Cancer care is a high-stakes health care practice that requires unparalleled levels of communication and collaboration to save lives. This is especially difficult for oncology teams composed of multiple specialists and care professionals from geographically, philosophically, and experientially disparate positions. According to one study published in the New England Journal of Medicine, a cancer patient and primary care provider communicated with 11 other providers within 80 days of diagnosis (2014; doi: 10.1056/NEJMp1406033).
When implemented well, this integrated care approach improves patient care while minimizing costs, making effective communication critical to optimizing coordination outcomes and patient/clinician satisfaction (J Oncol Pract 2015; doi: 10.1200/JOP.2015.003772; J Oncol Pract 2016; doi: 10.1200/JOP.2016.013300).
This potential is being challenged in a post-pandemic environment where oncology care units face significant obstacles in their return to normal operations. To rebuild resilience and restore employee investments, oncology units can build upon existing Culture of Safety principles to develop facilitative leaders who rebuild trust and enhance collaboration among health care organizations generally and oncology teams specifically. Here's how to begin the process during this crucial time.
1. Train Physician Leaders in Collaborative Best Practices
In addition to providing complex care through high-risk treatments, oncology practitioners deliver psychosocial and emotional support for fearful and concerned patients. All clinical team members are central to these efforts, and their voices and expertise help create a safe, effective health care culture.
For example, since medical errors are one of the leading causes of death in America, it's imperative that all care team members can voice concerns without fear of reprisal or rebuke. What's more, cancer patients may be more likely to communicate with nurses rather than doctors, giving them critical insights into patient well-being.
Oncology care relies on all team members to deliver these outcomes, empowering them to become facilitative leaders, armed with strong capabilities to communicate and collaborate, developing and encouraging teamwork and openness to others' ideas.
For example, facilitative leaders prioritize and develop trust at every level. They become managers of the decision-making process rather than makers of all of the decisions. They find opportunities to include team members appropriately, reinforcing the shared responsibility for creating a culture of safety.
2. Reconnect to Mission & Inspiring Vision
The pandemic took an untold toll on oncology teams, challenging their capacity to provide quality care and manage patient and professional risk as on-site and in-person visits continued to be essential.
According to one study, 88 percent of oncology practices faced challenges in providing usual levels of care and protection (J Glob Oncol 2020; doi: 10.1200/GO.20.00351). Of course, cancer patients are more likely than most people to experience severe COVID-19 symptoms, adding additional loss and disruption to already-challenged teams.
Revisiting the mission and sharing an inspiring vision reconnects team members to the foundational elements of their calling and the organization's aspirations for extraordinary care. Facilitative leaders understand and appreciate the importance of engaging team members to reinforce their purpose and remind them of the importance of their work, helping them process the past year's experiences while planning for the future. It's a foundational practice for regaining resilience and building team connections and relationships.
3. Balance Inquiry & Advocacy
An essential culture of safety principle is building a trusting environment. Team members must feel safe to raise concerns, ask questions, and communicate issues. Facilitative leaders are skilled in creating trust conditions, and they know that inquiry and advocacy skills are key to creating this environment.
In high-stress conditions, leaders often move to command and control. While they may solicit feedback and opinions, leaders often begin the discussions by describing what they are seeking, how they define the situation, and what they think the solutions are. This advocacy approach, while sometimes necessary, can discourage open dialog and tends to push team members to provide answers that align with the leaders' perspective, especially if used too often.
To build team members' confidence that a leader really is seeking their ideas, a facilitative leader knows that it's essential to use inquiry, asking many open-ended questions and truly listening to the responses, then fully engaging the team in deciding on the best alternative.
Helpful inquiry questions might include the following:
- What has been lost in this past year in our oncology team? What has the impact been?
- How have we adapted to these conditions, and what will we keep going forward?
- What will we remember from this experience? Why?
- What has been the greatest surprise in the last year?
- What have we learned?
- What will we do differently?
- What behaviors will we demonstrate to live our mission?
Facilitative leaders use inquiry and advocacy skillfully and appropriately, empowering their teams to appreciate this past year's experience, envision the desired future and plan, then execute a shared path forward.
Facilitative leaders create conditions where team members and leaders work together to realize the best possible outcomes for their patients through collaboration, communication, and trust. To achieve this, leaders need to be receptive and flexible in behavior, strategic in thinking, and collaborative in attitude. This moment provides an opportunity to reaffirm the importance of communication, collaboration, and purpose in cancer care teams, building capabilities for both leaders and team members who are ready to care for patients in new and better ways.
SHARON CONFESSORE, PHD, is a health system executive experienced in talent development, leadership development, executive coaching, innovation adoption, and organization culture. She is known for creating people-focused strategies and best practices for implementing corporate-wide learning solutions, which she's applied as the Chief Learning Officer of a regional health system and as a unit head of a fully integrated national health system. MICHAEL J. REIDY, a senior consultant at Interaction Associates and former head of the Dublin Institute of Adult Education, has been training teams in safety culture best practices for more than three decades. His expertise has supported companies around the world.