either Teams or Zoom platforms. The expertise of coaches, trainers and mediators to develop a community of practice was imperative to enable delegates to share their lessons learned throughout the programme. Each element of the programme was highly interactive and experiential, which is even more important in online development work than in the classroom, to manage the risk of distraction and disengagement.

The case was complex and challenging and there were several difficult moments along the way that highlighted the need for the TCM expert team involvement. At times, particularly in joint meetings it was important to remind the team members not to slip back into poor habits of behaviour such as threats of retribution, which had been an aspect of their relationship in the recent past. The sensitive and expert facilitation re-established boundaries for behaviour and provided a reminder of the need to create and maintain a safe place for open discussion. This created a recognition that it was essential to acknowledge hurt and damage, without threat in order to move forward with a future focus.

Furthermore, despite commitments of confidentiality, there was an incident where this was broken by one of the clinical team who chose to share details and their own perceptions of the process with another party relevant to the case. This breach could have potentially put the whole process at risk. This was confronted carefully, and the safety of the process re-established to enable the team facilitation to be set back on track. Handled differently, incidents such as this could have resulted in escalation rather than the resolution that was achieved. TCM’s longstanding expertise in conflict management and leadership development provide a uniquely valuable approach in clinical settings and other environments demanding high performance team collaboration under pressure. The team in question is now on a course to sustain and embed new behaviours and will be taking this forward internally, drawing on coaching expertise and support as necessary formally or informally from the TCM consultant team. The team leaders have firmly taken back the reins on managing the team dynamics, and following coaching, have developed capability andconfidence to lead this process.

Key Learning

Coaching was an important element of the programme and the advantage of TCM supplying a number of different coaches, all independent of the team coaching processes, was that each individual coachee was reassured of the objectivity of their own accredited coach. This inspired confidence in the process. The initial chemistry meeting with each individual established there was a good fit between coach and coachee. The initial programme was contracted for 6 sessions and planned to be initially frequent (every 1-2 weeks) with coach and coachee agreeing to a suitable period between each thereafter from 2-4 weeks. The use of personality type was extremely valuable to help team members to unlock the seemingly entrenched perspectives they had of each other for them to see that behaviours were not indications of incompetency but differences in thinking styles and approaches to work. The personality framework will continue to be an important reference point for the team moving forward to embed their more effective working styles and sustain a positive team climate. Their newfound capability to ‘disagree well’ will ensure the team can continue to problem solve and challenge each other robustly to find the best solutions while maintaining positive team behaviours and mutual respect.