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How to cultivate and lead a high-performing dialysis care team
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Within today’s value-based care paradigm, medical directors in outpatient dialysis centers are facing changes in their roles. In addition to traditional responsibilities, medical directors oversee the evolution of team performance as it relates to clinical care and patient outcomes.
In an ideal world, excellent clinical results and enhanced patient experience are achieved by a perfectly synchronized, high-performing care team. Team members are in harmony, performing tasks to the greatest of their abilities, finding fulfillment in their work, and continuously improving themselves and collaboration across the team.
In the real world, priorities change constantly, acute complications arise and patient care crosses multiple domains with varying degrees of ease. To reconcile the real world with the ideal, leadership is needed to emphasize and support consistent collaboration between the dialysis team (nephrologist, patient care technician, nurse, dietitian and social worker) and external teams (primary care physician, specialists, pharmacist and others). As a leader in the center, medical directors are well positioned to help build and lead teams toward achieving improved outcomes for each patient.
Traits of a high-performing team
A group of individuals, each performing clinical tasks, does not equate to a team. This “pseudo team” may get various parts of the job done, but without a foundation set by strong leadership, communication, vision and collaboration, individuals simply exist within task-driven silos. This can create gaps for potential errors, unfulfilled patients and staff, and team dysfunction. When evaluating ways to improve team performance, a medical director can consider how to foster the following key characteristics of a high-performing team.
Communication. Increased communication enables team function and performance. Medical directors have the responsibility to lead effective communication — making sure lines are consistently open to teammates, from teammates, between teammates and between the dialysis team and peripheral teams.
Clear goals. Medical directors can lead the team in creating clear goals and prioritizing goals daily as a team, evaluating and shifting as necessary. To improve team effort and success in reaching goals, medical directors can consistently focus on what is going well; ensure teammates understand how they contribute to the common purpose; help teammates smoothly handle urgent and emergent situations; guide teammates in reframing challenges and defining successes daily; cultivate emotional intelligence; and recognize when teammates are stressed and activate stress-relief strategies.
Shared leadership. The shared knowledge of all individuals is far greater than that of one individual, and teammates — including medical directors — should feel comfortable asking others for advice and sharing leadership opportunities. Medical directors must be aware they have an authority that no one else has. This can create a power differential with other teammates that needs to be overcome if the team is going to be successful. They also need to recognize the unique knowledge and leadership capabilities of team members and empower leadership in their areas of expertise.
Self-performance reviews. Team members should have the ability to review their own performance. For medical directors, this can be difficult: They are responsible for all outcomes within a dialysis center — both on a micro or macro level. Frequent, honest self-evaluation and feedback from others can pave the way for continuous improvement and learning.
Measures of success
Improving team performance and, ultimately, enhancing clinical outcomes involves effort from the whole team. When exploring ways to elevate team performance, medical directors should involve team members in identifying success measures.
These metrics can include healthier patients and fewer hospitalizations; enhanced patient satisfaction; improved communication among the core dialysis team and across the peripheral care team; and increased job satisfaction.
The complexity and pace of change in health care has prompted many to re-think best practices for engaging teams. The unique nature of the dialysis center and its multidisciplinary team is an advantage. People know the role of teams and the necessity of working across teams to succeed in delivering better patient outcomes and quality of life.
The medical director is uniquely positioned to see the skills and talents of each team member. The medical director understands the external environment, with intersecting teams and people who affect care in those parts of the health care ecosystem. With that knowledge and the willingness to exercise leadership skills, the medical director can be a successful leader of the dialysis care team.
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- Bryan Becker, MD, MMM, FACP, CPE, is chief medical officer for DaVita Integrated Kidney Care. He is also a member of the Nephology News & Issues Editorial Advisory Board.
Disclosure: Becker reports no relevant financial disclosures.