6/2/15

Overcoming the Five

Dysfunctions of a Team
Ken Thigpen, BS, RRT, FAARC
Administrative Director, Pulmonary Services
St. Dominic Hospital
Jackson, Mississippi
(Made possible through an educational grant provided by
Monaghan Medical Corporation)

Based on the works

of
Patrick Lencioni

Our time today . . .

•  Overview of the Importance of Teamwork and
the Five Dysfunctions affecting most teams
•  Walk through some team exercises
•  Check in as to our “current state”
•  Explore strategies to overcoming the Five
Dysfunctions
•  Identify some landmines to avoid in moving
forward

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Let’s make it a good afternoon!

•  Let’s work together to find a soft place for
everyone to land
•  We’ll keep things lighthearted and informal
•  This needs to be a “safe” place – what’s said
here needs to stay here
•  I want to challenge you to be direct without
getting personal
•  Have the courage to step into difficult
conversations

How many of you want to be a

part of a high-performing team?

What are you willing to sacrifice

to help make it a reality?

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The Case for Teamwork

•  Building an effective, cohesive team is extremely
hard
•  It’s also simple!
•  It’s not about possessing great intellectual
insights or extreme, masterful tactics –
•  It’s about possessing courage, persistence,
commitment – a.k.a. loggerheadedness!
•  Teamwork is a key differentiator in whether
organizations succeed or fail

Some Simple Truths about

Teamwork . . .
•  Hard to measure
•  Hard to achieve
•  It’s power can’t be denied!
•  Proven critical factor in helping people find
fulfillment in their work
•  Typically has an impact that reaches far beyond
the walls of our departments – it makes us better
parents, better friends, better leaders, better
people. . .

A Quick Overview of the Five

Dysfunctions Model
•  Absence of Trust
•  Fear of Conflict
•  Lack of Commitment
•  Avoidance of Accountability
•  Inattention to Results

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Two Important Questions:

•  Are we really part of a team?

•  If not, are we ready to do some heavy lifting?

Getting Naked
(not literally!)
•  Personal Histories Exercise

–  Where did you grow up?

–  How many kids in your family?
–  What was the most difficult or important challenge
of your childhood?

This is where we wade into the

waters of vulnerability.

Does anyone feel like they’re

drowning?

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Let’s start unpacking. . .

Building Trust . . .
The Most Critical Function of High-
Performing Teams

The first and most important

dysfunction a team must learn to
overcome is the absence of trust. . .

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Characteristics of Trust
•  High levels of vulnerability, It’s about keepin’ it
real . . .
•  People put the truth out there
•  People have the courage to talk about the
“elephant in the living room”
•  People care too much about the ultimate goal to
waste time with personal agendae and politics

What are the common symptoms of the

“Absence of Trust” dysfunction?
•  Tendency to hide our mistakes from one another
•  Reluctance to ask for help or give constructive feedback
•  Take care of ourselves yet don’t extend help beyond our circle
of influence
•  Judge other’s intentions and attributes without validating them
•  Failure to tap into each other’s skillsets and experience
•  Waste time and energy dancing around behaviors and attitudes
•  We hold grudges, refuse to forgive one another
•  Look for ways to avoid spending time together

What are the common symptoms of a high-

performing team?
•  You hear things like. . .
–  “I was wrong. . . “
–  “Oops, I blew it!”
–  “Can you help me?”
–  “Go ahead, you’re better at that than me. . .

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So, how do we get from where we are to where

we need to be?
•  Remember, first and foremost, it’s a marathon, not a
sprint. . . ;
•  We have to be willing to take risks, without guarantees
of success;
•  We have to be willing to be vulnerable, to put ourselves
out there with full knowledge that others may not
respect it nor reciprocate it. . .

Where do we start?
•  The key here is really pretty simple . . .
•  Decide that the way things are going right now
isn’t good enough and make the commitment
to change the course

Let’s peel off another layer. . .

–  Describe the time you felt most frightened in your

life.
–  Who has had the greatest positive impact on your
life? Why?

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Other natural “next steps” after

I’m gone. . .
•  Team effectiveness exercises
(help team members identify their “sweet
spots”)
•  Personality and behavioral preference profiles
(e.g., DISC, Meyers-Briggs, etc.)
•  360-degree generative feedback
•  Team-building activities

Roles of the Leader

•  “You go first!” – lead the group in getting
vulnerable – show them what’s real!
•  Never allow anyone to punish vulnerability
•  Help team members understand that this is a
critical step as we enter Mastering Conflict

“Take Home” points for building

trust
•  Trust is the bedrock of teamwork
•  Trust is all about vulnerability – remember this
can be hard!
•  Building trust takes time, but we can accelerate
the process – we’ve gotta make it a priority!
•  Like other good relationships, we have to be
intentional about maintaining this aspect of team

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Remember . . .
•  Building trust is the first and most critical step
of developing a high-performing team – it is
essential to overcome that most basic and
widespread dysfunction. . .

Mastering Conflict

The Key to Resolving the Second

Dysfunction

“Trust” is a requirement for

overcoming the second of the
five dysfunctions – Fear of
Conflict

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“Trust” is essential for teams to

fully engage in unfiltered,
passionate debate around issues
and decisions – “No holding
back!”

There can be conflict, there can

be arguing without trust – but it
usually ends without bearing any
fruit!

“The ultimate measure of a man

is not where he stands in
moments of comfort, but where
he stands at times of challenge
and controversy.”
-Rev. Martin Luther King, Jr.

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Conflict without trust . . .

What does that look like?

Conflict without trust usually has. . .

•  Team members calculating their next comeback, or
how to undermine the current train of thought rather
than listening for clarity, trying to build consensus, or
identifying opportunities for collaboration
•  Thoughts more geared toward manipulation of or
promotion of personal agendae rather than generating
solutions
•  Widespread practice of the infamous “meeting after the
meeting” or “watercooler sidebars”

Teams that fear conflict . . .

•  Have boring, unproductive meetings
•  Create environments where backdoor politics and
personal attacks constantly fester
•  Ignore controversial topics that are critical to team
success
•  Fail to tap into all the opinions and perspectives of
team members
•  Waste time and energy with posturing and interpersonal
risk management

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When we have the environment of trust, step into and

master conflict, the results are quite different. . .

•  We see productive, goal-oriented, ideological

conflict
•  There’s passionate, unfiltered debate around
important issues
•  We can generate positive lasting results
•  People own the results because they achieved
them together

A couple of questions. . .
•  Which team do you want to be on?

•  What are you willing to do to create it?

Let’s face it, most of us do not thrive

on conflict – it’s rarely comfortable!
•  Regardless of how specific we are in debating
issues, (we should never debate personalities!),
feelings still get hurt, people still feel as though
they’re being attacked. . .
•  When you hear, “I’m sorry, I really don’t agree
with your approach” or “I don’t believe this can
take us where we need to go” it’s hard not to
have some hurt feelings!

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BUT -
•  If we’re not willing to step bravely into this thing;
•  If we’re not willing to push our teammates buttons
every now and then;
•  If we’re not willing to have our own buttons pushed
every now and then;
•  Chances are, we will never do what’s “best” for our
team!
•  Chances are, we will never have an effective team

Quality is messy work!!!!!

Why is this so hard for us to get

our arms around?
•  Conflict doesn’t come natural for most people – we
don’t have the skillset to bring about resolution
•  Team members have different viewpoints and comfort
levels when it comes to conflict – there is a tendency
there for unmet needs
•  Some are comfortable with screaming, shouting, laying
it all on the table
•  Others would rather sit quietly and not disturb or
offend anyone

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It’s important for us to know where our

teammates fall in this range and why they fall
there . . .
•  Why is this important?
•  This is “ground zero” knowledge for us to
effectively build a culture of conflict that
everyone can understand and embrace!
•  We’ve got to establish a “conflict norm”

This is where our individual

behavioral profiles come into
play. . .

Do you think our behavior

profiles, the environment we
came from, the culture we grew
up in, shape our approaches to
conflict?

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Let’s take a closer look at this . . .

•  Think about when you were growing up – Were there
“spirited conversations” or did your family avoid
difficult conversations? (Archie Bunker vs Ward
Cleaver?)
•  What was the norm for your neighborhood or region?
•  Do you presently have unfiltered debate in your
professional life?
•  What’s your experience or comfort level with conflict?

These are important

discussions to have
among your team. . .
These are critical to creating an
environment that is “safe” for conflict
and growth

Some helpful ground rules . . .

•  Be honest, forthright – don’t talk behind
people’s backs
•  Say what you think, don’t worry about offending
someone (remember you can disagree without
being disagreeable!)
•  Keep it about the topic – never the individual
•  Never leave a meeting without sharing all your
thoughts

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Common Obstacles that interfere

with discussing or resolving issues
•  Informational – we’ve got to get the information, facts,
opinions and perspectives out there
•  Environmental – wrong place and/or time, inadequate
time for a good decision, mood, office politics, culture
realities
•  Relationship – issues between team members,
conflicting styles, perceptions, personal bias, suspicions
•  Individual – lack of knowledge or experience, differing
value sets or motives

Whenever you reach an impasse, invest

the time to analyze which of these
obstacles are creating the tension

•  Name the monster!

•  Either remove it or agree to work around it
•  Refuse to let it shape your ultimate outcome
•  Remember, keep it about the issue, about
achieving the desired results

Conflict Resolution Tips

•  Acknowledge that conflict exists and identify the
cause
•  Ask those involved to meet to discuss the issues
(agreeable time, limited in time and scope, in
quiet, private locale)
•  Establish the goal of developing an action plan
for resolution
•  Explore solutions – use active listening

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Next steps on conflict resolution

•  Draw up that action plan – a practical, doable,
agreed-upon solution to the controversy
•  Own your part – take responsibility for creating
the solution
•  Meet again, as needed to evaluate the
effectiveness of the solution

What is “active listening”?

•  We focus totally on other’s points of view
•  Seek clarification by asking questions when we
don’t understand
•  Listen carefully and avoid jumping to
conclusions
•  Clarify any misperceptions

Some final thoughts about

Conflict . . .
•  Conflict should be about the productive
exchange of diverse ideas and opinions in a
focused, efficient, and unfiltered way
•  Without it, quality suffers, decision-making
suffers, team members stagnate
•  Without it, there’s a tendency to revert back to
the “meeting after the meeting”, watercooler
sidebar mindset

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Key Points
•  Good conflict requires trust; it’s foundational for
passionate, unfiltered debate
•  Regardless of how good you get at managing it,
conflict will still at times be uncomfortable
•  Finding that safe place with basic ground rules
needs to be done and checked on
•  The fear of occassional personal conflict
shouldn’t stymie regular, productive debate

A final thought about conflict. . .

“Experience is the best teacher, but a hard grader.

She gives the test first, the lesson later. . .” -
Larry Dierker – Pitcher, Houston Astros

Achieving Commitment

Overcoming the Third Dysfunction

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“Buy-in” and “clarity” are the

absolute requisites for
overcoming the third of the five
dysfunctions – Lack of
Commitment

“Buy-in” is the achievement of

honest emotional support.

“The best hope of solving all our

problems lies in harnessing the
diversity, the energy, and the
creativityof all our people.”
- Roger Wilkins

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“Clarity” is the place where we

peel away all the assumptions
and ambiguity from a situation.

Let’s be clear – commitment is not

consensus!
It’s about a group of intelligent,
driven individuals buying into a
decision even when they don’t
naturally agree.
It’s literally defying a lack of
consensus.

Commitment without consensus . . .

How do you get there from here?

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The pieces begin to fall into

place!
•  You have to dive in and navigate through the
conflict
•  Leadership is critical – you have to maintain the safe
place for plowing through
•  Unapologetically abandon reservations, wade
through the disagreements to get to the best answer
•  Everyone keeps an open mind and embraces the
fact that it’s okay to change your mind!
•  It’s all about being supportive of the good of the
group –sometimes at the expense of our own
desires

What’s a leader to do?

•  A good leader will work to extract every possible
idea, opinion and perspective from the team
•  Don’t leave anything on the table!
•  A good leader will have the courage and wisdom
to step up and break the tie, if necessary even
though it may create conflict with team
members.

Here’s the deal . . .

•  What’s amazing is that 19 ½ times out of 20,
when the team delves in this deeply and
completes this process, everybody around the
table will leave the room engaged and “all-in”,
even when the decision doesn’t mesh with their
own recommendation . . .

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Most of us are more reasonable,

more logical than we think we
are!
We don’t have to get our way –
we just need to be heard and
understood!

What about clarity?

Achieving clarity and alignment

around a decision is critical!
We’ve got to move beyond
assumptions and develop a clear
roadmap. . .

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If we’re going to “disagree and

commit” then we need a clear
idea of what we’re signing up for!

How do we avoid the pitfalls?

•  Commitment clarification
•  Cascading communication

Commitment Clarification
•  5-10 minutes prior to the end of the meeting,
the leader needs to call the question- “What
exactly have we decided here today?”
•  Delve into the answers until everybody’s singing
out of the same songbook
•  We need to be extremely explicit about what’s
been agreed upon!

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Cascading Communication
•  What we agree upon as a team needs to be
communicated to the team within 24 hours of the
meeting
(preferably in a “live” setting, giving members the
opportunity to ask questions)
•  This expectation should also help to insure concerns
are raised appropriately during the “commitment
clarification” phase – no one wants to be embarrassed!

What commitments do we need to

make?
•  Commit to the rules of engagement:

–  Honor timelines for meetings

–  Be responsive and responsible in our
communication
–  Appropriate interpersonal behavior

Just as important, commit to:

•  Our purpose
•  Our values
•  Our mission
•  Our strategy
•  Our goals

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Key Points to Achieving

Commitment
•  Commitment requires clarity and buy-in
•  Clarity demands avoiding assumptions and ambiguity –
demands a clear understanding of what we’ve decided
upon
•  Buy-in doesn’t require consensus. Members of great
teams learn to disagree with each other yet still commit
to the decision the team decides is best.

When we’ve built trust;

Learned to master conflict;
when we’ve walked the talk of
achieving commitment, we’re
ready to look at how to embrace
accountability

Embracing
Accountability
The “Cure” for Avoidance of
Accountability (a.k.a. the inmates
running the asylum!)

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What is Accountability?
•  Simply put, it’s the willingness of the team
members to remind one another when they’re
not living up to the performance standards of
the group or their actions are such that the team
may be harmed by them

How do we make it part of what

we do everyday?
•  It starts with a team leader who consistently models the
behavior by being willing to step right in the middle of
a difficult issue or situation and calls all team members
to remember their individual roles and responsibilities,
in terms of behaviors and results.
•  We must develop a mentality where we’re comfortable
giving one another critical feedback.

“But I’m not comfortable doing

that. . .”
•  The most effective way to overcome this
reluctance is to help people realize that failing to
provide peers with constructive feedback means
that they are letting them down personally.
•  When we hold back, we hurt the team, we hurt
our teammates!

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Accountability is not just the role

of the leader. It’s about direct,
peer-to-peer feedback, which
provides the motivation to keep
folks on track

When there is a lack of

accountability, there is the
gradual loss of respect for one’s
teammates over time . . .

What do we get in the absence of

accountability?
•  We see differing levels of commitment and even
resentment among team members who have
varying standards of performance
•  Widespread mediocrity
•  Failure to set or achieve deadlines and goals
•  Placement of an undue burden on the team
leader as the sole source of discipline

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So, where do we start?

Another key learning exercise. . .
•  Remember, to go mining for and work to
reduce/eliminate the problems that are present
with the other dysfunctions
•  As a group, work to determine individual
behavioral qualities that contribute most to the
strength of the team for each member
•  Now, determine the same qualities that are
detractors

This is an important “jumping

off” point for teams
•  This “pruning” is critical!
•  Remember – no pushback or defensiveness
•  Ask questions only for clarification

Go around the room and ask

each team member to say what
he wrote about the leader’s
strengths. When everyone is
finished, seek responses –
“Any surprises?”,
Any need for clarification?”

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Now go around the room and ask

each team member to say what
he wrote about the leader’s
weaknesses. When everyone is
finished, seek responses –
“Any surprises?”,
Any need for clarification?”

Next Steps . . .

•  Now repeat these steps for every team

member

•  Ask every team member to identify one or

two things they will work on
•  Share your take-aways with the group

Closing thoughts on
Accountability . . .
•  Accountability means the willingness of each of us to
call our peers on behaviors that might hurt our team
•  We can’t afford to avoid it because it makes us
uncomfortable
•  We have to have the courage to “step into the muck”
with one another
•  Again, this won’t happen without trust, healthy conflict
and commitment

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Don’t forget!
•  Accountability on a strong team occurs directly
among peers
•  Peer pressure and the distaste of letting down a
colleague is a better motivator than a fear of
punishment or rebuke
•  For a culture of accountability to thrive, the
team leader must demonstrate a willingness to
confront difficult issues.

Now let’s take a look at the final

dysfunction – Inattention to
Results

Keeping Score . . .
The “Cure” for Inattention to Results”

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If we. . .
•  Trust one another;
•  Engage in healthy conflict around issues;
•  Commit to the decisions we make as a team;
•  Hold each other accountable for those
decisions. . .
•  Chances are, we’re gonna make it!

The question of the day is -

•  Is “making it” good enough?

•  The ultimate measure of a great team is

RESULTS!

•  If we fail to keep score, chances are that we’ll

stumble and lose sight of our ultimate goal.

Why is it so hard to stay focused on

results? The devil is in the details!
•  Self-interest
•  Self-preservation
•  Looking out for ourselves before our teams or
families
•  Once it starts, if not reeled in, it’ll spread like a
toxic disease – it erodes trust and teamwork
before you can blink!

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How do we avoid this?

•  Keep results in the forefront of people’s minds
•  Use scoreboards or dashboards
•  We get to create our own scoreboard – we get to
decide what we want to achieve and what
success looks like to us
•  We need to use objective, meaningful measures

Commit early to what you plan to

achieve. . .
•  State what you will achieve
•  Review your progress on a routine basis
•  Discuss your progress, or regression and
brainstorm as to how to continue to improve
•  This helps keep our priorities straight
•  Avoid measuring everything – this leads to
“initiative overload”

Stay tuned in to potential

distractions. . .
•  Ego – the ultimate killer on a team
•  Career development and money
•  “Silo” mentality

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If we commit to keeping these

distractions at bay and
implementing the strategies to
overcoming all Five
Dysfunctions of a Team, we’ll
find the road to success is paved
for us. . .

Earlier today we looked at some

examples of how it’s worked at
St. Dominic over the past few years

Examples of what we track . . .

•  Code 99 Charges - >$3 million and counting
•  Charge Audit capture - >$2.2 million
•  “Save an Hour” process - >$1.3 million in expenses
results in nearly $44 million in avoidable revenues
•  Vent protocol – reduced charges to system by $214
million and counting
•  Vent bundle – Avoided at least 64 VAPs
•  IHCA – 77% improvement in survival to discharge

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The Anchor Holds . . .

Why?

The Power of Engagement. . .

The benefits of teamwork

How did we achieve these

results?
•  By continuing in our journey to overcome “The
Five Dysfunctions of a Team”

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Raising the Standard . . .

•  From: •  To:
•  Absence of Trust •  Building Trust
•  Fear of Conflict •  Mastering Conflict
•  Lack of Commitment •  Going “all in”
•  Avoidance of •  Embracing
Accountability Accountability
•  Inattention to Results •  Focus on Achieving
Desired Results

And remember these things. . .

•  “He who is busy helping the one who is below
him doesn’t have time to envy the person above
him.” - Henrietta Mears

•  “If all anyone takes home from a job is a

paycheck, then they take home too little.”
–  Glendon Johnson

Thanks!

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