Relationships: Building a High-Performing Team

No matter how much passion you have, it will eventually wane if other people continually thwart your efforts. In this chapter, you’ll find the story of a manager trying to relieve the frustrations of the staff members on her unit who were working in silos. You will learn, as she did, how to harness the research on creating high-functioning relationships to achieve an extraordinary accomplishment for your staff members—and your hospital.

Rita's Story: the Problem

Rita looked beleaguered, slumped over her desk piled high with papers. Her posture suggested stress was taking a toll on this usually vibrant young woman. I noticed a flicker of fear in her eyes as she shifted her gaze from her computer to the office door where I stood. I wondered what was distressing her.

It had been about a year since Rita had become the nurse manager of the Blood and Marrow Transplant (BMT) case management program. Her group was responsible for clearing all the hurdles that had to be overcome for patients to receive lifesaving treatments.

At one of our initial meetings, she explained the details of the work her group was doing. “There are 100 hoops we have to jump through to get a patient a transplant,” Rita said in a demure tone. “People are referred into our BMT program from around the world. They’re very sick and urgently need our specialized treatments.

“But, a lot of stars need to align before it can happen. To give you the highlights: we need to get approval from health insurance companies, find time in a physician’s packed schedule, meet research protocol requirements, insure the patient’s and donor’s lab reports indicate they’re ready to undergo the procedure, and understand the unique needs of each patient and their family. If any one of those issues gets fouled up, we have to start the process all over again.”

In subsequent meetings with staff members I heard a lot about how frustrated everyone became when cases failed to clear all the obstacles. In fact, Rita and her case managers described feeling disappointed on a daily basis. The staff members said they frequently felt they were letting patients down when all of their hard work failed to achieve the desired outcome.

Tears were shed in one of our meetings when a nurse recounted her efforts to get a BMT for a gravely ill mother of three young children. In a race against time, the case manager described her struggle to get approval from the woman’s insurance company. “I was trying everything I knew to work through the appeal process. It didn’t happen in time, and I felt horrible when the family called to tell me the patient had passed. Later that day, someone called me to complain that I hadn’t gotten back to them on another case. I lost it. I’m sure others could hear me shouting but nobody said anything. Even though I sit next to five people in our tiny office, it’s often lonely.”

Screaming matches regularly broke out between staff members when tensions flared as people were desperately trying to meet deadlines. Rita frequently found herself playing referee, sending people to their respective corners of the ring to cool off. But it didn’t take long until the stony silence was shattered and the shouting resumed. Although these were dedicated people, they had succumbed to the fight or flight reactions that often arise when people work in an extremely stressful environment. The group’s focus on failure created an air of resentment that permeated the small room they shared.

The fallout from these clashes lead to another challenge for Rita. When frustration boiled over in her group, she would take the tough case herself to avoid further conflicts among the case managers. In conjunction with her managerial obligations, taking on many of the most difficult cases put her into perpetual overload. Conflicts and overwhelming workload were clearly the culprits driving her daily stress level through the roof.

Rita’s story exemplifies what happens when relationships devolve into dysfunction. Negative emotions reign supreme. People harbor frustration and resentment, which drive them into their silos—until the pressure builds to the boiling point. Then conflicts erupt, causing further damage and creating despair for everyone involved. Fortunately, researchers have found the formula for developing deeply satisfying relationships.

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