Best Practice in Interdisciplinary Team Management:Inside the Radiation Oncology Department

Author

Lorrie A. LeGrand

Baptist Hospital of Miami

Department

of Radiation Oncology

Miami

Florida, U.S.

[email protected]

Managing a radiation oncology department brings its own unique challenges. There are a multitude of work processes to consider and such a diverse group of employees to lead, that some days the word “challenge” is a distinct understatement. In this article, I discuss the three cardinal rules that any manager of an interdisciplinary team can use to improve synergies between the different groups in an interdisciplinary team. These are:

I. Be open-minded;

II. Be fair, and

III. Be ready for anything.

The Role of “Manager”in the Radiation Oncology Department

In a typical radiation oncology department in the U.S., a manager is called upon to oversee and coordinate the work of clerical staff, nursing staff, treatment delivery personnel (radiation therapists), physicians (radiation oncologists), physicists, dosimetrists, social workers and dieticians. Though the number of employees varies from facility to facility, this core group is frequently involved in the day-to-day care of cancer patients. Some employees have high school diplomas, others two-year college degrees, and so on, up to the PhD and MD levels of education. This wide range of educational backgrounds gives a well-rounded perspective to the department and each employee makes a unique contribution.

Potential Pitfalls in the Department

A potential pitfall for a radiation oncology department is to function in “silos". Each area is likely to have its own immediate supervisor to oversee day-to-day operations and each focuses on the management of the professionals working in each section. This approach puts up barriers between the sections of a department. Functioning in this manner will inevitably result in hearing “that’s not my job” from one employee after another. Team members need to be encouraged to step out of their professional comfort zones and pick up on whatever task needs to be accomplished for the benefit of the patient. Obviously, a social worker will not be able to deliver an external beam treatment to a patient, but she can facilitate the experience for the patient and ensure that the radiation therapists are aware of the patient’s specific needs and expectations.

The Three Cardinal Rules

I. Be open-minded

This brings us to the first cardinal rule of managing an interdisciplinary team; “Be open-minded.” Seeing all the employees of a department as equal members of a team, there are opportunities to shake things up a bit and make changes that might not be possible if the silo theory is followed. For example, a secretary is on medical leave. In the silo theory, a temporary staff member may be hired or the other office employeeswill have to pick up extra duties. Within an interdisciplinaryteam, those extra duties can be spread throughoutthe department. Why can’t a radiation therapist file patientnotes for the patients that they treat every day?

An open position gives the manager the timely opportunity to assess the team – not just the area with the vacancy – to determine how to best fill the position. Why hire a new person to come in and perform job functions that were most likely created many years ago? The new person does not know the status quo. Take advantage of this and determine if a person with different credentials may be able to take on the tasks of the previous employee plus additional functions in the department. As the department grows, job functions, employees, and administrators need to change and grow as well. The manager’s goal is not to merely fill a position, but to ensure continuous optimal functioning of the team as a whole.

II. Be fair

Be fair… two words that sound simple in theory but can be challenging to put into practice. This is especially true when managing people with a variety of job functions in the department. For example, a nurse is scheduled to be at work at 7:30 AM to get the exam rooms and nursing areas ready for the day. The first patient is not scheduled to arrive in the department until 8:00 AM. The nurse arrives at 7:34 AM, but gets all of her tasks completed before 8:00 AM. A radiation therapist arrives at 8:04AM for his 8:00 AM shift and does not get his 8:00 AM patient in the treatment room until 8:10 AM. Even though it seems as if the therapist’s tardiness had a more negative impact on the department, it is important to treat all employees fairly. An effective manager of this interdisciplinary team, will coach both employees and make expectations clear to staff throughout the department.

The concept of fairness can be very subjective. One method of getting feedback from staff is to create a Shared Governance Committee (SGC) comprised of the department's top performers, to routinely meet and discuss staff concerns and oversee employee satisfaction. This committee needs to include representatives from each area of the department and they need to be empowered to solicit and act on feedback. Managerial involvement with the SGC is minimal and is intended to offer administrative support and oversight only. When the SGC takes up an agenda item, they need to come up with a resolution that can be put into practice fairly and consistently throughout the department. Since it includes representatives from each area, they have a vested interest in coming up with solutions that are reasonable. In general, the SGC can help monitor employee satisfaction and comments regarding leadership.

III. Be ready for anything

Be ready for anything…it has been said that the only constant is change. As a leader of a radiation oncology department, one needs to be prepared for upgrades in technology, ebbs and flows of the economy and reimbursements, staffing challenges, and so on. Of course, the day-to-day "fires" need to be put out as well. Some days, managers need to put everything aside and just sit in the trenches until the battle is over.

The day will end and the staff will see that their leader will be there to support them when the going gets tough. There is no substitution for a manager who is willing to get his or her hands dirty. In the end, this attribute may truly define an "effective" leader.

There is no handbook or class to give us a recipe for leading every type of person in every type of situation. So much of our leadership style is learned from those leaders that have made an impression on us - positive and negative. Managers are in a position to model positive behaviours that foster cooperation, respect and responsibility. The interdisciplinary team will function most effectively with the guidance of someone who leads the way they would want to be led.