Generation Leader founder and Intensive Care Doctor, Hanieh Asadi, interviewed renowned Consultant Neurosurgeon, Mr Kevin O’Neill, around the topic of leading teams for effective performance within the clinical setting. Understanding how to tackle real life challenges by learning from current senior practitioners is key, as is the sharing of collective intelligence, so we hope you find this article valuable. The full masterclass is available on the Medical Leader Programme.
Question 1: What does effective team performance mean to you?
“As a neurosurgeon performance is pertinent, both as an individual and particularly on a team level.”
In order to answer this we have to understand what the team’s objectives are and what we are trying to achieve. Once this has been determined an objective outcome measure can be devised.
“The core objective is patient centred. I always start with the patient pathway which then allows me to design an exemplar pathway based on what we can give the patient at that time. From this you can then determine what you need in terms of people and the different skillsets required,” says Mr O’Neill. “Very often the key element is getting the team together as resources as often limited.”
Question 2: “What do you do when your team isn’t working well together and how do you recognise and address sources of team dysfunction?”
“Dysfunction happens when the team doesn’t engage enough and is not frequently brought together.”
You need a system in place where you are regularly meeting and monitoring your measures.
“A team does need a certain amount of structure, guidance and a reminder of what we are all here to do. There will always be someone who breaks away. Most of the time people just need to be re-engaged. The key is engagement and by doing this you will get a sense of what is going wrong and people will report that to you. It might be a systems issue that people are getting frustrated with and this will be easy enough to fix. You will never make someone do something that they don’t want to do and you need to find out if they want to carry on. If they need to leave and progress in another sense then you have to let them leave and allocate a realistic amount of time to replace them.”
Question 3: “How do you assemble an effective team and what characteristics do you look for?”
“The key is getting the right people with the right technical skills and the right personal skills.”
You need an in depth knowledge of the service and an understanding of what you are trying to achieve with that team, which will therefore give you an understanding of the skills required.
“Sometimes setting up an effective team falls by the wayside because someone gets parachuted in to perform the task who may understand the specialty but doesn’t have an understanding of the local issues. There are lots of constraints that will mould how you do things.”
It is ideal to assemble a team with people who have known each other for some time and who have come together voluntarily.
The key element to working smoothly and effectively is that each team member understands and knows their defined role and more importantly understands the definition of each other’s roles. They therefore complement and support each other, interact positively and develop a sense of co-dependency. This is underpinned by a group’s understanding of their collective mission and what they want to achieve together.
“The group also needs to understand that there will be secondary aims that arise from influences around us that will cause disruption, but as long as the team understands the primary goal they will get back on track,” says Mr O’Neill.
“Cost, quality and speed are important factors. If you want the extremes of all these it will never happen, but the focus should always be on quality. You normally settle for something in a spectrum within these three categories. It’s important to note We don’t always have full control over the team that we work with.”
The drivers to your service have aspects to them which include:
The political climate
The Medical Environment
The latter being of particular focus right now with the current Covid-19 pandemic. Many healthcare workers have been drawn away and redeployed.
“When putting a team together you need to know the team’s skillsets and importantly you need to know the people.” Says Mr O’Neill. The problem in medicine is “we appoint people based on one interview but we don’t really know what they’re capable of. The way I’ve put teams together is by engaging the team. I’ve had a process of sharing a vision and seeing who’s put their hands up, who wants to be a stake holder and making them incentivised and sharing the goal. Collective buy in is essential. Occasionally you will need to fill a gap and appointment someone by interview. However it’s better to know and nurture someone to the position rather than appoint cold.”
Question 4: “ How can you motivate team members to work towards a common goal?
“This is the vision we have and we have to do it together. Everyone has their role.”
It’s key to lay out the vision and an idea of how to get there with a pragmatic pathway showing how this will be achieved. The team needs to see an emphatic way that they will contribute to the goal. “ It’s all about a recognition of their contribution to ensure a feeling of self-value and self-worth,” Says Mr O’Neill.
“Clinical leaders need to use the metrics and measures as an incentive, not as a stick. You need to celebrate the team and have regular social and professional interactions to bind the group together.”
Question 5: “How have leaders you’ve worked with positively impacted their teams and patients?
“A leader needs a clear sense of direction and a clear vision to positively impact a team.”
Great leaders demonstrate with each meeting how the team is progressing towards their goal at a steady pace.
“You need the ability and adaptability to get over hurdles and be able to discount things that aren’t so much of a problem”, says Mr O’Neill.
“Most of the people that I’ve admired have been very good at what they do and good at conveying that to others. You can have a surgeon who is great technically but tends to live in their shell, therefore not teaching others. It’s all about interactions and your value is your interaction with society and how society, or your immediate society, views you and what they get from you and you get from them.”
Question 6: “How does poor leadership impact the performance of teams?”
“Poor leadership is stopping the two way relationship with the team. Ensuring the team is engaging is key.”
“A poor leader often focuses on dictates from above and on processes, rather than on developing and nurturing people. For example, a leader who focuses on auditing, constraining and micro managing in times when performance is dropping. Such actions will only worsen the situation. Coming up with a collective solution to the problem and presenting an atmosphere of positivity is a far more productive solution.”
A team needs structure but they also need the freedom to use their intuition and the opportunity to innovate.
Leaders need to give praise when it’s due and not condemn when it goes wrong. “ I want to know about people’s failures but would not condemn them for it. I would be supportive and accountable for that failure as their team leader.” Says Mr O’Neill. When colleagues feel supported in such situations they are willing to go the little extra for the team. “ Accountability is very important but it needs to be shared.”
Question 7: “Which skills are most important, setting aside clinical skills?”
“ To be a good doctor you need to be able to communicate on a personal level”.
Good bed side manner is essential. “You need to show a patient that you are their advocate, you are their problem solver, it’s a skill that makes medicine more optimal. You need to put patients at ease.”
The ability to deal with stress
Time management, “There’s always too much to do”
Question 8: How important are management and leadership skills as a healthcare professional?
“You need to have these skills if you want to work within the system that governs you. To achieve clinical excellence you have some degree of management skills.”
About Generation Leader
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About Mr Kevin O’Neill
Mr Kevin Sean O’Neill is one of London’s most reputable neurosurgeons. He practises at Charing Cross Hospital and other prominent clinics in the capital specialising in brain tumours, spinal surgery and peripheral nerve surgery.
He is dedicated to research and has been widely published in peer-reviewed journals on many field-related topics. He plays an important role in various professional bodies including the Society of British Neurological Surgeons, the British Neuro-Oncology Group and the Research Society of Neurological Surgeons (USA).
• More than 30 years of experience
• Head of Neurosurgery, Imperial College Healthcare NHS Trust (2014 – present)
• Consultant Neurosurgeon, Imperial College Healthcare NHS Trust (1999 – present)
• Consultant Neurosurgeon, Cromwell Hospital (1999 – 2013)
• Senior Registrar, National Hospital for Neurology and Neurosurgery, Queen Square (August 1998 – February 1999)
• Senior Registrar, Great Ormond Street Hospital for Children NHS Foundation Trust (February 1998 – July 1998)
• Senior Registrar, Atkinson Morley’s Hospital, Wimbledon (1997 – 1998)
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