Today's webinar is entitled Relational Leadership, Building Strong Teams and Culture in Home-Based Care, and presented by Primary Care Progress. My name is Dana Crosby, Senior Director, Engagement and Practice Development at HCCI, and I will be your moderator for this event. Before you begin, I would like to cover a few housekeeping items as we go through. All participants are muted, but please use the chat or the questions boxes located on your screen to submit comments and questions. Questions that are submitted will be addressed when we transition into the virtual office hours portion of the webinar. The recording of this webinar, the slide presentation, and supplemental handouts will be made available on the HCCI Intelligence page within the next few days. Today, we are joined by Dr. Carrie Mader, Assistant Professor, University of Colorado School of Medicine and School of Public Health, also the Director of Clinical and Education Innovation at Aurora Community Health Commons, and a trainer for Primary Care Progress. Also joining us, Dr. Turner, Assistant Professor, University of Utah College of Pharmacy, and also a trainer at Primary Care First. With that, I will turn it over to our presenters. All right, and thank you, Dana, and thank you to all of you for joining us, whether you're here right now or later. We're really excited to be here. I know Carrie and I, because of not only our love of this content, but also of clinical care and taking care of patients, just feel really at home with this group, and so thank you for the invitation to be here. We'll talk a little bit right now about what we hope to accomplish by the end of the session. So we're going to introduce today the relational leadership framework, a way that you can think about your own leadership development. We're going to talk about the characteristics of high-functioning teams and get some applicability to clinical teams in particular. A lot of what we're going to talk about is psychological safety, so we're going to get a definition for that and talk about the benefits of psychological safety on our teams and figure out ways that we can increase that psychological safety on your team and on all of our teams in our day-to-day work. Next slide. So like I mentioned, we're going to introduce relational leadership. We're going to talk about those characteristics of teams. We're going to explore the concept of psychological safety, and then we're going to wrap up all in about 40 or 45 minutes. So it's a daunting agenda for today, but we're excited to dive into this with all of you. Next slide. So to kick us off, you know, in thinking about big system changes that are needed, I think if there's one thing we've learned in the pandemic as though these, you know, maybe the waters recede a little bit and the cracks that we knew existed in our health care system are still there, and in many ways they were brought to the forefront. And I think all of us have felt the desire at one point or the other to fix that system, and health care is a huge system, right? It's complicated. There's a lot of players. There's a lot of financial implications. There's multiple institutions. I mean, it is a huge, huge system, and our philosophy at Primary Care Progress is that big system changes need to happen, but the way in which they happen are often not top down, right? There's not a leader or an entity, you know, instilling that change on everyone below. The philosophy that we prescribe to is that those large system changes are actually made up of many, many small relational changes where leaders, regardless of title, choose to make a difference in their sphere of influence. And as I thought a little bit about this and thought about, you know, my own experience, so I'm a clinical pharmacist. My day job is taking care of patients as part of a health care team. I was really excited to join all of you. I know what it's like to be in a patient's home and all the information and the way that the relationship builds when you do that. You know, I was thinking about my sphere of influence, and I was thinking about stories, a story that I could tell that would highlight what we mean by these small relational changes. And as I thought a little bit about that, I thought of Olivia. Olivia is the social worker at my primary care practice. And when I first met Olivia, you know, we're introduced to each other and, you know, we're co-located in a room, but I didn't know a lot about Olivia. But Olivia took the time to get to know me. She took the time to check in when things were off. She's like, I'm noting some problems. What's going on? And maybe it was the social worker in her who were phenomenal, by the way. So if we have any social workers joining us, all my praise to you. And she would care, right? She would make sure that not only were the patients getting the care that they needed, but the team was actually getting the care that they needed. And I think a lot about it. I often think about what Olivia did on a day-to-day basis to check in and to make sure we were OK and to work together. And in many ways, that set up a foundation, not only for us to enjoy the work that we did together, but actually provide better care. It actually provided the structure and the connection for us to provide a better service to our patients. And one day I was meeting with a patient. She was about 65 years old to come into clinic. Her blood sugars were out of control. So we're often brought in to help people figure out the right medicines for them when their diabetes isn't totally under control. And I sat there talking to her for a minute. And at one point she said, you know what? I've been really down the last little while, and I've actually thought about taking my own life. And if you want to talk about a pharmacist out of his depth, that moment I was, you know, a little bit in shock. My head was spinning. I had no idea what to do. I mean, we're trained to kind of figure stuff out and problem solve. But I was clearly unprepared and underqualified to address her particular need in that moment. But as I sat there thinking and talking to her, I thought to myself, I know who can help with this. I know that if I walk in and I tell Olivia what's going on, Olivia is the right person to help solve this particular challenge for this particular patient. And I think a lot about how comfortable that was, how easy it was in that moment because of what Olivia had done to say, I don't know the answer to this, but I know who does. And I know the person who can help make this patient's life better in this particular moment. So when we talk about small relational changes that are needed to help fix and heal the system, that's what we're talking about. We're talking about the day-to-day changes that we make in the way that we operate as a team that are going to lead to better systems and better patient care. Next slide. So when we introduce the concept of relational leadership, that's really what we're talking about. It's an approach to leading and to being part of a team that cultivates authentic relationships to help us achieve connection, common vision, and interdependent action. So just to kind of highlight those three points, connection, right, that we do the practices and we have the mindset that connects us with the people that we work with and the patients that we serve. We have a common vision of what we want to accomplish, and we recognize that we're interdependent. I couldn't necessarily fix this woman's diabetes until we had addressed where she was from a mental health standpoint, and I couldn't solve that myself. All my training, all my background, what expertise I brought to the room wasn't enough at that moment. I needed somebody else, and that's the interdependence that we're talking about. So we actually embrace that. We embrace the need that we have for each other, and we call that relational leadership. Next slide. So relational leadership has four domains and maybe sort of a shadow domain. The first domain is managing self. In order to be an effective team member and an effective leader, we have to understand ourselves, who we are, the identities that we carry, our backgrounds, our strengths, maybe some of our blind spots, and how we show up in team spaces. From there, we talk about strategies that teams can utilize to be more effective and to increase the well-being and the satisfaction of the team members involved. The next domain around coaching and developing is the idea that all of us can continue to improve, and sometimes we're coaching others because we're invested in their development. Sometimes we're receiving coaching because we still have a ways to go ourselves, recognizing that something works in everyone and how to bring that forward for their benefit and the benefit of the people around them. Finally, as all leadership is, there is an element of change, right? We have to fix and improve and make things better, and what are some of the strategies that we use to do that? The sort of shadow domain is this concept of advocacy, and I think in many ways there's big A advocacy that might happen on Capitol Hill, either in the nation or in our state, but there's also little A advocacy. Am I an advocate for my patients? Am I an advocate on my team? Am I an advocate within our system? So whatever domain that might be, all of these skills and these domains lead us to become advocates in our sphere of influence. Next slide. I'm going to bank on the fact that we have no geese experts either in the room or listening in later. If there are, somehow let me know all the mistakes I'm about to make as it relates to the actual functioning of geese, but I think I'm pretty close. So we're going to assume that I know what I'm talking about when it comes to the habits of geese, but hopefully that will help us with an analogy. When we think about the way geese operate, they fly in the V. I think about like the mighty ducks, right? The flying V. Maybe I'm dating myself with that reference, but the geese fly in a V because it's helpful, right? It's helpful for them to get where they need to go. It eases the burden of the geese together, and it provides an element of sort of protection. And you would think naturally that the goose at the head of the formation is the leader, that they are directing this whole flock of geese where they're supposed to go. What's really interesting about geese, and maybe be slightly applicable to humans, is that actually the way that the geese fly is determined by each member of the flock. All of those geese are constantly attuned to one another and to the environment around them. And they are constantly sending signals about what's going on to each other and adjusting as a group. So if one geese happens to notice danger, right, they're able to alert everyone and everyone can move together. Or perhaps a goose recognizes that there's an easier airflow a little bit up, and they can help the group adjust. Humans aren't that dissimilar. We are constantly attuned to the signals that we are getting from other people. Think about the last time you walked into a meeting. Okay, maybe that's a bad example, right? We don't walk into meetings anymore. But think about the last time, pre-pandemic, you walked into a meeting. We immediately start to take note of what people are doing. Are people talking together? Are people's computers out? And we adjust in that moment to the behavior that we're seeing. Think about a party you attend, right? We're always kind of like figuring out who's who and where is our place in all of this. So as much as that can be bad when we adopt a bad culture, there's a power in that. For each of us, you know, whether or not we hold a formal leadership position or not, each of us has the ability to influence the other team members around us, just like the geese influence the flock from whatever position that they're in. So much of what we're going to talk about today and hopefully will inspire you to explore later is learning to be better signalers, right? Learning to give signals to other people that they're welcome, that they can contribute and help to have a better team culture and better team performance that leads to better outcomes for our patients and happier teams. Next slide. So there's a primary care researcher named Bodenheimer out at UCSF who's done a lot of research about these concepts of teaming and team culture and how teams operate. He says changing team structure without addressing team culture does not lead to improvement and actually could make things worse. So we're talking about co-location, right? I sit with a group of other professionals in my clinic. Maybe team huddles, maybe the concept of rounds. Just those structural components not accompanied with culture may not really make things better and may just, you know, further isolate and reinforce bad culture. We need to complement that with the practices that make teams successful, right? So on the next slide, we see the characteristics of high-performing teams. And, you know, we could probably have a seminar on each of these, right? But the concept of diversity and diversity in its fullest sense, right? People who are from different backgrounds, different places, maybe different professions. When we think about high-performing teams, they value that diversity. They actually seek it out because they recognize that when you bring in multiple perspectives, that the sum is greater than each individual part. There's the concept of shared power, right? That, you know, we live in constant power dynamics. But effective teams learn how to share that power and co-create their plans and goals together. As we were talking about before, you do need a clear and effective structure, right? People have to understand, you know, what is their role and come to bear with their expertise. And so that does have to be developed. That also gets paired with trust, right? Can we be open? Can we share? Do we trust that the other person is going to do what they say when they say that they're going to do it? Finally, a growth mindset, right? That we recognize that our team is going to constantly need to evolve and to improve. And we embrace that, right? We're not just going to say, yeah, this is how we are and this is how it is, and we're going to live with that. A growth mindset says that we have the ability to improve things on a consistent basis. And thinking about these characteristics of high-performing teams, you know, some of them are hard to put your finger on, right? Sometimes we recognize them when they're there, and we really recognize them when they're not. I had an experience about a year ago where I was actually in a faculty meeting. So another part of my day job is working at a college of pharmacy where we teach students. And we were in a faculty meeting, and we had just launched this really great faculty development program around leadership and the way we see each other. And I was so excited because I teach a leadership course, and I thought, ah, I'm going to bring this into my classroom. And I'm going to be able to share this with the students and then the faculty and the students can get together, and we can get along better, and we can solve our conflicts. And not the moment that I get done sharing that, three members of our faculty, almost that felt like in unison, just took my head off, right? And just told me why that was a bad idea, why I'd broken the rules, why I didn't get permission to do that, and basically just laid into me. And I sat there in that faculty meeting, and I felt totally alone, right? I felt like nobody on the team had my back. I felt like I was never going to say another word in faculty meeting again. And it really demoralized me, maybe even until this day, right, the way I feel about that faculty meeting. So it's important to note that these characteristics come into play all the time. They're really important. And as we start to think about the next topics, I think we're going to try and zero in on some of the principles that make teams really effective. So with that, I'm going to turn it over to Kari and let her keep walking us through some of these concepts. Great. Thanks so much, Kyle. And just to echo, it's really nice to be here with you all as well. Maybe one day we can be together again in person. So thanks for setting the stage, Kyle, for the justification behind why we need a relational approach to our leadership practices and teaming, back on our own teams, at our own institutions, and our practices. Essentially, we can't achieve any change unless we address the relationships and changes we need between each other. And I think it's really nice to look at a slide and say, oh, that's a high-performing team. And like Kyle said, when we review a slide like this, we often can think of some examples of like, oh, there's an example of where I know that I was on a team that kind of represented that. There was at least diversity or we had some shared power. And then I think more often we'll look at a slide like this and think of those examples where we weren't on a high-performing team and obviously see a lot of opportunities to improve. But one thing I will say is even if you're on a team right now that you don't feel is high-performing and meeting what characteristics are on this slide, building awareness of that is the first step in order to be able to change things. We can't change things we aren't able to see. And I know for me, my first experience where I truly felt like I was on a high-performing team that started to actually really turn on my passion for this work and why I'm still involved in this work today, teaching people around the country now eight years later, it all started with a team that I was on in my residency training. Midway through my residency training, I remember being in a really burned-out place. I'd come out to Colorado from Florida to become a family doctor, a family doctor that could do everything, be everything for patients. And I was on a busy inpatient month and finished rounding that day and sat down and opened up an email from a cardiologist I'd been working with around a really complex patient of mine. She's a patient who didn't speak English and had rheumatic heart disease and had recently had a valve replacement and was still having some complex symptoms after that. And I'd been helping to fill the gap for the patient when she no-shows for appointments, when we were seeing language barriers. I was just kind of going that extra mile always whenever I could to make sure she got the right care. And that was the culture and expectation that had been set for me and that I was also setting for myself. And in this instance, I saw that he reached out over email, opened up the email, and he was like, this patient has no-showed again. I'll just leave it to you. I'm not sure what to do, but I hope you can do something. And I immediately, without even thinking, wrote back and said, hey, yeah, I'll take care of it. I'll call her after work. And then after I sent it, I turned back to my things and suddenly became very aware that I had a very long list of tasks to do that day before I could leave the hospital. And I realized that if I called her and got an interpreter on the phone and actually was able to get her on the line and talk through all the barriers, I was going to end up leaving the hospital super late yet again. And I was going to have to cancel on a really good friend of mine that I'd already canceled on twice that month yet again. And I just realized in that moment, I was like, I don't want to be this person. Like, I just can't do this in medicine. I can't keep being this for all people and losing a part of who I am. And with that, though, that came a really high sense of feeling overwhelmed. I work in a federally qualified health center, an underserved health care center, and I felt a little scared to be able to ask other people on my team. Everybody's pretty overwhelmed, it always seems like, and everybody's working really hard. You never want to ask somebody else to do something, I felt. I shouldn't ask somebody else to do something, something that I could do myself. Luckily, I didn't get in that train of thought forever. I decided to reach out to a nurse that works on my team because I was like, we're kind of friends. We had a small talk on the side, maybe she won't think I'm just dumping on her. Sent off that email. Within just a couple hours, I got a call back or an email back, and she was like, Carrie, I know this patient. Thank you so much for asking me to help. Remember, we're a team. I want to help with her. I knew this woman from her pregnancy. I'd love to help. And then she added a little line. She was like, by the way, I hope you're finding time to rest. I just remember feeling such a sense of relief when she did that. It was the first time I had ever done something like that, and I felt so safe in that moment. Like, oh, yeah, I can do this. I can ask for help. And everybody knows who I am. They know that I'm not going to dump on them. And that experience, that one moment turned into a partnership with Cheryl for the following seven years until I recently left that practice. So we started just partnering on patients all the time. She knew I wasn't going to enlist her unless it was a patient that really needed help. And it increased her job satisfaction to be able to contribute in an interprofessional way, and my patients got better care. And from there, I remember that was the first time I tasted what is it like to lean into that discomfort, to that fear, and see how that can change team dynamics. And you just heard a little bit of a story from Kyle when he was in a faculty meeting. Where that environment did not feel safe. And in my environment, it didn't feel safe in the beginning with my team member Cheryl. But in the end, it did. And that feeling of safety on teams is a true concept. And you can move to the next slide. Thanks, Dana. This concept of safety on teams has had increasing awareness and research in the last 10 to 15 years. Dr. Amy Edmondson is a researcher on this slide. She is a PhD researcher up in the Northeast, and she spent her thesis and is spending her entire career researching this concept of safety on teams, and specifically the concept of psychological safety. Psychological safety is a shared belief that a team is safe for risk taking. It's safe for getting out of our comfort zones. It's safe to dig into our fears, to face them and not be afraid of retaliation and know that we'll be supported. We're able to be authentically ourselves and our team without retaliation. And when we look at high functioning teams, psychological safety is continuing to be shown in the literature and in different venues to be the secret sauce that leads to that. And it hasn't just been found in the business and now in the healthcare literature under Dr. Edmondson's work. Google actually figured this out. And this helped to make this concept really mainstream back in 2015-2016. Back at that time, Google was observing a really interesting phenomenon on their teams and their organization. They were noticing that people that had all the perfect degrees, the perfect areas of expertise, the right levels of people on teams, those teams were not performing nearly as highly as they expected. And then other teams that didn't have all the perfect makeup, they hadn't brought all the right CVs and resumes together were actually performing perform more highly. So Google brought on a researcher and a whole research team to actually look into what it takes to unlock creativity, to unlock innovation, to unlock opportunity, and team function, and to understand the phenomenon going on. And when they landed on the at the late when they finally landed at the core of their research, they described psychological safety to a T. Then they went to literature and realized, this is what Dr. Edmondson was talking about. If you guys are interested, you should just Google, or Google, Google, Google, Google, psychological safety. There's a really cool article that was in the New York Times describing that. And so it is applicable to functioning teams across multiple settings. And we really need to bring this into healthcare. And that's what we're unpacking today. You can go ahead and click in the next animation. And so when you when we think about psychological safety, in the beginning, all we knew is that this was a phenomenon that existed. And now we're starting to unpack in the research, what are the types of things that lead to this overarching concept of psychological safety, this team feeling safe, for risk taking, feeling safer, authentically bringing your whole self to work. There's four components of safety that lead to that. The first is safety of inclusion. This is just a concept that you feel like a member of the team. When Cheryl replied to my email and just said, Carrie, I'm we're a team that made me feel included. It didn't make me feel like an outsider. She wasn't like, Hey, why are you breaking into my zone and asking me to do something else in my workday? She said, Welcome. We're in this together. So camaraderie and a sense of team is incredibly important to psychological safety. A second component of that is safety to learn the ability to say, Hey, I need help. I'm not enough. I have I have growing edges. Or maybe I don't know that. This is an incredibly important piece to psychological safety that the and we know this from the kind of error based medical culture and increased awareness that we can't view errors as personal individual failures or system failures. That that approach in medicine is great. It's really helping to facilitate the safety to learn in the medical environment. And it's an incredibly important, important precursor to psych safety. So when I opened up and shared that I was struggling, and I needed help, that was really important that Cheryl met me where I was at and affirmed that in me. Third is the safety to share and this tightly links. A safety to share is just the ability to really be yourself to share what you're thinking about to share what's on your mind. The ability to say you know what, I'm coming to work today. And it's the middle of pandemic. I've been isolated. I've got a kid at home, I'm struggling, the ability to be able to bring your authentic self to your team into your space, and not have that shame is incredibly important. And then lastly, the safety to challenge and I think about safety to challenge as a function of some of the other safety components. When those when those other components are there, we have the freedom to say, hey, maybe let's change the status quo. Welcoming changing up a status quo, rather than saying that, hey, you're trying to break the system, you're trying to mess up the system, these four components are incredibly important. And if all you do and walk away, walking away from this presentation today is know that psychological safety is a phenomenon and that these are important components of it to reflect on, that's a win. Because again, building awareness of a concept is important for moving that forward. And Kyle, before I pop to the next slide, I wonder if you could pop in and just quickly comment on what safeties were at play when you share that story of being on that team with your faculty in the faculty meeting? What, what safeties do you feel like were threatened or weren't there for you? Yeah, absolutely. And I will say, you know, I felt a little bit of safety of inclusion. I was like, hey, we're in this together. But I think in that moment, that safety to share, you know, I was trying to share something that I thought was meaningful. I think that's the one that was just obliterated, right? Like that was just broken in that moment. And then I would never even go now to safety to learn or safety to challenge. I can't even imagine the ability to raise my hand and say, I think we're wrong. Right? I think we're going the wrong direction. Just, you know, it's almost like you build to that ability to challenge and, and, and those are the ones that come to mind for me. Thanks so much, Kyle. And just a comment, if you feel like you're on a team right now, that's not high functioning problem data, or that you don't even have any of these, I would say you can just start thinking about which one can you start to build on your team, if there's one precursor, one field of safety you think is within reach, because they are additive, you can't tackle them all together. But starting anywhere from a relational framework of authentic connection, helps you to start moving in that direction. Next slide. Thanks. So overall, another another quote from Dr. Edmondson, it's just psychological safety is about being able to be direct, be yourself, take risks, be willing to say I screwed up. That's okay, that's normal, that's human, being able to ask for help when you're in over your head. That's what being on a psychologically safe team is. And that's the crucial secret sauce to moving toward being high performing and having all of those important components that are reflected about the high performing team. Next slide. And so I won't spend too much time on this, you guys will have these materials and you can come back and look at this. But what we're talking about with psych safety is really getting toward that high performing team. And what happens in between that, when we when we have psychological, psychologically safe environments, people are able to speak up, like we said, they're able to share, they're able to put out incoherent thoughts that are still being processed, without being afraid of thinking, Oh, my gosh, my words aren't going to be perfect enough for this group. Tech safety can can support really productive conflict. You don't have to go to, you know, I have not participated in many conflict trainings, but just having training in psych safety and being able to know what can I do to make spaces safe, that helps with conflict, it helps with learning and creating a learning environment. It can promote innovation to raising novel ideas and possibilities that safety of being able to challenge. And it can also increase accountability. When we build psych safety on our teams, we're actually building again, that sense of inclusion, that sense of being in this together, we're learning together, we're challenging the status quo together, that can actually increase accountability, and help all members of your team to perform with higher standards to get at this work together. And so working on this has so many benefits that have a trickle down effect. Next slide. And ultimately, psychological safety is getting safety is addressing our fears. Our fears are actually a really big driver. When we think about professional risk taking, when we're afraid to speak up, we're often being perceived as ignorant. So we hesitate to ask questions. Maybe we're viewed as incompetent. So we hesitate to admit mistakes or ask for help. That was a core thing with me. Even though I'm in family medicine, I'm in primary care, it's about interprofessional care. And that's important for being able to perform well on a team. There's still a subculture that tells me each and every day that I'm supposed to be everything for my patients. So to lead the team, I'm supposed to be the leader, and I'm supposed to know all the answers. And so I have to consciously work against that, and make that a personal practice. And psychological safety can help empower me to do that. Go ahead. Next slide. So we're going to spend the last few minutes unpacking, and just highlighting a couple strategies for fostering psychological safety. And I just want to say this list of just a few things is definitely not all inclusive. And the research around this space is new. But if you just reflect going back on those other slides about what is psychological safety, and what are some of those components of what make up psych safety, that's safety to learn, safety to be included, you can also come up with techniques or strategies on your own that just makes sense to you in the context of your team. But just to get those gears working in your mind, first thing you can do is just personal reflection, just reflect yourself, ask yourself, for instance, when was the last time someone disagreed with me? How did I respond? Just do a personal check in about do you feel safe on your team? Or do you think that based on your observations of other people around around you, they feel safe with you? That's the first step to understanding and getting a check in on the pulse of your team. The second is acknowledge reality, just provide space to name and signpost some of the hard things that are happening around us. And so this is more of an outward focus, you as a leader on your team, can provide space for that. Like such as in a team meeting saying, hey, let's just check in on what's hard. This is a hard learning environment. This is uncharted area for areas for all of us. And we're bound to make mistakes, for instance, on our teams in this COVID pandemic. It opens up the opportunity for them to sit and say, well, what's the best way for us to communicate when things go wrong? It helps to invite people in, calling people in rather than calling them out. And these next two points here are really about kind of what I say, facilitation methods, or modeling vulnerability as as an authentic tool from yourself to be able to allow connection with others. So making space to listen is more of a facilitation technique. If you're on on able to be a leader of a team, even using a check in at the beginning of the meeting to just ask how everybody's doing. I know this has been a challenge for me. I'm sure it's different for all all of us. How is everything going for you, that helps to build a sense of inclusion. And then vulnerability, saying where you're really at, and what you're struggling with, can definitely set the tone for a team that make it more and more psychologically safe space, particularly if you're someone who is ascribed a lot of power from a leadership position, whether that's your profession. And so people if you're listening on this call, if you're somebody who is in a position of power of leadership, modeling vulnerability to a group to open up, allow to provide space for that and other people is a really incredibly powerful tool that can foster a psychologically safe environment. And I'm going to hand it off to Kyle to wrap up the next part of this. So for me, when I think about these strategies, I think about the geese, right? I think about the signals that we're sending to our team. And I think as you want to think about the building blocks of a psychologically psychologically safe environment, it's made up of the day to day signals that we're sending back and forth to each other. So like Kerry mentioned, it's safe to be vulnerable here. It's safe to listen, it's safe to pause and check in. So as we think about these continued strategies, we want to invite feedback when I ask someone for their feedback, I'm signaling, signaling to them that I value them that I value their perspective, and that I want to improve. I had an interesting experience, I work with a clinical technician, a pharmacy technician in our practice. And one day, I just, you know, I was going through a little bit of training was getting invited to do some, make some changes. But I, I sat down with her and I said, What is it that I do on a daily basis that makes your life easier or harder? And is there something I could do? Is there is there a change I could make that would make your life easier? And all she told me is, you know, we work in different spaces in the building, I would just love to know when you arrive and you're ready to get to work. So I can know when it is I can I can start to send you some things. Like you just want me to check in, you just want me to let you know that I'm here. That's it. That's like the change you want me to make. I could do that so easy. And it's made her life better, right? It's made her life easier. And it's made our working relationship even stronger. So inviting feedback is just one more way to signal that this is safe. I want to be better. I want to make your life better. And I want to work together as a team. And that helps to foster that sense of psychological safety. Another way is to think about amplifying voices. And I think in a, in a normal world, there's people whose voices are recognized more often, there's people who are willing to jump in and, and put their voice out there. And there's people who are sometimes marginalized on our teams and whose opinion isn't sought. I think this is even more pronounced in sort of our virtual world at the moment. So as a leader, or as a team member, if I can help amplify the voices of everyone, and be inclusive of those voices, that can help demonstrate a certain level of psychological safety. Finally, I would just encourage people to gather data. So Amy Edmondson's team has tools that you can use to try and measure psychological safety, Google the same way, I would submit that there's another set of data, there's qualitative data. Think about throwing this out the next time you're having a one on one discussion, right about asking how safe they feel in the team and the environment. Maybe throw it out in your next team meeting. And if you get crickets, you'll know that maybe there isn't as much safety as you thought. So using both kind of the formal methodology, the quantitative measures and potentially some of your own qualitative measures that can help you figure out how safe your teams are. Next slide. So let's bring this all together. We're almost done with this didactic component. Like I mentioned earlier, psychological safety is something that you recognize when it's not there. And you'll know it when you you know, hopefully with this awareness from today, you'll know it when you start to see it. So team members might feel that they have agency to act that they are capable. You might notice it because the dialogue gets more honest, more frank, more transparent, not that it gets unkind, but we confront the realities that we're facing. People are more willing to raise uncomfortable topics. People have curiosity, they want to know more when people have ideas, and they want people to continue to share. Team members might ask more questions, they might solicit feedback, regardless of where they sort of sit in the hierarchy of the organization. I think a big one is are people willing to raise concerns, I would submit to you that if everything feels like it's going awesome, that could be in some aspects, a warning sign that there isn't enough safety for people to raise the concerns that they have. Nothing is ever perfect. And so the more safety we have, the more people will raise those issues. If people will offer ideas, if brainstorming sessions are robust, and if people will own and acknowledge their their own failures. So we recognize that this is a big topic, we recognize that we've really just touched the surface here. And so this is an area for all of us to continue to learn about, for researchers to test and really start to get our arms around it. And so we're grateful for the opportunity that we had to present today. We recognize there may be questions in other domains as well, but we will stick around for the chance to answer questions as they come as well, if they pertain to this content. And thank you from Carrie and myself and from Primary Care Progress for the chance to present. Great, thank you, Carrie and Kyle for a great presentation, some very thoughtful, useful information. At this time, we are going to transition to our HCC Intelligence Virtual Office Hours, Ask the Experts session. For this session, we are also joined by Dr. Paul Chain, HCCI's Senior Medical and Practice Advisor, and Brianna Plintzner, HCCI's Manager of Practice Development. And they are here to ask questions on the topic or not. And now we will open it up for those questions to begin. And one question we have here for presenters, how do you balance between interdependency and over-dependencies on another? I don't know, Kyle, you want to take that one or Carrie? Kyle, I can take a stab at that. And feel free to add in. You know, it's funny, in Primary Care Progress, we talk a lot about tension. And I think I don't have a perfect answer to that. I think in a psychologically safe environment, if you think there's some over-dependence happening, you actually have the firm foundation to give feedback, if you think over-dependence is happening. And that's actually working against the optimal function of the team. I think, in general, the history in healthcare has been a lot of operating in silos. They think there can be a lot more interdependence than is there right now. So that's the general focus of what we move toward. But I agree that you can do that too much, that then you've got some people that are over-dependent, it's maybe not healthy. But with attention to that, in a psychologically safe environment, if you've built that firm foundation, you should be able to address it. Kyle, do you have any other thoughts or reflections on that? Yeah, the only other thing that I'm thinking, Carrie, is about sort of the story that I had with Olivia. Olivia and I had figured out each other, right? We knew we cared about each other as team members, as we respected each other as professionals. And I think one thing that has helped, at least in my experience with high interdependence, when people understand each other's roles, and they understand their strengths, they're more able to achieve that interdependence. I knew my own, I knew where my expertise stopped, and somebody else's started, and I was able to engage them. I think there's a component of the over-dependence where we have to help people step up to their potential, you know, coach them up and, and making sure that, you know, they see the potential in themselves and what they can do. And then we help foster that. So again, not perfect answers, but just some some thoughts based on our experience together. As you look to build a team or put one into place, are there certain characteristics of a person that would lend them to be more, you know, susceptible or influenced to take on relational leadership? Kyle, I know we didn't decide who's taking what. That's okay. Go ahead, Carrie. I, what I would say is, and this is an optimistic stance. But I would say that all people have that potential within themselves to become relational leaders. I think we all are relational by nature. We're all emotional people, we make decisions. We make decisions emotionally, we connect with people emotionally, even if we're strong thinkers on the Myers-Briggs, we do, and there's some research behind that, that we won't get into. But I think all people have the capacity. It's just a matter of whether or not we've provided a safe environment for them to do that and to kind of unlock that. And some people might require a little more prodding. I actually see a note in the chat about any advice on getting the quiet team member to speak up. Even if someone's quiet, and we think about that often sometimes between extroverted and introverted, both of those personality types are incredibly relationally based, they might just do that in different ways, and in a way that facilitating in a way that feels tailored to them. So it's interesting in our primary care progress work, we do a lot of narrative storytelling as part of our leadership practices. And no matter where people are, every single person who experiences it always says that it really resonates and it was a powerful experience for them, which just speaks to I think that unity of that approach. Kyle? Yeah, I think it's really on the leader. I think it's the tone and the culture that you set when you're able to do that, that you value these aspects of things. It's not just about the work being done, but it is also about the people doing the work. And I think people will respond to that. We, you know, can talk more in future and, you know, about strategies and techniques around that. But there is something in all of us. It's again, that signaling, like we all are paying attention to it. And we just might need to engage people a bit differently. Not everyone is going to just jump in and give you all their thoughts in a meeting. But they might in an email or they might in a hallway conversation or in other aspects. And so it's on us as leaders to try and figure out how does everyone tick and to help to facilitate productive work, utilizing all those people and some of their different ways of performing. Is there any other questions in the chat or Q&A that we want to take here? Okay. All right, I am going to just move us along here. And just let you guys know, as we conclude today's event, just a reminder that our recording of this webinar, the virtual office hours and the slide presentation will be made available on our ACC Intelligence page within the next few days. You will also find at our ACC Intelligence Resource Center, some additional ways that you can connect with us and also get resources that you may need going forward. If there are no other questions today, I would like again to thank our presenters. It was very great to hear you guys bring this. I know there's going to be some future conversations from this webinar that I know will continue to be fruitful. So thank you all for joining today and we really appreciate it. Bye bye.

relational leadership

psychological safety

team culture

team dynamics

high-performing teams

positive work environment

fostering psychological safety

learning and growth