Thread by @OBsleepmerchant

@AmyCEdmondson presents the opening keynote at #SOAPAM2023 on Teaming in #OBAnes

First poll of the day at #SOAPAM2023 - it’s obviously A

Did you get it wrong too? You’re not alone, the majority of #SOAPAM2023 got it wrong

But there’s more too it (scatter plots for the win). Highly diverse teams do achieve breakthroughs more often, BUT they have lows too. Note: psychologically safe teams show what we expected! #SOAPAM2023

@AmyCEdmondson’s book - worth a read for #OBAnes leaders. #SOAPAM2023

Did you know you could be fired at Ford for smiling? Thankfully not in #OBAnes (well maybe the occasional birth plan requests this). Fear works if you don’t need a brain to do the job. Arguably for #AnyAnes is when it doesn’t. #SOAPAM2023

Psychological safety became a watchword recently (after Teaming was published). “Anyone’s voice could make the critical difference at an unexpected moment” but this sabotaged by interpersonal risk ( they haven’t studied #medtwitter). #SOAPAM2023

Very few decisions are #OBAnes 100% sure of (arguably it’s a bad thing if there are any things you’re 100% sure) - we make high-quality bets. The “aye’s” seldom have it. There is a calculus to speaking up at work/ in OR/ on #MedTwitter. #SOAPAM2023

Not speaking up has consequences in #AnyAnes as much as #OBAnes. High quality bets are based on information- don’t let a lack of conversations or poor quality ones sabotage quality care #SOAPAM2023

#OBAnes don’t want to be the Apathy Zone, might enjoy Comfort Zone. Ideally we want to be in Performance Zone. However, most likely we exist on border of Anxiety Zone. Silence can also be productive. NB psychological safety is NOT the goal. #SOAPAM2023

Sadly the results of @AmyCEdmondson’s study aren’t surprising (pretty sure it’s similar for #OBAnes labour ward environment - different players). Why is psychological safety not the goal? Because benefit most in knowledge-intensive task settings. Conversions require leadership.… twitter.com/i/web/status/1…

How do #OBAnes leaders or as team leaders on Birth Unit/ Labour ward/ in OR build psychological safety. 3 steps: starting with framing the work. (re)-framing is essential. #SOAPAM2023

Not that #OBanes want to fail or should be expected to fail, but if we never fail we never improve. Complex systems like #OBAnes require speaking up to save lives/ improve care (intrapartum pain at cesarean section comes to mind) #SOAPAM2023

As much as @GongGasGirl hates aviation analogies, this may very well be a good approach from Ben Berman. Toyota approach also helpful - #OBAnes only fix problems we know about (intrapartum pain at cesarean section again). What can YOU do? Memorize. #SOAPAM2023

Context matters - low complexity, low failure, failure risk increases as things become more novel/ complex. 3 types of failure - and no it can’t only be intelligent failures (there are criteria) #SOAPAM2023

How you respond to being informed of failures. Turning Ford around took one red light/ red report, a positive reception, and within 12 seconds Ford was turning the corner. #SOAPAM2023

Even in OR #AnyAnes/ #OBAnes how we respond to “failures” make the difference to whether that “failure” has an impact (@BBreebaart’s #RAUK23 talk comes to mind @ajrmacfarlane). How do you do it? Keep it simple. NB = “how inclined am I to listen?” #SOAPAM2023

Accepting that what you “KNOW” you may very well improve. Teaming across boundaries is hard - especially in complex teams. Strategies are useful. #SOAPAM2023

Seek understanding BIDIRECTIONALLY. 4 steps to joint problem-solving. As in everything, REPEAT (forever) and TEAM UP. #SOAPAM2023

How do we shape the change and what are we hoping to achieve? Not aiming for sustained crisis (but arguably unavoidable in #OBAnes), but leadership style has to adapt to achieve improvement in patient care. #SOAPAM2023

And straight INTO the @kkjaermd’s President’s Panel #SOAPAM2023

Now this is a format harder to tweet as not anchored by a slide. Themes emerging:

when entering a new place come with a spirit of enquiry, ask the questions seek to understand before trying to change (“why isn’t this working?” “I’ve been here 20 years and you never asked”)

Create a team that works and plays together, supports eachother, a sense of TRUST is important.

Tbh @kkjaermd hits nail on head that trust is implicit through the themes of @AmyCEdmondson’s talk

Examples: trust in competence, and intention-based trust.

@aljabut discusses how you can establish teaming in large academic centres - when constantly orientating new students/ residents to #OBAnes.

He asks lots of questions, expresses curiosity. Walks them through process, leading by example. #SOAPAM2023

Quite important that we acknowledge we never know whom will have the passion we have for #OBAnes, how we meet them makes a difference to their perception.

Failing successfully is a skill!

How do you titrate listening? Ability to ask questions and actually listen to answers… twitter.com/i/web/status/1…

Pivot from being an expert (speechless for 6 - 9 months), to a “learner” listening, asking questions- stop/ paused and moved forward. Those who were barriers became champions.

REMOVING EGO and accepting things take time may be key.
#SOAPAM2023

Why do some not want to transfer patients? Ego “I can handle this” prevents acknowledging constraints and system flaws.

@AmyCEdmondson: swimming upstream against cultural norms, traditions - what do we need to do to team up faster? It starts with enquiry and listening. Also the… twitter.com/i/web/status/1…

Poor communication creates issues, especially when ego involved. Hallway conversations are challenging - could be good or bad. Awareness of walls having ears is NB. Diverse cultures can have different ways to communicate.

Recognition when you need a mentor is important… twitter.com/i/web/status/1…

@aljabut talks about when he got it wrong in assessment of how things would play out?

Responding to obstruction, said “you pulled out tube too early” - response: “let’s take this conversation offline”.

Said something factually correct, BUT assigned blame - alternatively don’t… twitter.com/i/web/status/1…

@AmyCEdmondson states the skill required to re-frame is HARD to achieve without practice. It’s hardwired socially as we are growing up.

Pause, verbally edit, make choice of how we communicate - reorientation is hard, takes work.

#SOAPAM2023

NB can’t always choose your team! Think aloud - someone may see something missing

@aljabut brings up @simonsinek (very inspiring) - “I love my job” anecdote - leadership style makes a difference, “how can I help you”

@AmyCEdmondson: two good go to questions - What are you… twitter.com/i/web/status/1…

“We work well together because we know it other” does familiarity modify team behaviours? - @DalAnesthesia’s own @AnaSjaus asks a question at #SOAPAM2023

@AmyCEdmondson - YES, although not necessarily. It’s difficult to change failure of intention- based teaming, it has an… twitter.com/i/web/status/1…

*not necessarily POSITIVELY*

I definitely typed it in my head - time for a coffee refill! #SOAPAM2023