Page 64 - Harvard Business Review, Sep/Oct 2018

Grit”), but because they’re easy to game, we don’t recommend Building Teams
using them as hiring tools. Instead, we recommend carefully Gritty teams collectively have the same traits that gritty
reviewing an applicant’s track rec ord. In particular, look for individuals do: a desire to work hard, learn, and improve;
multiyear commitments and objective evidence of advance- resilience in the face of setbacks; and a strong sense of
ment and achievement, as opposed to frequent lateral moves, priorities and purpose.
such as shifts from one specialty to another. When checking In health care, teams are often defined by the population
references, listen for evidence that candidates have bounced they serve (say, patients with breast cancer) or the site where
back from failure in the past, demonstrated flexibility in they work (the coronary care unit). Gritty team members may
dealing with unexpected obstacles, and sustained a habit of have their own professional goal hierarchies, but each will em-
continuous self-improvement. Most of all, look for signs that brace the team’s high-level goal—typically, a team-specific ob-
people are driven by a purpose bigger than themselves, one jective, such as “improve our breast cancer patients’ outcomes,”
that resonates with the mission of your organization. that in turn supports the organization’s overarching goal.
Mayo, like many gritty organizations, develops most of
Many people in health care associate commitment to a team
its own talent. More than half the physicians hired at its with the loss of autonomy—a negative—but gritty people view
main campus in Rochester, Minnesota, for example, come it as an opportunity to provide better care for their patients.
from its medical school or training programs. One leader They see the whole as greater than the sum of its parts, recog-
there told us those programs are seen as “an eight-year job nizing that they can achieve more as a team than as individuals.
interview.” When expanding to other regions, both Mayo and In business, teams are increasingly dispersed and virtual,
Cleveland Clinic prefer to transfer physicians trained within but the grittiest health care teams we’ve seen emphasize face-
their systems rather than hire local doctors who may not to-face interaction. Members meet frequently to review cases,
fit their culture. set targets for improvement, and track prog ress. In many
Creating the right environment can help organizations de- instances the entire team discusses each new patient. These
velop employees with grit. (The idea of cultivating passion and meetings reinforce the sense of shared purpose and commit-
perseverance in adults may seem naive, but abundant research ment and help members get to know one another and build
shows that character continues to evolve over a lifetime.) The trust—another characteristic of effective teams.
optimal environment will be both demanding and supportive. That’s an insight that many health care leaders have come
People will be asked to meet high expectations, which will be to by studying the description of the legendary six-month
clearly defined and feasible though challenging. But they’ll Navy SEAL training in Team of Teams, by General Stanley
also be offered the psychological safety and trust, plus tangible McChrystal. As he notes, the training’s purpose is “not to pro-
resources, that they need to take risks, make mistakes, and duce supersoldiers. It is to build superteams.” He writes, “Few
keep learning and growing. tasks are tackled alone… The formation of SEAL teams is less
At Cleveland Clinic, physicians are on one-year contracts, about preparing people to follow precise orders than it is about
which are renewed—or not—on the basis of their annual developing trust and the ability to adapt within a small group.”
professional reviews (APRs). These include a formal discus- Such a culture allows teams to perform at consistently high
sion of career goals. Before an APR, each of the clinic’s 3,600 levels, even in the face of unpredictable challenges.
physicians completes an online assessment, reflects on his or Commitment to a shared purpose, a focus on constant
her prog ress over the past year, and proposes new objectives improvement, and mutual trust are all hallmarks of integrated
for the year ahead. At the meetings, physicians and their practice units (IPUs)—the gold standard in team health care.
supervisors agree on specific goals, such as improving com- These multidisciplinary units provide the full cycle of care for
munication skills or learning new techniques. The clinic then a group of patients, usually those with the same condition or
offers relevant courses or training along with the financial closely related conditions. Because IPUs focus on well-defined
support and “protected time” the physicians might need to segments of patients with similar needs, meaningful data
complete it. Improvement is encouraged not by performance can be collected on their costs and outcomes. That means
bonuses but by giving people detailed feedback about how that the value a unit creates can be measured, optimized, and
they’re doing on a host of metrics, including efficiency at rewarded. In other words, IPUs can gather the feedback they
specific procedures and patient experience. The underlying need to keep getting better.
assumption is that clinicians want to improve and that the or- UCLA’s kidney transplant IPU is a prime example. Two
ganization, and their supervisors in particular, fully backs their years after the 1984 passage of the National Organ Transplant
efforts to reach targets that may take a year or more to reach.

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