Treatment Team Leadership: Lessons From Coach Wooden
By Faren Levell, MS, LCSW, LMFT
Your team is one point down with 15 seconds left on the clock. Do your players know what to do to score? Expressed in psychiatric language, a team member is out with a client that is rapidly becoming psychotic, and the case manager's call comes through to you. Do you, the team leader, know what play to call? Although the stakes are much higher in healthcare, the treatment team leader operates much like a basketball coach in that he must motivate, teach, and frequently direct the actions of the team members to achieve success.
Leadership is: Learning the Skills
As mental health services have transformed over the years, the members of the management team at Southwestern Indiana Mental Health Center, Inc, where I work, have received additional skills training outside of the usual clinical domain. Training sessions have been used to cultivate effective leadership and improve or reinforce the good management skills of the team members, many of whom were primarily trained as clinicians. One of the first assignments given to those of us on the leadership team was to write a report on a management book of their choosing. Being from Indiana-where learning how to properly play the game of basketball is considered an essential stage of developmental growth-I chose Wooden, the autobiography/life philosophy of a college basketball coach I have admired for years. John Wooden is recognized as one of the greatest coaches in basketball history. An All-American player at Purdue University, he later coached the UCLA basketball team to an unmatched 10 national championships in 12 years.
Wooden realized early in his career that being a skilled and knowledgeable player did not necessarily make one a successful leader or coach. Similarly, Southwestern Indiana Mental Health Center management recognized that several of its best clinical managers could become even better at their jobs through leadership training that would ultimately improve the organization's efficiency. This article offers several pointers adapted from Coach Wooden's leadership philosophies that have been put into practice by some of our Championship Treatment Teams at Southwestern Indiana Mental Health Center.
Leadership is: Managing the "Game" Clock
Given the need for cost-effective psychiatric care in our communities, staff time is very valuable. For this reason, good leaders must plan for all staff interactions. Coach Wooden is fond of the saying, "Failing to prepare is preparing to fail." He deliberately taught his teams at each interaction or practice, often scheduling the exact time needed to teach and rehearse a specific activity. Wooden stressed that no task, however small, should be overlooked. For example, on the first day of practice, he taught his players how to put their socks on in a manner that prevented foot problems. We, too, must be good managers of our staff time. We must utilize teaching and educational efforts in the most efficient way possible. On the first day with a new staff member, I introduce him or her to the entire team and start explaining how the new employee's duties fit into the team effort of teaching the client how to get the best medical care possible from the physician(s) and the rest of the team members.
Leadership is: Teaching
Wooden indicates that the difference between team leaders who are successful and those who are not is the ability to teach and motivate the individuals they supervise. The team leader, therefore, has an enormous responsibility. Treatment team members must be taught all domains of the major mental illnesses. They must be provided training to recognize psychiatric symptoms and be given the tools to effectively report vital information to the physician. One of the most effective training goals for team members is teaching them about the mental status exam used by the physician for clients with schizophrenia. When the physician provides the training, team members can learn exactly how to recognize symptoms and report their occurrence in a manner that the physician can best use to fine-tune the medications. When we provide team symptom monitoring scales, such as Clinicians Assessment of Symptom Severity (CLASS), we improve the team's impact on a client's symptoms while providing a basis to educate that client about his or her particular illness.
Leadership is: Members Knowing Their Important Role in Being Successful
Wooden acknowledged that each player had a significant role to play in the team's success, and allowed every player the chance to shine in his respective role. Likewise, in coordinating the efforts of our team members, team leaders need to recognize each team member's role in helping clients be all they can be. This can be done by acknowledging the member's impact-even something as simple as a pat on the back or formal recognition in the company newsletter. Team leaders should also make special effort to recognize roles that are often overlooked. Here are some examples of specific contributions to a client's success that might be singled out for recognition:
- Medication education done by the team nurse
- Psychosocial illness management series provided to a client by the day treatment staff
- The physician seeing the individual when needed on an emergency basis
- Exhaustive entitlement coordination completed by the case manager
- The therapist coordinating family support and assisting in treating symptoms
- Detailed behavior observations on sleep patterns or mood changes provided to the physician by the mental health tech after a medication change
- The Supported Employment Specialist assisting the client in getting his or her employment of choice and teaching the individual how to manage symptoms on the job
- And most importantly, the raw courage displayed by the client in his or her efforts to work with the team to manage his or her illness
Leadership is: Medication Adherence with Respect
Team members are not the "medication police," and we must strive not to be perceived as such. Although team members should recognize the significance of medication compliance and its impact on the symptoms of SMI, we must also respect client choice and be cognizant of the stages of acceptance of all major illnesses. The way in which we approach and teach adherence is often the key to success. Cooperation and client improvement seldom occur before a therapeutic alliance is established. Team members must ensure that our relationship with each client remains therapeutic and trustful. We must constantly reinforce that the team is fighting the illness, not the client. We must educate the client on how to best use the physician's medical expertise and team support to handle symptoms.
To revisit our basketball analogy, teams work to set up their leading scorer for the best chance at a basket. Team members assist the leading scorer by running plays that get him the best possible "look" at the target. They then deliver the ball in the optimum position so the shot can be taken with the highest chance of success.
In mental health, the team sets up the physician (our leading scorer) to have the best look at a client's symptoms (the target). Teams set up clients for their appointments by teaching them how to best report their symptoms to the physician. The physician gets a good look at the symptoms and takes his or her best shot at medication (no pun intended). The team then makes sure the client gets the medication and reinforces the importance of adherence through encouragement, education, and support until the next physician appointment. At the next appointment, the results are given to the physician, who adjusts medications as necessary to hit the target again. The more times we "hit" symptoms, the greater our chances to win the contest and improve the client's life.
Leadership is: Team Unity and Fairness
All players on a team must be unified by a common goal and operate in a professional manner. Often, team members need to be taught or reminded of the best ways to communicate with each other. Wooden encouraged team members who scored to always thank the others who set up the play. His players knew that he was responsible for handing out constructive criticisms, and that this should not be done by fellow teammates. We can follow Wooden's example by reminding team members to thank others for "covering" for us or providing assistance on any given day. Wooden pointed out that leaders will often get better results by giving praise and recognition in a group setting. He also believed in using constructive criticism, but made sure the member being instructed knew the intent was to teach and improve the player's skill level.
Leadership is: Team Pride in the Service Provided
Wooden taught that fear, punishment, and intimidation do not produce positive long-term results. He strove to instill pride in his players so they would be motivated to achieve levels of play that benefited the whole team. He raised the bar for efficiency and hard work by making his players want to perform at their very best. He believed that pride in one's work comes from the respect given by the leader.
As treatment team leaders, we must strive to instill value in the performance of daily duties that far exceeds pay scale or an external evaluation processes. Team members must believe in the worth of their clients, and fully immerse themselves in the treatment process. Once given value and respect, team members will generally assume the responsibility to improve their work performance. In other words, they will go the extra mile and strive to be the best they can be.
The field of mental health is ever changing, uniquely challenging, and often stressful. At the same time, it can be intensely rewarding personally. Treatment teams can become positive and powerful therapeutic change agents when all members work harmoniously toward the common goal. As team leaders, we must accept the responsibility to lead, teach, and direct our teams. We must continually develop our leadership skills and improve our efficiency in a healthcare environment that requires us to do more with less.
In conclusion, in standard Wooden fashion, I would like to thank everyone that made the writing of this article possible: John Wooden, for his many inspirational books on leadership; the directors of Southwestern Indiana Mental Health Center, Inc, who have given me the opportunity to lead several teams over the years; and the team members and clients themselves.
Faren Levell is a Licensed Clinical Social Worker and has more than 25 years of experience in the field of psychiatric mental health. He has a bachelor's degree from Purdue University and a master's degree from Indiana State University. He currently works as a Coordinator in the Community Support Services at Southwestern Indiana Mental Health Center, Inc. He has held a variety of leadership positions in running Residential programs, ACT and Homeless teams, and most recently a Supported Employment Program. He is the proud recipient of the Marilyn Halloran award for his work in the field of mental health.
