amy-edmonsonAmy C. Edmondson is the Novartis Professor of Leadership and Management at Harvard Business School. Edmondson’s research examines leadership, learning and innovation in teams and organizations, and has been published in numerous academic and managerial articles. Her book, Teaming: How organizations learn, innovate and compete in the knowledge economy (Jossey-Bass, 2012) highlights how continuous improvement, understanding complex systems, and promoting innovation are all part of the landscape of learning challenges today’s companies face. Organizations, Edmondson argues, thrive based on how well small groups – teams – within organizations work with each other. The pace and breadth of change in today’s world demands leaders who can create an environment where individuals can team, and teams can succeed.

Edmondson spoke to RCRC about her book, and about what teaming means for relational coordination and healthcare.

How does teaming advance the concept of Relational Coordination?

I think that relational coordination is very much about effective teaming. Relational coordination is a very precise and helpful way to measure and encourage good coordination. Relational coordination says first and foremost it’s not just a task, not just the tool, or the technical work that we do when we talk about relational coordination. Coordination must fundamentally happen between people who are emotional beings, and who have to connect with each other in genuine ways for it to work. Relational coordination calls attention — by design — to aspects of the relationship side of work coordination. It recognizes that the relational side of coordination is essential for organizational effectiveness. In that sense, Relational Coordination and Teaming emphasize the same phenomena, but use different windows to talk about the challenges we confront in making positive change.

When I talk about teaming, the gap I am addressing is that people are too individualistic and pay insufficient attention to their interdependence and thus to the need to work together. I am saying that the gap here is for people to recognize that they are interdependent. Similarly, the relational coordination construct and research were inspired by Thompson’s understanding of the different kinds of coordination in organization, and by the central importance of what he called “reciprocal coordination” – where back and forth communication was central to effectiveness. Both traditions – relational coordination and teaming – recognize that we can’t coordinate well while being insensitive to relating to each other.

Concerning healthcare, what do you think is the next step to move toward more coordinated delivery of care?

I believe the next step in healthcare is leadership development. By the way, this is starting to happen more and more. By leadership development, I don’t just mean CEOs or chiefs of service lines, but helping to develop people at all levels of healthcare industry in some basic practices for developing and influencing others, and for encouraging and engaging collaboration in new ways. One thing going for us in healthcare there is no shortage of intrinsic desire or motivation to do the right thing. The challenge becomes shifting individualistic mental models. The industry has grown up with a mental model that says, “if I do my job well and you do your job well, the patient will get the best care.” That was once was true, in earlier eras of health care, a century, or even a half century ago. Today it is anything but true.

There are some aspects of teaming in healthcare. For example, in surgery. What is missing?

What is missing is a deep awareness of interdependence – in caring for both hospitalized patients and patients in general, even in surgery. This stems from the culture of the profession, which is grounded in individual expertise. This kind of professional culture is not just characteristic of healthcare. The mindset of a professional is the study and practice of a deep and relevant body of knowledge – one with important relevance to problems in the world. This mindset, historically, has been, “I go to school to master a profession, and then I go to work to exercise that mastery and expertise.” A professional, in short, is someone who masters important expertise and applies that expertise in the world. This notion of an essentially solo activity was for years appropriate in healthcare, and still may work well in some other industries.

However, today, particularly with the balance shifting from mostly episodic care to mostly caring for patients with chronic conditions, the work is becoming an ongoing, teaming process — whereby we monitor, help, and encourage patients to be part of that collaborative process. The world has slowly changed around us, and our mental models of an individual professional who can do what it takes to get the job done are out of whack with the new reality of the care process.

You had mentioned that the idea of teams is in decline but that the idea of teaming is ascending. What does that mean?

I wouldn’t say the idea of teams is fading or dying, but rather that the reality of formal teams in 24/7 industries like healthcare — and many others with extremely fluid work contexts where we require staffing flexibility that precludes the composition and maintenance of stable and formal teams — is on the rise. It’s not that teams are not good; it is just that in many settings it is no longer realistic to go that route, to say, “okay, let’s put together well-composed, well-designed, well-practiced teams, and they will do better work than otherwise.” Absolutely, they will. But back up: Can we actually do that? Not really, because people have different shifts, different needs, and the ability to keep stable work partnerships together is pretty low in healthcare.

What does that mean for health care organizations? It means that the need for collaboration isn’t going to go away. And if we can’t rely on formal, stable teams, then we have to get good at teaming – at the activities and processes of collaboration and coordination of teamwork, rather than the structures and designs of teamwork.

Do people have a natural ability to team? Or do we have to overcome what comes naturally to us, in order to team?

We are born with natural curiosity, which is an absolutely essential aspect of teaming. If I’m not curious about who you are and what you bring, then I am unlikely to be very good at teaming because I am just looking at the world through a very self-centered lens. We’re born with that, but as we go through school and grow older, we can very easily lose that curiosity. That which is natural (meaning we are born with it) and that which is socialized is not always the same thing

What do we need? We need in a very basic way to be as interested in what another person is bringing to the party as what we are bringing, in what they are hoping to get done as in what we are, and very importantly, what they are up against. What are they up against means the little barriers and hurdles that might get in the way of their ability to do their best work. It is not written across their forehead, and so we often don’t realize that we’re unaware of the hurdles others might face. What I am describing is the ability to balance advocacy and inquiry, which Chris Argyris has described for so long. This does not come naturally, as it turns out. It certainly does not come naturally to adults, even if it may come naturally to children.

Does the ability to team emerge, or become hardwired at a certain stage of development?

That is a provocative idea, and the answer is probably “yes.” I don’t have my own data on that, but I would argue that higher stages of adult development, which bring greater self-awareness and emotional maturity, would be helpful in effective teaming. Once has to realize that the work ahead is “not about me,” it is about us and what can we do together.

Should teaming, as a concept, be given greater emphasis in the workplace?

It’s a useful device to get people thinking about communicating and collaborating, to get their attention. When I say “teaming,” people know what that means. It means coordinating, collaborating, sharing, working together, being far more integrated and open than one might naturally be. It’s not a program or set of specific activities and practices that are brand new to the world, but rather more of a mindset that people at all levels of complex organizational systems need to keep in mind so that we can think differently and act differently.

Your book examines some very interesting and dramatic examples of where teaming was successful, in particular, the Chilean mining rescue. In that instance, the rescue depended on the teaming among government, engineers, and the miners, themselves. What are the lessons that we should take away from that experience?

First, it was a novel situation. There was no blueprint, no solution. The only way to develop a solution was to innovate, to come up with something together, through immense dedication and persistent trial and error. And that necessarily took place across boundaries of all kind — geographic, national, expertise-based, and hierarchical. The lesson we can take away from that case is what initially seems truly impossible is sometimes doable, through highly effective teaming.

They had to do everything right in that rescue operation. This does not mean not fail — they failed many, many times; in fact, several times a day. But, they had to do everything right in the collaborative, interpersonal sense, in the listening, in the engaging, and the persisting through failure.

In this particular extraordinary case, I saw teamwork – teaming – underground, above ground, and ultimately between them. All of that teaming had to be done in a very open, straightforward, dedicated way. Perhaps most of all, it required careful listening and synthesizing of different ideas and points of view. This is not easy and it doesn’t happen spontaneously. It takes very effective leadership to encourage people to bring their best selves to the situation – to offer ideas, to listen, to help, to leave their egos at the door.

Here in the U.S., there is a strong element of individualism that goes to the core of our identity. Does that impact our ability to team?

I think that this may make teaming more difficult for us. Yes, I do think that we can be handicapped by that. But, at the same time, we are also pragmatic people, and after we diagnose a situation appropriately, we will generally jump in and do what it takes to coordinate and collaborate. In this way, we’ve done amazing things: We put a man on the moon and brought him back safely. So I think we can do it – engage in teaming, that is. And perhaps I don’t think it is as much a problem for Americans in general, as for the healthcare industry (in particular), where the professional individualistic mindset is salient. This is not so much about American individualism as about training and expertise. I think as Americans, we cherish individualism but we are eager to and highly capable of engaging with each other to do things we could not do alone.

Putting culture aside, is there a basic desire for a person to seek individual action and reward in the workplace? Or is that trumped by a need to belong in an organization?

I think there’s a balance. We don’t want to get rid of individual identity or individual differences. We need different expertise, and we must value different opinions and mindsets, to innovate and do many things that are worth doing. It’s not a matter of just nurturing the strong collective identity as one might find in other cultures, but rather of developing more skill in using the differences we have collaboratively to accomplish ambitious goals that we could not accomplish alone.

How do you foster that teaming mindset?

In a word: Leadership. People need to be invited into a new way of operating and they need to be challenged to do that. The leadership process is about getting people to first envision the possibility of what needs to be done. If I can envision and communicate that, then I can get people to start thinking about what their part of the journey might be.

Then I need to enroll them. I have to make it more personal to them, and I need the individual to understand that I need their help.

The third step is to engage them in the actual work. We have to stop talking and start trying. The trying will be fraught with failure along the way. We will try something that is beyond our starting point, and it will fail, and then we will have to celebrate that, talk about that and figure out what we learned and do something else.