Red Teaming in Healthcare: Create transparency, understanding and a healthy culture among providers and management.

Christopher Payne
Dec 6, 2019 · 4 min read

In the era of for-profit health care, constantly-changing regulations and an advancing science, uncertainty surrounding the future of many organizations creates tension between the two camps that need to work together the most. Management and Providers. Management is under pressure from state and federal regulators in areas of both procedure and finances. Providers direct their focus at the rapidly advancing field of medicine and quality patient care. Often, these different but equally important pressures put the two groups at odds with each other. Providers believe that management only looks at the bottom line, and management believes that providers never look at it. Imagine what could be accomplished if these two groups were able to come together and understand each other’s worlds while simultaneously sparking innovation and inspiring collaboration.

The Red Team Handbook was initially designed for the military, but the principles contained within it can apply to organizations that are often silo’d and struggle with communication and relationship within complex systems. In 2016 Forbes Magazine published an article detailing the frustration that providers are experiencing when attempting to practice medicine. In a survey, 48% of doctors expressed that they were frustrated and burned out because the systems and structures of their organization overworked them and misunderstood their challenges. Red Teaming works to remove frustration by creating spaces where honest conversation can happen.

Suppose an initiative is handed down from the healthcare system that owns your local hospital. Instead of simply telling providers that they need to comply with the initiative, imagine what would happen if management brought some key stakeholders into a room, including both management and providers, and invited them to brainstorm how that policy presents challenges to the current way of thinking. In fact, what if multiple groups, utilizing multiple methods, such as mind-mapping, 5 whys, stakeholder mapping, and 4 ways of seeing (all tools in the Red Team Handbook) approached these new initiatives with those tools? Once the information is gathered, it could then be filtered to other groups, who would use tools such as SWOT, argument deconstruction, or a frame audit. Once this has been analyzed and discussed, that information could then be sent to other teams that will generate solutions or recommendations using weighted anonymous feedback or 5–25 (pp. 87).

For simpler initiatives, use the “what if” strategy that defines what will happen if that initiative is wildly successful or if its a miserable failure. The elements that would make it successful become the metrics by which you measure its success, and the elements that would make it fail become pain points and should be addressed before they become concerns, taking a proactive approach.

For more complex initiatives with unknown potential results, teams should be assembled to perform an alternative future analysis. Alternative Futures Analysis is a tool where teams can strategize around multiple potential outcomes when a situation would be too complex to nail down a single projected outcome.

One of the primary challenges with teams is that there is usually someone in the room with most of the power. You’ve all been to meetings where the person in charge pretty much dominated the conversation, accomplished what they wanted to get done and no one else really got the opportunity to provide an honest or opposing perspective. Or even if they didn’t, there may have been a director or CEO whose words carry a lot more weight than others in the room. This is the reason why many people abhor meetings, as they generally only meet the needs of one person. There are certainly some processes described within the Red Team Handbook that could end that could at least partially eliminate the barriers to true teamwork. However, some tools, like 5–25 and dot voting give the opportunity for a truly good idea to survive a popularity contest or brown-nosing.

Another difficulty may be getting people into the room who truly care about the organization. They may care about doing their job well, or their department, but finding people who have a more global perspective may be challenging, especially if the organization hasn’t made that way of thinking a priority.

Despite those challenges, relationships still need to improve. Providers need to feel less burned out and less misunderstood. Administrators need to feel that they can be trusted. Anyone interested in creating a healthier team culture needs to stop at nothing to get both parties in the room and creating a space where everyone can feel like they’re contributing, where everyone has the opportunity to innovate and create space to be heard and listen. Red Teaming gives us the tools we need to take those steps to a healthier, more productive culture.

References:

https://usacac.army.mil/sites/default/files/documents/ufmcs/The_Red_Team_Handbook.pdf

Christopher Payne

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