Redesign team had to fight resistance from all sides

Trust is the keystone of teamwork

Managers often complain about staff resisting proposals for change, but at St. Luke’s Episcopal Hospital in Houston, the lab staff were frustrated by contrary managers.

The lab had formed a staff-run redesign team that was generating dozens of proposals to streamline processes and boost departmental morale, but managers balked at implementing many of them.

Managers were uneasy because the staff were making decisions management used to make, and the staff were frustrated because management was not supporting them. "They had to learn to trust each other," says Duke Rohe, a health care industry consultant with Holland & Davis in Houston. Rohe is St. Luke’s former in-house re-engineering consultant.

As the two sides spent the next year building that trust, they became one of the hospital’s most productive work teams.

Here Rohe and members of the St. Luke’s lab team share their team-building experiences:

The lab formed its own redesign team in 1995, following the example of a nursing unit that was rolling out a patient-focused care redesign. The lab team had the support of its managers, including Linda Wesley, MA, MT, (ASCP), administrative director of pathology, who already was well-versed in self-directed work teams. Wesley had been serving for the past two years as team leader of the nursing unit’s patient-focused care redesign.

To promote staff empowerment and ownership, the lab’s team initially excluded managers. The group held brown-bag lunches every other week, spending months learning to trust each other and work together. Group members built themselves into a productive unit and brought proposal after proposal to management. The redesign team expected support, but instead met with resistance. Both sides sought Rohe’s help to solve the problem.

‘It had to be a holistic team’

In his first attempt to smooth the friction, Rohe pulled the managers into their own team meeting. He quickly realized, though, that the two groups would have to be integrated to work together.

"We tried [the managers] as a side team, but we could see it wasn’t going to work. It had to be a holistic team," Rohe says.

The integration of management onto the already functioning staff team was rocky. The staff-run team by now had hit stride, and throwing managers into the mix disrupted the dynamics.

"It was like starting from scratch," Rohe says. "They had some new mindsets they had to learn to deal with. They had to grow back into comfort."

Wesley says the managers had to learn to coach rather than direct. Although most understood the concept, they could not execute it. Wesley held role-playing sessions so managers could practice their techniques and learn where they were prone to mistakes.

"At first, when they joined the team, the managers kept quiet, because they didn’t want to suppress the ideas," Wesley says of the rebuilding process. "Slowly, we got them more integrated into the team. It’s extremely hard to let go of the old way, of making the decisions. It’s a continual process of learning how to change."

The staff, too, are still working through their own paradigm shift.

"Some staff still need to learn that the managers will no longer pick up after them," Wesley explains.

Rohe says the setback may have been disheartening at first, but the work is worth the long-term returns.

"It was a slow demolishing of the we/they mentality," he explains.

In addition to combating resistance from management, the teams also caught flack from staff members who were not part of the re-engineering process. The staff resented the team members for spending time in meetings, and the team members resented fellow staff members for overlooking their hard work to improve the department. Approximately 25% of the staff has served on a team. Wesley estimates that about half of the remaining 75% support the cause.

To enhance staff understanding, the team asked Wesley to give a "State of the Lab" address in which she updated the entire department on the team’s progress and solicited ideas for further problems to be tackled. She hopes to give these addresses quarterly.

The team also publishes its minutes and shares any pertinent information, such as the financial effect of the changes.

The team itself functions by example as part of an effort to stimulate buy-in from the rest of the department. When the team changes a process or procedure, they go about their business as if everyone supported them. If they encounter resistance, they deal with it then.

Win some, lose some

One of the proposals the management/staff redesign team struggled with during this tumultuous period was the implementation of Casual Day. The two sides worked through trust issues to negotiate a compromise, but were later overruled by hospital administrators on one clothing item: jeans.

"The team grumbled," Rohe says. "They were upset when they realized they had input, but no control over the decision. But that’s part of life. You don’t always get what you want. They had to work through some issues, but they’re OK because their successes have outweighed the few rejections."

Wesley adds that although the team’s recommendation for any given proposal can be rejected, it is still a leading factor in management’s consideration.

Despite the no-jeans amendment, the casual day policy has been so well-received that the hospital’s human resources department is considering enacting a similar policy throughout the hospital.

"They didn’t get all they wanted, but it shows what one small team can do," Rohe says. "They’re having an effect on the entire hospital."

With this and other projects behind them, the management/staff redesign team is now deemed a success. However, at one point Wesley became so discouraged with the excruciatingly slow process, she thought about turning back herself.

"I didn’t then, and now I couldn’t stop it even if I wanted to," Wesley says.