Troubleshooting is an activity to be performed by team leaders and team sponsors and only very occasionally by team members other than the leader. Sometimes more senior leaders in an organization need to troubleshoot problems in a team within the organization, but troubleshooting from afar tends to be ill-informed interference or tampering, and so senior leaders are usually more effective when they prompt action by a team leader or a team sponsor instead of taking action themselves.

COACH INDIVIDUAL TEAM MEMBERS

Team leaders often have occasions to correct problems in the team by coaching individual team members. Individual team members can provide coaching too.

Granite Hills Health Center, a rural hospital, was considering expanding its cardiovascular service line to provide more emergency heartcare services, possibly including a medical intensive care unit (ICU). An ICU would enable Granite Hills to care for patients with myocardial infarction (heart attack), eliminating the need to transfer these patients by air ambulance to a larger hospital. The advent of ICU telemedicine had made this expansion of Granite Hills’ service worthy of consideration. With telemedicine, cardiologists can provide ICU care at a distance by using electronically communicated x-ray images, electrocardiograms, and other information. The senior leadership of the hospital had charged a task force with considering the medical ICU as well as other possible additions to the cardiovascular service line.

The task force was led by Gita Juntasa, RN, MSN, the hospital’s Director of Nursing. The other members were mainly nurses and physicians, including Peter Olsen, MD, a general internist. The discussion quickly focused on providing ICU care for patients with myocardial infarction. Beth Rappaport, MD, a family physician, spoke enthusiastically in favor of investigating the possibility. She emphasized the value of keeping the patients at Granite Hills, where they would have the support of their families. Current practice was to transfer these patients to a hospital that was 125 miles away.

Dr. Olsen spoke next. He was opposed to creating an ICU, and he had done his homework. He reported a series of facts and figures to the task force. He addressed most of his remarks to Dr. Rappaport, speaking in her direction and looking directly at her. He reported that the number of myocardial infarction patients during the previous year had been 27. This number, he said, was too low for nurses to able to maintain their skills in caring for these patients. No other rural hospital in the state was using telemedicine for ICU care, he reported. Based on a telephone call he had made to a hospital in another state, he related that the cost for the necessary equipment and training would be in excess of $2 million, a sum that Granite Hills could not afford. He continued on for 10 minutes, speaking in his usual confident, declarative manner, expressing no doubts. Although Dr. Olsen did not say so, his manner suggested that anyone who had reached a conclusion different from his conclusion was either poorly informed or foolish.

When Dr. Olsen had finished, initially there was silence in the room for nearly a minute. Then various doubts were expressed about the conclusions Dr. Olsen had drawn. For example, the number of myocardial infarction patients might be increased if Granite Hills received similar patients from hospitals in surrounding towns, avoiding the need for these patients to be transported 100 miles or more.

Dr. Rappaport said nothing. She felt overwhelmed and embarrassed. She thought that other people in the room probably saw her as naive, even mawkish, for suggesting that myocardial infarction patients should be treated closer to their families. She looked dejected, as Ms. Juntasa noticed. Dr. Olsen did not notice that she looked dejected. However, he did notice that she was silent, and he inferred that he had won the argument.

To some people in the room, Dr. Olsen appeared to be bullying Dr. Rappaport. Dr. Olsen would have been dismayed if anyone had later told him that he acted like a bully. He intended only to present reasons not to establish an ICU, supported by the many facts he had assembled. He did not intend to humiliate Dr. Rappaport and had given no thought to how his remarks might affect her. He did not consider her feelings (or his feelings) to be relevant to the discussion. The purpose of the task force, in his mind, was to reach the conclusion that best served Granite Hills’ patients.

Ms. Juntasa noted that Dr. Olsen could have achieved his short-term goal—reporting a host of relevant information—without causing the damage he caused. She had observed Dr. Olsen behave in similar ways in the past. The next day, she sought him out and asked to speak with him alone. Ms. Juntasa and Dr. Olsen held each other in high esteem. Recently, they had worked together to see the hospital through a difficult time, dealing with community relations and with funding. Ms. Juntasa told Dr. Olsen that Dr. Rappaport was quite upset the previous day. Initially Dr. Olsen was skeptical that his remarks had had any ill effect, but then he said that he was sorry for unintentionally upsetting Dr. Rappaport. He added that, in his opinion, she should set aside her feelings and deal with the work of evaluating the possibility of establishing an ICU. Ms. Juntasa told Dr. Olsen that Dr. Rappaport was very unlikely simply to set aside her feelings and probably could not. The incident during the meeting was likely to have ill effects on Dr. Rappaport’s participation in the task force and ill effects on her working relationship with Dr. Olsen well into the future. Dr. Olsen had alienated Dr. Rappaport and thereby diminished his own capacity to work effectively in the hospital.

Dr. Olsen was astounded, but Ms. Juntasa had been persuasive. Her comments were a revelation for Dr. Olsen. Four years ago, he had finished his residency in internal medicine at an academic medical center. The milieu in the training program rewarded clinical observation, medical knowledge, and logic. The feelings of patients were important, but the feelings of colleagues during discussions of diagnosis and treatment were not important. All professional staff were expected to act with dignity, calm, and logic. Humor was encouraged, but feelings were not to be displayed because they were irrelevant and threatened to interfere with clear thinking.

Dr. Olsen had never considered that his assertive, direct manner might be intimidating and might create barriers to the achievement of his own goals. He regarded Ms. Juntasa as having done him a great service by coaching him on his behavior in dealing with colleagues. In the weeks that followed, Dr. Olsen asked her several more questions about how he might make his behavior more effective.

In one of their follow-up conversations, Ms. Juntasa introduced Dr. Olsen to the notion of an emotional bank account (Covey, 1989, pp. 188-203). An emotional bank account is a reservoir of trust that someone can develop in a colleague by keeping commitments, respecting what is important to the other person, and other positive interactions. Each of these trust-generating actions makes a deposit in the bank account. These feelings of trust facilitate joint action. If one team member has a high balance in his emotional bank account with another team member, collaboration or at least serious consideration can be expected from the other team member. If the balance is negative, opposition or indifference is far more likely.

In this case, the team leader (Ms. Juntasa) was the coach, but Ms. Juntasa could have coached Dr. Olsen even if she had been a team member without being the leader.

Sometimes dysfunctional actions that appear to be fully considered and deliberate are in fact performed without any attention to their effects. The possibility that dysfunctional behavior lacks full awareness should always be kept in mind by those who are in a position to coach. Sometimes, with the permission of the person being coached, additional team members can be enlisted to point out the undesirable behavior tactfully as it is happening or shortly afterward.

On the other hand, some dysfunctional behavior is fully conscious and intentional; and in these situations, more skill is required in the coach, as discussed next.

INTERVENE WITH DIFFICULT TEAM MEMBERS

Imagine now that Dr. Olsen’s behavior had been much worse—that he was fully aware of the effects of his forceful manner and that, although he did not deliberately seek to intimidate and to humiliate, he was quite willing to accept these secondary effects if they happened to be the price of reaching what he saw as the correct answer to whatever question was being considered. Imagine further that Dr. Olsen sometimes deliberately used intimidation to win arguments and that he engaged in this and similar behavior often. In other words, imagine that Dr. Olsen was a “difficult person” or that he was frankly abusive.

The handling of difficult team members is discussed briefly in Chapter 9 in connection with a vignette about physicians and nurse practitioners considering whether to stop distributing pharmaceutical samples provided to the clinic by pharmaceutical representatives. Several options are offered in that discussion for how a team leader can deal with someone whose behavior as a team member is objectionable.

West offers several more considerations about difficult team members (West, 2012, pp. 195-197). First, he observes that some people are labeled “difficult” when they are simply consistent dissenters. If the person in question often disagrees with other team members but does not dominate, demean, or otherwise inflict psychological or physical harm, then his or her dissenting remarks actually should be regarded as a help to the team in its attempts to examine choices carefully. Second, a team leader should not try to deal with a difficult person by immediately excluding the person from team meetings or other team activities. This approach will not eliminate the offending behavior and may cause resentment that makes the behavior worse. Third, at the outset of dealing with the problem, the team leader (or a delegate) should assume that the problem behavior is not fully conscious and that it may yield to coaching as did Dr. Olsen’s behavior in the earlier vignette. One attempt at coaching is not sufficient. It may be desirable for more than one person to try coaching because different people in the team and elsewhere in the organization will have different kinds of personal connections with the difficult person, opening the door to coaching in unpredictable ways. Fourth, persistent difficult behavior or abuse of others in the workplace should not be tolerated. In some cases, the departure of the person from the team or the organization is warranted. Leaving the person and the behavior in place continues the harm to the team and encourages more behavior in the same vein since there is no adverse consequence for the wrongdoer. Avoiding dealing with the problem may even encourage dysfunctional team behavior in other people.

Dyer and colleagues (2007, pp. 136-139) present an escalating series of options for dealing with the problem when the difficult person is not receptive to coaching:

1. Direct confrontation by the leader with the individual member in private, describing the offending behavior and specifying consequences if the behavior does not change

2. Direct confrontation by the team as a whole, describing the behavior and its effects

3. Cooptation of the member by assigning him or her to special roles, such as summarizing discussions, or even serving as acting team leader

4. Restricting participation, such as allowing attendance at team meetings but no participation in discussion during the meetings

5. External assignment, that is, after full explanation of the situation and the ill effects of the individual’s behavior, assigning the difficult person to perform tasks separately from the rest of the team and to participate in the team only through individual effort carried out independently of the team’s collaborative activities

If none of these approaches results in a satisfactory resolution of the problem, then removal of the person from the team should be considered. Removing a stubbornly disruptive team member is always awkward and sometimes painful. The team sponsor’s support is often required, and the sponsor may be able to provide useful advice about how to achieve the removal. Removing the team member not only from the team but also from the organization often raises legal issues, and an attorney may need to be consulted. In larger organizations, the Human Resources Department will be able to help. And in some situations in health care, removing the difficult person may not be possible. For example, if one among several owners of a medical practice is persistently abusive to the point that everyone in the practice wants him or her to leave (but he or she is not behaving illegally), it may be impossible to force a departure without the practice making an intolerably large severance payment or running a substantial financial risk due to a law suit. In such a case, the coaching should then be directed to those who are being harmed by the disruptive person, teaching them means for coping with the disruptive person’s behavior.

RESOLVE RELATIONSHIP CONFLICTS

Carol Reyerson, RN, PhD, FAAN, was recruited to take the position of Vice President for Patient Care Services at Crispin University Medical Center. In this position, she would oversee all nursing services, pharmacy services, the operating rooms, respiratory therapy, occupational therapy, and several other services provided directly to patients. Before accepting the job offer, she requested that social services also be included within the scope of her job. Social services previously had been included among the services overseen by the Vice President for Support Services, Michael Balcerzak, MHA. David Laferte, MBA, the Chief Operating Officer (COO) of the medical center, agreed to Dr. Reyerson’s request, and Dr. Reyerson soon joined the senior leadership team. Mr. Balcerzak was informed of the organizational change and the rationale for it, but he was not given an opportunity to object to the change or to offer reasons for maintaining social services as part of Support Services.

As soon as Dr. Reyerson began work at the medical center, Mr. Balcerzak’s antagonism to her was apparent to everyone in the senior leadership team. He often made sarcastic comments in response to her statements in team meetings. When she distributed written proposals for comment, he usually responded at length with trenchant criticisms. Soon Dr. Reyerson responded in kind, forming alliances with other team members to oppose Mr. Balcerzak’s proposals. Within 9 months, the conflict between the 2 of them was disrupting not only discussions at meetings but also the smooth function of the team in addressing issues that were important for the medical center.

Managing conflict is discussed in Chapter 11, where relationship conflict is distinguished from task conflict and process conflict. Both task conflict and process conflict are ordinarily useful for team effectiveness. Resolving task conflict helps to clarify the team’s goals. Resolving process conflict helps to clarify roles and the methods used by the team to accomplish its goals. In contrast, relationship conflict concerns personal or social issues that are not parts of the team’s work.

Relationship conflicts, unless they can be shelved for the sake of smooth team function, are almost always damaging to the effectiveness of the team. Since they are not concerned with issues that constitute the work of the team, it is not necessary for the whole team to deal with these conflicts. In fact, it is normally best to deal with them privately, as discussed in Chapter 11. Either party to a relationship conflict can, in principle, initiate discussions to resolve the conflict, and the ability to resolve conflicts to which one is a party is a competency to be sought by all team members (see Chapter 7).

The team leader has reason to intervene if the parties do not seek to resolve the conflict or if they try and fail. Task conflicts and process conflicts are properly matters for the whole team to address, but unresolved relationship conflicts ordinarily call for troubleshooting by one person, usually the team leader but sometimes the team sponsor if the leader is a party to the conflict. The methods for addressing relationship conflicts are discussed in Chapter 11.

In the case of Dr. Reyerson and Mr. Balcerzak, Dr. Reyerson was in the best position to initiate discussion of the conflict since she had gained by the organizational change while Mr. Balcerzak was a passive victim of the change. In any case, if Mr. Laferte, the COO, were to encourage the quarreling parties to settle their conflict and no resolution was reached, then Mr. Laferte would need to troubleshoot. Incidentally, any unpleasantness for Mr. Laferte would be, in a sense, well deserved since he handled the organizational change poorly and in effect caused the conflict.

COACH THE TEAM LEADER

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