I briefly mentioned something that I called the Accountability-Authority Matrix last month. Today I wanted to raise an issue that frequently comes up, particularly during events that involve some degree of urgency and stress and that involves making sure that authority and accountability are assigned clearly and appropriately. I will start with a clinical example, which I have found to be particularly useful when engaging on this topic.
The literature on teams frequently talks about crisis response teams that are characterized by (1) rapid deployment (often with little warning or pre-planning), (2) limited team familiarity (in other words, the members of the team have very little history of working together and, in some cases, may not even know each other), (3) rapid progression through Tuckman's stages of group development (forming-storming-norming-performing), and (4) relatively short lifespan (i.e. the team or group dissolves once the crisis is over). These kinds of teams have been called swift action teams in the literature, and if you've ever spent time in a hospital (not as a patient, but as a health care worker), you're probably thinking about the Code Blue team as the perfect example of this kind of team.
For those of you who don't work in health care, a "Code Blue" is called when a patient has an emergency event, such as a cardiac arrest or breathing difficulty. Most, if not all, hospitals have a team of health care professionals that respond to these events, called either "Code Blue Teams" or "Code Teams". The roles and responsibilities are frequently decided in advance, though unfortunately this is not always the case. Thankfully, "Code Blue" events are relatively rare in the hospital setting, so the members of these teams have other patient care responsibilities. When a "Code Blue" is called, the members of the code team stop their normal duties and responsibilities and proceed quickly to the location in the hospital that is experiencing the event. If roles and responsibilities have not been decided in advance, the code team quickly forms and the code team leader immediately assigns the different responsibilities (performing chest compressions, drawing up and administering medications, documenting the actions performed, etc). Once the emergency is over, the members of the code team return to their normal duties.
As you can imagine, one of the most important responsibilities for the leader of the code team is communication and coordination with the other members of the group (see one of my favorite articles on this topic, "Leadership of resuscitation: Lighthouse Leadership" published in 1999 in the journal Resuscitation). The same is true really for any swift action team. Experts in this area speak to the importance of closed loop communication, using a shared mental model, briefs, huddles, and debriefs. One aspect of closed loop communication that I've personally found to be important involves assigning accountability and authority. It involves the "who" and "what" of closed loop communication and avoiding confusion as much as possible.
Imagine the following scenario. A code team has responded to an event. Upon arrival, the senior physician immediately takes charge and assumes responsibility for leading the rest of the team. The leader is working through the problem and suddenly looks up, "Will someone please draw a blood gas?" Who is the team leader referring to? Is there someone on the team named "Will Someone" perhaps?
Of course, I am being a bit cheeky. There is likely nobody on the code team who has the name, "Will Someone." But in the absence of clear, targeted, and direct communication towards a specific individual, who is going to assume responsibility for drawing the blood gas? The likely result is that no one will do so, and in about five minutes the team leader is going to start asking for the results of a blood test that no one drew.
What should the team leader have done instead? A more effective approach would have been to point directly at one specific individual, hopefully use that individual's real name, and say, "John Doe, will you please draw a blood gas?" (of course, John Doe is a fictitious person here).
Specific, direct, and targeted communication avoids the confusion associated with trying to figure out which person on the team is named "Will Someone"! Assigning clear authority and accountability during a code event (or in any situation involving a swift action team) is always a good leadership practice! We'll talk more about some of these leadership practices in the next few posts, as collectively they comprise some of the best leadership practices of high reliability organizations.
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