[00:00:00] Mat: Welcome to Doctors at Work. My name’s Mat Daniel and this podcast is about doctors’ careers. Today I’m having a conversation with Simon Craig and we’re talking about how to create great teams. Now we all work within teams, but what makes one team great and another one less all of us instinctively know it feels a certain way.
In this episode, Simon tells me about teamwork and we talk about culture. Now, he’s written a book called From Hurting to Healing, in which he explores how we can change medicine for the better. He tells me about the importance of belonging, leadership and cake. And his top tip for doctors would be to really invest in high quality connections.
Welcome, Simon. Tell me a little bit about yourself.
[00:00:45] Simon: Hi, Mat. Thanks for having me on the show. So I’m an Australian doctor. I specialized in obstetrics and gynaecology, and I’ve done that for many years and loved that. And I’ve had a career change and moving into some different areas now.
[00:01:02] Mat: It’s a very exciting career journey.
And I invited you to talk because you wrote a book.
[00:01:08] Simon: Yeah, that’s right. I wrote a book called from hurting to healing, delivering love to medicine and healthcare. And the reason the book came about was because towards the end of my clinical career, I was thinking more about different issues.
I was thinking about the struggles we had in healthcare cultural burnout, these types of things. And also what. What we could do about it. And I was particularly interested in teams. I’ve always been interested in teams in every realm, sports, music, whatever it is. And it struck me that some teams in my organization and many other organizations were fantastic, high functioning teams and others with similar backgrounds were not performing well and having lots of issues.
And it’s hard to know why that would be. And. I thought, what are the elements that create high functioning teams? And I didn’t know what they were necessarily. I had an intuition. And if we could identify what these elements were, why weren’t we trying to put those elements into play with every particular team?
So I went off and was getting a bit interested in these questions and couldn’t find the answers. And so my sort of journey to look for these answers and how we could improve things. Led to the book
[00:02:32] Mat: and actually I really enjoyed the book the aspect around teams, but there are multiple layers in the book because there’s lots of stuff there about individuals and individual burnout and how people are defining success and that sort of struck me is really useful for the individual as well as that and how culture develops and how all of us influence culture, and maybe let’s talk about teams.
Then, first of all, what do we know about teamwork in healthcare settings?
[00:03:00] Simon: We know that high functioning teams and effective teams are essential for healthcare. We all. We all intuitively know this. We know that patient outcomes, there’s evidence that patient outcomes are better with good teams.
We know that being in the members of the team is higher. We know that the organization flourishes on every parameter, every measure. So teams are really essential. I think we perhaps don’t do teams as well as we used to. I think perhaps there’s a little bit more sort of separation from the leaders and the juniors, maybe there’s a little bit more competition, perhaps our relationships and our communication have slipped a little bit, but quite often we don’t have the teams that we’d like to be in and we all know when we’re part of a great team.
It just feels good. It’s great. And we remember those teams from the past, don’t we? We remember when we were a junior resident and having an amazing leader. And it’s such a beautiful memory.
[00:04:03] Mat: What goes into a really good team?
[00:04:10] Simon: I think there’s a lot of factors and they mostly come down to human interaction. I think it’s much less about the technical and more about the person to person. And I think back on when I’ve learned technical skills or when I’ve learned obstetric skills and things. And I remember less about who taught me the skills, but I remember more about how I felt in certain teams and how I felt with leaders.
Perhaps even. When you think you’ve made a mistake or when something hasn’t gone as well, how you were treated in that team, maybe how quickly you were integrated into that team, how quickly that the very senior professor knew your name, rather than you being the intern or the resident, these sorts of things how quickly you feel you belong.
And I saw something of yours the other day that you were talking about leaving work early and there were two of your juniors there and you were going off to have lunch or something un work related and you wondered whether to tell them the truth and you did and I thought that’s fantastic because that’s honesty and that’s integrity and that’s, there’s some of the elements that the juniors model on us seniors is.
That’s how our teams will develop.
[00:05:31] Mat: I think that’s going to be my mission, Simon, that by the time that I retire, we’re all going to go out to lunch more. And I’m going to know that I’ve achieved when we’re all going out for lunch at least once a week.
[00:05:42] Simon: It sounds like a good team.
[00:05:47] Mat: Okay so let’s think then.
I’ve got a new person that’s coming and joining the team that I work with. So for me that might be theatre team, for somebody else it might be award multidisciplinary team. So what can the team members do to integrate a new person as quickly as possible?
[00:06:06] Simon: Firstly, that thought, what can we do to integrate them is probably Or you’re already ahead of the game, I think, because you’re thinking of the other person and what they can provide to you and what you can provide to them.
And I think actually saying that out loud because everyone, no matter how junior they do. Bring things to the team. They might bring they’re filling gaps in the on call roster. They’re chasing up results. They might be doing the seemingly least important roles, but the critical roles and I think that has to be recognized and discussed.
And I was thinking about this the other day because I was watching them. This is a little bit off topic, but I was watching Peter Jackson’s video about Get Back, about the Beatles album, recording the Beatles album, and John and Paul were the stars, of course, and George and Ringo was the other guy, but when you watch that, Ringo’s the glue.
He’s the guy going around making the relationships and keeping everyone happy and having a joke. So he’s not the genius. But he was providing such an essential function in that team.
[00:07:20] Mat: Or maybe he was the genius because he was the one that actually the, maybe that was the function of genius is to bring people together, isn’t it?
And perhaps maybe as a society that isn’t a function that we value because we value all of the individual superheroes, don’t we? Yeah.
[00:07:38] Simon: Yeah. That’s a great point. Yeah.
[00:07:41] Mat: Okay. Okay. It’s good to start off thinking how can we integrate this person? Have you got some examples maybe from your own past as to when you were integrated really well or when you’ve seen it done really well and maybe times when you’ve seen it done not so well?
[00:07:59] Simon: I remember a time I joined a ward, a unit, an obstetric unit, and I’d worked in the unit for a week and on the Friday was our antenatal clinic and As we’re working in this massively chaotic antenatal clinic which most antenatal clinics are, I’m not sure if you’ve been in one, and a message came over the loudspeaker saying can all staff report to the meeting room and we all went into this little meeting room and the most senior consultant came in with two thermos flasks of boiling water from home.
And he made us all a cup of tea or coffee, and it was a teabag or a spoonful of Nescafe in those days. And so he, and we sat around, and so he and the other senior consultant were serving everyone. And then someone had brought in a cake, there was a cake roster. And so they cut that up and that’s, divided it out.
And then the senior consultant said to me, Hey Simon, how about you bring the cake next week? And he said, None of that health food rubbish. No seeds or nuts. We want chocolate. And this was my first day with all these people, really, as a group. And he was integrating me. He was making me feel I was part of it straight away.
Plus he was also getting some chocolate cake out of the deal. But things like that, bringing people in, making them feel like they’re part of the team.
[00:09:34] Mat: So I’m wondering, because you see, because if that was the team that I work with, I would say nothing with sugar and chocolate, definitely no cake. I want seeds and nuts and possibly some dates that might be the most sugary as we go.
So what you’re saying Simon is that I need to forget the seeds and the nuts and I just need to bring in cake.
[00:09:54] Simon: I think that’s right. I think the world’s changed in what we’ve what we think a good cake is, but I think it’s yeah, bringing the cake in, having a cake roster is a pretty powerful thing for a team, I think.
[00:10:09] Mat: So somebody’s going to say, I can’t possibly justify taking 10 minutes out in the middle of a busy antenatal clinic. What would you say to that person?
[00:10:20] Simon: I’d say that’s, a stitch in time. I think that the way you create those relationships and the way, those people that then. The junior consultant, the junior resident rings the consultant immediately, you know who they are, you don’t have, there’s a degree of trust, you’re creating communication channels that ultimately are for the benefit of the patient.
And also, empowering people so that they aren’t scared, you’re, that you become a person as the consultant, rather than some scary figure. Things don’t get hidden, because a lot of our serious mistakes, serious errors in medicine, there’s lots and lots of errors, and quite often that relates to a communication error.
We don’t want a communication error that’s come from fear. I
[00:11:09] Mat: think one of the challenges that, that certainly I experience in relation to those connections is that the way that the workloads are structured, certainly I spend very little time with our foundation doctors, house officers, people that are within the first few years.
There’s a registrar that I spend a lot of time with, but people that are maybe within the first four years of the postgraduate training, the way the work is structured very rarely see them. And that’s. Not because I don’t want to, it’s just that the way the work is structured. I guess so that might be a slightly bigger question, because I know in, in your work you talk about the overall culture.
And if I wanted to change how we work, what can I as an individual do?
[00:11:59] Simon: I think the biggest change that we can make in That team environment is how we show up and how we behave and the values that we show to our juniors the efforts we make to get to know each other the way we communicate. And it doesn’t have to be just it’s got to be authentic and it’s got to be.
Serious, this is important work, but we can have good relationships and we can like each other and we can be kind to each other in a very important field.
[00:12:35] Mat: And I also like to comment earlier about the that, the professor was serving others. So I wonder if you could, can you tell me a bit about there you are, that’s, there’s the leader, the senior person that is serving.
What does that say? What message does that send? Yeah it implies,
[00:12:53] Simon: it implies a little bit more equality. Doesn’t it? That we’re all, and we are, we’re all individuals. We’re all people. We might have different training and different expertise and backgrounds, but at the root of it, we can all enjoy a cup of tea together and a chat and perhaps medicine, particularly.
It’s incredibly hierarchical and it’s incredibly conservative and that’s been a good system that’s been a functional system to have that hierarchy and people with expertise expanding that downwards it can, the benefits can sometimes it can change the balance can change and it can become too rigid and too scary for those at the junior level.
[00:13:43] Mat: And what, why is that hierarchy a problem?
[00:13:49] Simon: I think when it, any, it becomes too rigid and the leadership is such a vertical leadership, it becomes, decision making becomes a lot slower, slower, so a more horizontal style. For example military leaders, if you’re the general and you’re sitting in, let’s say, Washington, and there’s people on the ground in Afghanistan, they’re going to have to make decisions real time.
It can’t all go back to the general, because otherwise it’s delayed. And I guess similarly in healthcare, there are things that your residents, Mat, All your registrars will have to do without running every single decision past you. And if they’re scared or they think this is such a rigid team, everything’s got to go through Mat.
Treatments will be delayed and things will be slower. And that will lead to a less functional team and perhaps a lesser outcome for that team’s patients.
[00:14:43] Mat: So I’m wondering that in some circumstances, they’ll think there’ll be some trainees. Who might say, Oh, this is great that sort of, I talked to the boss about everything.
This is fantastic. Yeah, but there are going to be others that are going to be immensely frustrated that that they’re not being trusted or enabled to do everything. And I guess equally, there’s going to be some senior doctors who are going to be very micromanaging who can say, I want to know everything about every one of my patients.
And there will be others who are say just get on with things. There’s the different permutations. So I’m wondering if there are some trainees that, that like to run everything past their boss. And that may be hierarchy related, which was, which is bad.
But I guess also for some of them they might lack confidence. They might not trust themselves, which actually that’s also bad, isn’t it? So whichever way we look at it, it’s bad. Yeah. There needs to be an appropriate amount of discussion. Not too much, not too little.
[00:15:43] Simon: Maybe that’s the key. Maybe there has to be discussion between the consultant and the registrar or the resident.
And maybe that. A degree of self-awareness. If you know you’re the consultant that gets anxious and wants to micromanage, you can say that. You can say, it’s not about you, it’s about me. Or if you’re a less, more of a hands off consultant, you may discuss that, but say, it’s always fine to ring me about things you’re worried about.
I remember having a senior registrar who basically completed their training and was working in our team. And She wanted a lot of help, but it wasn’t from lack of confidence. She said, look, the more I interact with the consultants, with them assisting me or whatever it is, things I can do, but I’ll be a consultant soon and I’ll be on my own making, so I may as well suck up every little bit of knowledge I can at this moment.
That was a fantastic comment.
[00:16:39] Mat: Yeah. Yeah. That’s a good reason for discussing things, isn’t it? A genuinely good reason, that kind of learning mindset. I’m reminded of when I was a trainee, I rotated between two consultants that were my trainers at the time. And one person was very hands off.
And I remember when it came to operating, they said you get on with things. So I’d struggle along, from nine till 1150. And then he would come at 1150 and in 10 minutes, it would all be finished. No matter how far or not I had gotten 10 minutes later, it would all be finished.
So that was great because it enabled me. to make progress and clearly he trusted me and he let me do stuff and he knew that he could bail me out. But I never really progressed. I got stuck at a point and then my training didn’t progress beyond that. The other half of the firm was a consultant that very closely watched what you did and sat with you.
And, for that person, Sometimes I found that frustrating and I said, just leave me to it. I can do this, let me do what I can do. But the plus was when I got stuck, they were there to say, oh, this is what you do. This is what you do. They moved me forwards. And then I did a bit more and we operated together.
So it was a good learning experience at the point when I got stuck, even though. Up to that point of getting stuff, I found it quite frustrating that I wasn’t let to let I wasn’t allowed to do stuff, but between the two of them, I thought this was a perfect mix because, between the two of them, they were the perfect training firm.
[00:18:09] Simon: Yeah. It does sound like that. Doesn’t it? Very complimentary. I wonder if they knew that they had that that relationship.
[00:18:16] Mat: I don’t know, I might ask them. Yeah. I’ll still talk to them both. Oh, great. Yeah, I suspect at least one of them I think did, yeah. Probably the one that sat with me, that, that’s probably the one that noticed and paid attention.
The other one that left me probably didn’t notice what was going on. That would be my guess.
[00:18:36] Simon: Yeah,
[00:18:36] Mat: Let’s go back to teams then. So we talked about how somebody’s new to the team, how can we get them introduced and how can we try and get them to be part of a team as quickly as possible.
But from your experiences or from your research or the stuff that you’ve done for your book, what else distinguishes a team that’s working well from a team that isn’t?
[00:19:02] Simon: I think the sort of creation of belonging and the induction process that you just alluded to is absolutely essential. I think we have markers, don’t we? We have clinical markers that we know teams and we can compare ourselves to other teams, both within our organization, other organizations.
Other countries. So we have those sort of clinical markers for what they’re worth, bearing in mind that every population and every, has different demographics, it’s catchment area might be. You might have more difficult medical problems. So we have that. And I think we do know, I think sometimes that data really is hard to work out, how do you define an optimal team?
And this is a thing, a little bit like culture in my opinion, Mat, that a lot of it is intuitive. When you’re part of a good team and others will know, how do you measure that? Is it just on clinical data or is it on other things that are harder to, the subjective things? How do you objectively measure those things?
How do you measure Mat’s relationship with his registrar as opposed to the next consultant? How do you measure the amount of happiness? How do you measure? What you’re providing in terms of training, I don’t think we measure that accurately. How do you measure the examples you’re setting and maybe the building blocks you’re putting into place for that registrar’s career, that registrar’s well-being, that registrar’s ability to be a leader in due course?
And we don’t measure those things. But we all know.
[00:20:52] Mat: So I’m wondering are those kind of things measurable?
[00:20:58] Simon: It’s difficult. It is difficult, but there are some really interesting newer developments. For instance. Emotion in a team. I think we’d all agree that a level of positive emotion in a team facilitates team function and outcomes more than negative emotion.
I think that would be a general agreement. And we can measure emotion in terms of written analysis of words, what people write down can be analysed for the level of emotion. So we can analyse it if we take surveys. So these sorts of things but making these subjective elements objectively measurable is a really interesting process, I think.
And that’s something that’s I’m also trying to do for culture in organisations and teams.
[00:21:48] Mat: I think the challenge that I foresee there is that, that if we’re not careful, what happens is there are certain metrics and then what gets measured gets done. If there’s, if somebody invents, a new system, and then that becomes the be all and end all, and then That’s the only thing that we measure and that’s the only thing that we focus on and some of the other stuff that is unmeasurable or more difficult to measure or even easy to measure, but we choose not to measure it then that kind of stuff falls by the wayside.
[00:22:21] Simon: it’s true. And in a busy, in the busy world and the busy lives we have, it’s hard to give attention to these things because a lot of these things take time, don’t they? It probably takes. How are we going? Even such an open question is that to assess team dynamics.
[00:22:39] Mat: Okay, so what else do we need to do to create better teams?
[00:22:46] Simon: I think the power of the leader is, everyone has their own power and everyone’s important, but leadership is critical. And how we produce leaders is really important. And in health care, oftentimes, it seems that the leader is the next most senior person in the team. When the leader leaves, it’s the next oldest person or the, and they may not be the best leader, or it’s often in a surgical team, for instance, it’s the most skilled surgeon that becomes the team leader, but they may be a great surgeon, but they may not have any leader.
Leadership ability and sometimes no leadership desire, really, they don’t want to give attention to the junior. They might be prepared to be the person who’s out in the tearoom while you’re struggling for two and a half hours. They may be the person that doesn’t really want to give cognitive attention to how do I integrate these juniors.
They’re more interested in their own performance because that’s been their focus for 20 years. So how do we assess leadership? Who should be the leader without upsetting everyone else or upsetting those people? But I think appointing the right leader is really important in how you develop your team.
[00:24:06] Mat: And what would you say are the characteristics of a good leader?
[00:24:11] Simon: All those things that we’ve talked about, I think I think being a good person is a pretty good start. Being a good teammate, I think if you can be a good teammate and support your teammates, you probably have the qualities that will become a great leader because you understand relationships, you understand the support we need and how we’re all at different points in our lives.
And interestingly Jim Collins, the good to great guy, found that the best leaders had a degree of humility, of humbleness, that they weren’t the driving tough guys all the time, that, that self cantered, they were more the humble guy who had attention for everyone in the team. They don’t have to be the star all the time.
[00:24:55] Mat: And maybe that’s back to the Beatles then, aren’t we? The who’s the star and who’s the humble glue? That brings everything together. What are what are the advantages for the leader of being a leader?
[00:25:11] Simon: Of being the leader a good leader? You mean, or just, because obviously, sorry, obviously advantages of leadership are a degree of status possibly remuneration, possibly other things like that. So there is a desire, our society values leaders and. We all have an ego. We like to be recognized.
So I think there’s a lot of things that come with leadership. And I think on that sort of meta level, what are the other advantages of being the great leader that we just talked about? Maybe that satisfaction at the end of your career of knowing how you’ve influenced people and seeing other people that you’ve trained becoming leaders.
I can’t remember whose quote it is, but it’s a good one. And yeah. The main job of a leader is to produce more leaders. Yeah,
[00:26:05] Mat: I’m interested in, in, the status and the finances because I think in UK context. I wonder how many people are willing to step up and lead and maybe that’s because perhaps there isn’t any particular financial or status reward for your average medical leader in UK and, maybe it’s different in, in, other countries.
But that concept of what difference you’re making to others and how you’re making changes, I think that strikes me as important. Yeah. That, you’re a leader because that gives you more opportunity to make a difference and it gives you an opportunity to leave a legacy.
It gives you an opportunity to make changes. So some of those, partly legacy, but also, if you are the leader that gives you the opportunity to implement changes and that gives you the opportunity to make things better. And if you’re not a leader, you perhaps wouldn’t have those opportunities in the same way.
[00:27:00] Simon: Yeah, I guess that comes back to your mission, the mission of the team, the mission of the group and the purpose. And. Keeping that in mind. Yeah, they’re all really good points. And I guess all of our mission when we start is to help people, isn’t it? And then there’s so many competing demands and things that sometimes.
That mission can get a little bit lost and maybe that when we do get a little bit lost, we have to take a step back and say what is our mission? What are we here for? We’re here for the people we’re looking after and we’re here for our community and we’re here for each other as well to look after each other.
And it’s a demanding career medicine. It’s a very tough career. It has its rewards, but the Lead some people to struggle, and we’ve talked before about burnout and things like this. But we need to look after each other and that’s one of our roles, I think.
[00:27:59] Mat: You’ve used the term culture a number of times.
What is culture?
[00:28:04] Simon: Yeah culture is really a difficult concept and we all talk about it, but it’s difficult to define, but it’s The way things have arisen to enable the work to be done, or in an anthropological way it’s the most Persistent and well entrenched features of any society, and in organizational culture they talk about the three levels of culture, which is the artifacts, which is what in you.
For instance, if you walk into a hospital, you’ll see a secretary behind a desk directing people, you’ll see tables and chairs, you’ll see an outpatient clinic. Then there’s the espoused values, which is what we say we believe in and how we say we operate. And then there’s the sort of under the surface, deeper assumptions.
And that’s. What really goes on. So that’s, if we say culture is the way we get things done around here, the assumptions is the way we really get things done around here. So that might be those poorer leaders that, you know, that we’re saying all the right things, but you know that if you make a mistake, they’re not going to be forgiving and kind and helpful.
And yeah, so that, all of that is, is the culture. Culture is something that we can talk about, but it’s often something when you walk into an organization or you become part of a team that you feel, and maybe as a junior resident, it’s the team you join where after a few days you think, I’m already part of this team.
I’m already belonging. I don’t have to pay my dues. Do my time, all of those things. You’re a member and you’re accepted immediately as a member.
[00:29:44] Mat: How do cultures change?
[00:29:48] Simon: Cultures change very slowly. Culture change is really difficult. And in organizations they say that it will take years. For instance, the British Airways culture change took seven years, famously. It’s something that can be done, but it, culture change is also difficult because it’s resisted because as humans, we don’t like change.
We, we fear it because it’s unknown. How do we change? I guess surfacing those assumptions, those hidden things and those difficult things which might be, for instance, for me, I might say you know what? I’m really not that nice to my residents. I’m really not the leader. I’m telling myself I am.
And and I am when everything’s smooth, but when something goes badly, I lash out. And that’s so surfacing assumptions can be really painful and difficult, but that honesty and willingness to go into difficult places is really the way you will change culture.
[00:30:53] Mat: And if somebody is new organization or somebody has been somewhere for a while and things.
I don’t like how we work here. We need to change what can an individual do to change culture?
[00:31:07] Simon: I guess what response they get to those comments will indicate the culture of the organization they’re currently in that if they say something and then they’re really shut down quite quickly or they have to be Silenced or they’re not listened to that will indicate a particular type of culture and some difficult aspects what can they do?
I think they have to speak up or talk to their leaders. And then the response they get might indicate how enjoyable their current job is, or how long they want to stay. And for the organization that they work for. They’re making comment about how they listen may dictate the quality of their workforce and this is relevant in health care because people are leaving.
Being able to listen to new ideas and how we listen to people may improve your. human resources. You may not have as many people leaving. You may not have disengaged workers.
So it’s perhaps as much some people speaking up, but people that are in senior leadership roles, the way that they influence culture is by listening And encouraging that speaking up and taking action and being prepared to go to the difficult place for themselves and for the organization.
Yeah, I think so, Mat. And it’s not easy, is it? I think we both, even while we’re talking about it, we’re acknowledging that these are not, it sounds easy, but it’s not in practice easy to hear. For instance, if someone came and spoke to you about your health care team and had some negative statements.
It’s difficult to hear that, and I think our instinct is to deny or not want to listen, but in hearing it and saying I don’t think this is true, but what if it were true, and of course there will be some truth in it, because that person’s seeing things from a completely different angle to what you are.
I guess a key thing for me there would be going back to your point, what’s the purpose? What are we here for? Because if the starting point is that we’re here for others, we’re here to serve, we’re here to look after our patients, we’re here to look after our team. Then if that’s the mindset it’s becomes much easier.
To listen to comments, no matter how painful they might be because you have a vested interest in hearing those things because, if I’m here to look after my patients, my team, et cetera, I need to know those kinds of things because that’s what’s going to enable me to look after them.
Asbestos. Yes. Yeah, that’s right. And that courage to, to say that and listen is is going to create a very strong team, I think.
Maybe I’ll bring us to a close, Simon. So what would be your top tips for doctors at work?
I think many of us are familiar with the Harvard study on aging, that the key to happiness and being throughout life is relationships.
And I’m interested that you said, Mat, that you’re still in touch with those older consultants from many years ago, so you still have relationships with those, and that’s probably a very nourishing and really great part of your life. And I, so I think attend to our relationships. We all want friends.
So to have friends be a good friend, I think concentrate on our relationships as we’re progressing through medicine from day one. And I think our work lives and our home lives and our, the whole of our life will be more enjoyable.
That’s a great tip. Thank you very much, Simon.