Step 1. Pick a good team leader
If possible, make sure that each team - the practice nurses or receptionists, for example - and the practice as a whole, has a leader with some of these attributes:
- High standards of behaviour and leads by example.
- Able to motivate others.
Most leaders in general practice have an inclusive and psychologically close style rather than being dictatorial and psychologically distant. A good leader will be able to switch style if circumstances dictate, for example, in a crisis.
The tasks forming each team leader's 'job description' include planning ahead by identifying clear goals and involving others, problem solving, making sure plans are progressing and the team is functioning effectively. The leader needs to maintain morale and give feedback to the team.
Good communication is key: the team needs to understand practice goals; individuals need to be clear about their contribution and be kept up to date on progress.
Step 2. Establish clear accountability
If you find that decisions made one day tend to unravel the next, or are made 'on the hoof', consider decision-making processes and accountability. Teams do not function well when clarity, consistency or involvement is lacking.
- Does everyone contribute to meeting agendas?
- Are meetings chaired well?
- Are minutes distributed and actions reviewed?
- Is there a clear organisational chart of responsibilities?
- Are team members encouraged to use defined pathways for raising
- Does everyone adhere to them?
Step 3. Define roles and responsibilities
Particularly when new structures and processes are being introduced, make sure that people know what they are meant to be doing and the standard expected from them.
- Review and update job descriptions.
- Clarify reporting structures and make sure they work.
- Update policies and procedures if things have moved on.
Step 4. Know team members' strengths
A leader must understand what motivates team members and their strengths and behavioural preferences.
Not every GP will make an excellent business partner, not all administration staff are fantastic at dealing with patients and not all practice managers handle human resources issues well.
- Explore preferred team roles and behavioural preferences.
- Match roles to strengths/preferences as far as possible.
Step 5. Set an example
A leader must set an example of the standard of behaviour that is acceptable and take action if it is not met.
Teams can have an established culture: 'How hard we work, how much effort we put in, how we refer to each other and to patients, if and how we show respect for colleagues and what our reaction is to change or to new team members.'
Some individuals may have a lot of influence, so find out who they are and whether their influence is positive or negative.
It is the leader's job to be aware of their team's culture and to look after the team and its individual members.
- What is team morale like?
- Is there an 'atmosphere'?
- Are there cliques or harmful alliances? Why? Is action needed?
- Do people feel free to say what they think without fear of negative consequences?
- How can you find out what's going on? Try individual meetings with all team members or circulating a questionnaire.
Step 6. Encourage decision sharing
Leading a team through change is most successful if members can contribute to decisions and believe their opinions count. This helps establish a feeling of belonging and being valued. Team members will be motivated to do their best.
- Establish ways of listening/consulting through regular team meetings, sharing minutes of meetings, using the practice's intranet and holding regular 'one-to-ones'.
- Listen to team members' suggestions for improvement and act on them if practical.
Step 7. Tackle dissent and conflict
Effective team working is destroyed if dissent and conflict are not managed.
The team leader should be aware of their usual method of dealing with conflict. This may be 'knocking heads together', avoiding the situation and hoping it goes away, smoothing things over without finding a solution or exploring the issue and finding compromises.
The last is the most effective, but it may not appear to be the easiest.
Step 8. Manage poor performance
When someone is performing poorly or not taking on their share of the workload, good team members may decide to leave if this is not dealt with.
Other team members will be unhappy until the situation is dealt with. Meanwhile the leader's/team credibility is undermined.
- Establish a procedure for dealing with poor performance.
- Review performance on a regular basis.
- Take action when you think there is an issue.
- Stick to the established procedure.
- Be fair and give support to aid improvement.
- Fiona Dalziel is a practice management consultant, www.dlpracticemanagement.co.uk
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