"The strength of the wolf is the pack..."

 The legendary basketball coach, Phil Jackson once said, "The strength of the team is each individual member.  The strength of each member is the team."  That sounds a lot like a line from Rudyard Kipling's poem, "The law for the wolves" from his book, The Second Jungle Book.  Kipling writes, "For the strength of the pack is the wolf, and the strength of the wolf is the pack."  Maybe Coach Jackson "The Zen Master" was thinking of that passage from Kipling (he is an avid reader who often gave books that he found inspirational to his players) when he talked about the strength of the team.  We can forgive him if he did, after all he won two NBA championships as a player, and coached the Chicago Bulls and Los Angeles Lakers to a combined 11 NBA championships as a head coach.

Both Jackson and Kipling are making an important statement about teamwork.  As the old metaphor goes, a chain is only as strong as its weakest link.  A team depends upon all of its members to achieve their collective goals.  Similarly, sometimes just being a member of a great team brings out the best in us - team success leads to individual success.

Perhaps not surprisingly, there's been a lot written in the management literature on teamwork.  I recently came across an article that really peaked my interest.  The article was written by a group of investigators from the Massachusetts Institute of Technology's Sloan School of Management.  It was the title that caught my attention - "Establishing high performance teams: Lessons from health care."  Please forgive me for being honest, but I wouldn't necessarily look to the health care industry for examples of great teamwork.  So, I couldn't help myself but to take a closer look.

The MIT investigators, Michael Anne Kyle, Emma-Louise Aveling, and Sara J. Singer, studied 12 primary care clinics trying to focus on improvement and become high-performing, multidisciplinary teams.  High-performing teams are foundational to organizations as they become high reliability organizations (HROs).  These investigators identified three different approaches to establishing team-based care as part of a journey towards high reliability: pursuing functional change, pursuing cultural change, and pursuing both functional change and cultural change together at the same time.  

Teams that focused on functional change only trained team members in quality improvement skills, such as PDSA cycles (plan-do-study-act), Lean/Six Sigma, and process improvement.  By teaching everyone on the team the new skills of improvement, everyone would have the right set of tools to not only help with an improvement project, but also to lead an improvement project.  Conversely, teams that pursued cultural change focused on improving communication, developing shared mental models, flattening the hierarchy, and being willing to accept failure and learn from it without fear of reprisal.  Finally, some of the clinics pursued a dual approach, focusing on both functional change as well as cultural change.

Which approach was the most successful?  It probably won't surprise you to learn that focusing on both functional change and cultural change together created the highest performing teams.  When you think about it, we really shouldn't be surprised by these results.  Functional change and cultural change, at least as described in the current study, are mutually reinforcing.  You really can't have one without the other.  

A few of the teams provided feedback.  One of the nurses in a high-performing clinic said, "We have become data fanatics."  Conversely, a social worker from one of the low-performing clinics said, "We have these projects and a lot of energy goes into them, and then they get dropped."

Cultural change created the favorable conditions in which everyone on the team felt comfortable speaking up to share their concerns, ask questions in order to learn, and challenge others on the team to do better.  Functional change gave the teams the skills to drive improvement, but the culture change created the atmosphere and team climate where it was possible to do so.  In other words, culture change and functional change together created an atmosphere where the strength of the wolf is the pack, and the strength of the pack is the wolf."