Dr. Eleanor Barbera

Having enough of it at work, I tend to avoid drama in my entertainment choices unless it involves aliens or post-apocalyptic nonsense. My family and I are currently enjoying the creative spectacle of Project Runway “Teams” version from a few seasons ago. In it, the judges of the clothing design competition repeatedly make the point that “teams are only as strong as their weakest link.”

A significant part of the Project Runway teamwork challenges involve communication. Collaborators who take over the project and those don’t speak up can both get penalized by the judges. Similarly, teamwork within the long-term care setting heavily relies on communication. For the best healthcare outcomes, it’s essential for all team members to contribute their expertise.

An article in the American Psychological Association Monitor, however, suggests that people who feel powerful are more likely than those who don’t feel powerful to share “opinions that differed from the norm,” a important element of team interactions.

Further, the authors cite research that describes how “people who feel powerless are more likely to…behave in inhibited ways. People in positions of greater power, on the other hand, are more likely to…act in uninhibited ways.” A care team member who feels inhibited is less likely to speak up and contribute to a group discussion.

In the hierarchical world of LTC, administrators, nursing directors and medical directors have more perceived power than, say, charge nurses or recreation therapists, despite whatever layers of upper management and accountability exist.

In my conversations with aides and residents, there is consistent disagreement among them regarding who has the power. Aides will argue that the “Resident’s Bill of Rights” gives the residents control, while residents, waiting on aides for intimate care, feel that the aides are in charge. Both struggle to deal with the moods and behaviors of the other.

Family members can be considered a part of the team that wields power in the form of potential phone calls to senior staff, the ability to transfer their loved one to a different facility, a negative social media review or a lawsuit. At the same time, relatives are often overwhelmed by the new and unfamiliar situation and the shifting dynamics within their families and many feel powerless in relation to the staff members upon whom they depend for good care for their loved one.

The challenge for LTC is to empower all team members to overcome their “inhibitions,” so that they offer their expertise despite the imbalance of power and in perceptions of power.

One way to do this is for leaders to actively solicit and act upon feedback from team members so that they know their input is valuable.

Earlier this month I spoke on the subject of teamwork and communication at the annual management conference of the National Healthcare Corporation. NHC makes a point of soliciting feedback through regular employee and family satisfaction surveys, which is an excellent way to gather data and to impart the message that the opinions of all participants matter. The organization also calls their employees, “partners,” which sets a nonhierarchical tone.

As part of the session we did an interactive group exercise called “The Medical Mystery Tour” to address aspects of team communication. In the subsequent discussion of the interaction, an impressive number of NHC administrators reported that they get phone calls about work matters from direct care “partners,” such as aides.

Perhaps that could be the benchmark of organizational communication: As a leader, do team members at all levels feel comfortable enough to talk to you directly?

Further, are department heads and leaders of direct care units learning all they need to know from their team members? In other conferences, “The Medical Mystery Tour” exercise has revealed teamwork gaps among nurses, for example, who often have little to no management training yet need to manage their team of aides.

On the Project Runway competition, the “weakest link” is the least innovative and tasteful designer. In LTC, the “weakest link” is the individual who holds key information about resident care but either doesn’t realize it or is afraid to share it with the team. Good leaders recognize the challenges of open communication in a hierarchy, find ways to empower their teammates and ensure that all team leaders within the organization have the skills they need to do the same.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Gold Medal blogger in the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with more than 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.