Adaptive Challenge

Leading a team of healthcare professionals from various disciplines involves understanding, flexibility, openness, and support. The team consists of multiple individuals with differing personalities, backgrounds, experiences, and training. This is further complicated in the attempt to provide individualized care for patients just as unique.

What makes the manager a leader?

What makes the leader an adaptive one?

• As a leader of a healthcare team, one must be able to motivate, manage and lead nurses, social workers, physicians, chaplains, and music therapists
• This is a challenge that exists each and every day, multiple times a day

The patient elected hospice due to a terminal diagnosis and wished to die at home when the time came. The nurse went in for an initial assessment, determining that oxygen was needed. The nurse was concerned that the patient was a smoker and would continue to do so on oxygen.

The social worker immediately noticed the living conditions and insisted that the patient be transferred to a clean and safe living environment such as a nursing home or assisted living apartment

The music therapist came in to provide music to the patient. She had no concerns, stating that the patient was pleasant and accepted the visit. Music included Elvis, the Beatles, and Peter, Paul, and Mary.

The chaplain states that the patient benefited from end-of-life discussion. The patient shared that she had recently lost her husband due to cancer and died in the house. She felt that she was closest to him when she was there in the living room.

At the weekly interdisciplinary team meeting, conflicting opinions quickly escalated into argument in regards to where the patient should be living

As team director, I was concerned with the well-being of the staff and their concerns as well as patient choice and her safety.

Being a manager, leader and licensed professional conflicting solutions presented themselves. This was further complicated by varying opinions, all correct to some degree.

• Asked the team if we are providing the best care under the circumstances ("How" not "what")

• Directed the conversation towards what the patient and healthcare professionals "can" do

After providing all the tools to the team, it was decided that the patient would be able to continue to stay in their own home

Despite somewhat unsanitary conditions, it was perfectly legal for the individual to reside in the home

While it is unsafe to smoke while on oxygen therapy due to its flammable properties, more harm would result if the patient did not receive oxygen versus smoking with oxygen.

As a compromise, the team decided that education with each visit was necessary to attempt to keep the patient safe. This would satisfy regulations and compliance. This was documented with each visit.

Housekeeping services were suggested, and with the blessing of the patient, set up by the social worker. This satisfied the concerns of the condition of the home.

By following the adaptive leader model, the team was empowered. Each individual felt that their concerns were heard. Instead of being told what to do, they were able to come up with a solution that satisfied regulations, each team member's concern, and the patient's wishes.

By Dan Krzysik

Adaptive Challenge:

Leading the Interdisciplinary Healthcare Team

• The nurse is upset that the patient is smoking on oxygen
• The social worker wants the patient to be transferred to an assisted living or skilled nursing facility due to the living conditions
• The music therapist states she has seen much worse and it's "no big deal"
• The chaplain believes that the patient has every right to live in this way as it is not illegal and within their right
• The primary MD is only concerned with the patient's compliance and comfort
• As the leader, I must find a way to bring understanding and acknowledge each individual while respecting the patient

Example: A home patient lives in a home that has been neglected for some time. Beer cans litter the tables, two pet dogs urinate on the carpet on a daily basis, the trash hasn't been taken out in two weeks, and the patient smokes while on oxygen

The Challenge

• As a manager, my concern in this situation is for safety and regulatory compliance
• As a leader, my goal is to allow for compromise and help my team make the "best" choice
• As a healthcare professional, my duty is to maximize patient safety yet allow for their wishes

Working within the confines of regulation, adaptive leadership taught me to do the following...

...Don't limit communication

...instead of the activity itself

...Don't keep it withheld

• Provide the regulations (information) to the team

Adaptive Vs.

• Allowed the team to take turns defending their position (flexibility and collaboration)

technical

...not "can't" or "don't"

...Rigidity is constraining

• A list of "rules" can paralyze and limit productivity
• Allow for failure and talk about why things didn't work
• Give the power to the employee in order to foster a "can do" attitude

• There is more than one way to do a task
• Allow employees to take care of the patient
• Each discipline needs to understand its counterpart
• Cross-train as allowable (within state license)

• Make sure the patient is taken care of in the way they were intended
• Think of what you would want for you or your loved one
• It's more "how" than "why"

• Allow for growth
• Encourage free-thinking
• Let employees ask questions and play devil's advocate
• Knowledge is power
• Power should be held by the team, not just the leader

• While it is important to know what employees are doing, give them the tools to think and work together
• Trust and allowance for independence not only fosters creativity, it encourages and motivates

What is your adaptive challenge?