Addressing TCG Deficiency in Leadership Teams

Thursday, June 1, 2017 | Larry Sobal

 

I was working with the governance council of a Cardiovascular Service line recently to help crystalize their vision for the future and prioritize their strategies, something they had struggled to do in the past. At one point the hospital CEO lamented “our biggest challenge is that there is so much uncertainty in healthcare right now, what’s the point of developing a strategy when we will likely be wrong?” To his, and possibly everyone else’s, surprise, I replied that “the biggest challenge this team faces has nothing to do with uncertainty, it’s your TCG deficiency”. The befuddled looks on everyone’s faces begged for further explanation so I will share with you what I shared then.

 

TCG deficiency is my description of the three most common elements I most often find lacking when leadership teams can’t seem to get their “you know what” together and are fated to spend their time meeting, discussing, and rarely ever accomplishing anything of value. And since you are probably wondering, the TCG stands for Trust, Consensus and Grit. So let me explain how I came to the development of a TCG label.

 

In my role as a consultant, I work with a lot of teams, almost all of which are some combination of physicians and administrators, mostly in cardiovascular service lines or cardiology practices but sometimes in hospitals, multispecialty practices, and even health industry vendors. When you work with a lot of different teams, you see the full gamut from highly effective to highly dysfunctional.

 

Some time ago I began to ask myself why some teams seem to perform well while others don’t. Fortunately, this has been a highly published topic.   I’m a pretty voracious reader so my research led me to a number of great books and articles such as Patrick Lencioni’s The Five Dysfunctions Of A Team and the Harvard Business Review article The Secrets Of Great Teamwork to name a few. They were all written by people smarter than I and had great perspectives.   But none of them seemed to best describe what I typically saw in teams at the lower end of the performance continuum.

So let me explain what I think TCG deficiency represents, and you can decide for yourself if it has any merit or possibly describes your team. Let’s start with Trust.

It’s common for me to meet with individual members of a struggling team to get their confidential perspective on what is working well and what isn’t. And almost always I will hear various comments along the lines of “I don’t trust them” or “we lack a trusting relationship” or “over time, there have been so many negative incidents that I just can’t seem to find a way to trust so and so.”

When pressed further about why there is a lack of trust it is not uncommon to hear stories about poor communication, lack of transparency, patronizing involvement, lack of follow through on commitments and unexplained inflexibility. The problem with trust is that it is so hard to gain yet so easy to lose. What is interesting is when I turn the conversation to “what would it take for you to trust (fill in the blank of person A, B and/or C)” often I hear of some specific examples, or that the person has to ponder that question for a while before answering.   But rarely do I hear that they are totally closed to the possibility. That’s where the consensus reaching process can play a helpful role.

Let’s talk about the next deficiency, Consensus. Trust is almost 100% subjective and abstract, although most people feel it is more easily understood if it exists or doesn’t. Consensus, on the other hand, is possibly one of the most misunderstood and mishandled components of leadership team. Consensus is not, and should not be, a fully democratic process where everyone compromises to the most widely acceptable decision. Instead, as described in the great article There Is An "I" In Team it is absolutely possible to build consensus (and very productive relationships) with even the most adversarial of individuals if unique perspectives, philosophical differences, and dissenting opinions are viewed as an opportunity.

It is absolutely possible to build very productive relationships with even the most adversarial of individuals if unique perspectives, philosophical differences, and dissenting opinions are viewed as an opportunity.

 

Reaching consensus is about a team’s ability to forge consensus for action. Consensus is derived with both process and outcome. Consensus should utilize a process in which everyone has their say and divergent views are fully addressed by the team until you reach a point where the team can walk out of the meeting agreeing to support the decision and desired outcome and not to undermine it. In many cases, I will go so far as to ask for a formal showing of hands on a decision with the questions being “Can you leave the room and not only support it, but also agree to not take any steps to undermine it.” That’s a lot different than the weak method of asking whether people vote in favor of the idea.

Remember, consensus is not necessarily the decision most preferred by all members. Most importantly it invokes  a feeling that all team members are motivated to see the decision through to completion. Not surprisingly, the better you become at reaching consensus, the higher your degree of trust. Likewise, the higher degree of trust, the easier it likely is to reach real consensus.

But trust and consensus aren’t enough for leadership teams to be successful, and that brings us to Grit. If consensus is about forging an action plan, and trust is reliant on transparency, communication and follow through, then grit is the fuel for sustainment and validation of those. As noted in her TED Talk about Grit and her bestselling book on the subject, Angela Duckworth describes grit as passion and perseverance for very long-term goals. Grit is having stamina. Grit is sticking with a plan, day in, day out, not just for the week, not just for the month, but for years, and working really hard to make that future a reality.

Grit doesn’t mean blindly following the original plan, but rather having the courage and tenacity to sincerely self-reflect, seek out and listen to feedback, to measure the important leading and lagging indicators, and to adjust course when necessary to get to the goal and move the performance needle. Maybe most importantly, grit is having the fortitude  to focus on the meaningful few things that truly make a difference and let other less important possibilities go unpursued. In other words, the strength (and wisdom) to prioritize.

Think about the best teams you ever were a part of and how they differed from the worst. I’m willing to bet the best teams had an abundance of T, C, and G while the worst had a deficiency. As for my client, or any healthcare organization trying to figure out its future in this era of great uncertainty, an abundance of TCG will give any leadership team the foundational relationships and capabilities to successfully navigate their way through whatever changes come their way.   Without TCG, a team is likely to flounder even in a stable predictable environment.   Let me know what you think.

 

Illustration: Lee Sauer

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Larry Sobal is Executive Vice President and a Senior Consultant at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and health insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems. His weekly blog post comes out on Thursdays and can be accessed at www.medaxiom.com.

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