A little over a year ago, I started a job on a nursing unit that charged nurses for their coffee. I later discovered that coffee was previously free, but the administration had revoked this privilege. Had I known this prior to beginning the job, I would have considered this a red flag and from now on I will ask whether or not coffee is provided for the staff. The first day I had to pay for my coffee, I was shocked. I voiced my opinion to the other nurses that charging staff for coffee was sacrilegious. Coffee is not just about coffee; it is about culture. Coffee brings nurses together and gives them an opportunity to talk and share ideas or frustrations. Also, an organization that provides coffee to their staff appreciates their employees.

This has always been a soapbox of mine, so when I heard this TED Talk I was intrigued by its application to healthcare. Margaret Heffernan, a former CEO of five businesses and explorer of human thought patterns discusses the benefits of effective team building and the characteristics of people who make great team members. SIDE NOTE: Margaret Heffernan is a brilliant woman and I encourage you to read about her or listen to any of her amazing TED Talks herehere, or here.

She begins the TED Talk by narrating an experiment done by a biologist at Purdue University on the behavior of chickens. He was interested in the productivity of chickens for breeding purposes, so he separated his chickens into two groups. The first group was comprised of average chickens and the second group was comprised of exceptionally high producing chickens called “super chickens.” After six generations, the average chickens were healthy and producing at higher levels than before the study. Of the “super chickens,” only three were still living. They literally pecked each other to death. These “super chickens” had only achieved their previous success by suppressing the other chickens.

The reason this became even more interesting to me is because I, like many, work in an institution with a fancy name, made up of a bunch of “super chickens.” I thought if I could make it to a school or a job with a bunch of “super chickens,” I would have an opportunity to learn from the best, which would make me even better. Not only this, but if I could sustain the grueling schedule and work load for minuscule pay, it would be worth it for the fancy name on my resume. I was lead to believe that if I had to claw my way to the top, at the expense of others, it was what I had to do. These ideas never settled well with me and they never proved to be true.

So, this leads Mrs. Heffernan to her next point. If having an institution with a bunch of “super chickens” leads to aggression and cultural dysfunction, then what makes a successful group? Some researchers at MIT answered this question.

MIT recruited several groups of people and presented them with difficult problems to solve. The most successful groups did not have the highest IQ’s. However, they did have three differentiating qualities:

  • They had a high degree of empathy and social sensitivity toward each other.
  • No one was dominating or passive in the group, everyone was given equal time to express their opinions and ideas.
  • The most successful groups had more women.

Therefore, the key to creating a successful group is “social connectedness.” In the nursing world, this means that what happens between nurses and members of the healthcare team is important. Nurses intertwining themselves into their team members’ lives and getting to know each other initiates ideas and growth.

This concept of “social connectedness” is interrelated to a “culture of helpfulness.” This is a philosophy that does not glorify the individual. It recognizes that when teams work together and help each other, problems are solved. What creates a “culture of helpfulness” is getting to know each other. In the nursing world, you could have the worst day on the books, but if you work in a “culture of helpfulness,” it will somehow be okay. Because you know, your team members have your back no matter what. You also know, you and your nurse buddies will be getting dinner and drinks after the horrible day of work to decompress.

This leads to my soapbox. When employees cultivate relationships a “culture of helpfulness” develops. Mrs. Heffernan actually refers to her experience with companies who have banned coffee cups at desks. These companies want their employees taking coffee breaks with each other to build relationships. In the healthcare industry, especially in big, fancy institutions, cutting edge ideas are flowing. When nurses and doctors are performing revolutionary work they will inevitably be presented with stressful situations. In those tough situations, they must have people they can rely on for help.

Companies don’t have ideas, only people do. And what motivates people are the bonds and loyalty and trust they develop between each other. What matters is the mortar, not just the bricks,” says Heffernan. Now don’t get me wrong, I understand nurses and doctors can’t stop what their doing and synchronize their coffee breaks, but drinking coffee together is the tip of the iceberg when forming relationships to create staff retention and better patient outcomes.

This irreplaceable time together creates “social capital.” “Social capital” is the interdependence between people that builds trust. “Social capital” is a term coined by sociologists who were studying communities that were particularly resilient during times of stress. Businesses and industries need “social capital” to succeed and teams who work together longer work better together. It could take years to build a solid team that is comfortable enough with each other to be candid and truly trust each other. So, some companies have even coordinated coffee breaks so employees spend more time with each other. When they did this, employee satisfaction and profits increased. These companies recognized that creating an environment where conflict is safe is how great ideas begin.

Related to nursing, I instantly considered the high turnover units where I have always worked. How do you build social capital in a university hospital ICU, where you have to know the most, work the hardest and longest hours and shifts, have the sickest patients and get paid the least? Bedside nurses are fleeing to anything except bedside nursing because they realize they cannot sustain a life in the profession.

Hospitals must invest in every member of the team, not just the “super chickens,” for the sake of the employees’ health and well being, as well as the patients’. The best patient outcomes build the best institutions. Divesting a nurses’ worth will inevitably catch up to hospitals at some point. When the baby nurses are leaving the bedside with less than two years experience and the experienced nurses are leaving the bedside so they can have a better work/life balance, “social capital” is an unachievable goal that leads to irrevocable problems.

Investing in all for the greater good is not a typical way of thinking in healthcare or the United States in general. So Heffernan wondered if managing this way would rid the world of “superstars”. She discovered that the “superstars” did not last long. However, collaborators enjoyed long careers because bringing out the best in others helped them bring out the best in themselves. I’m pretty sure there is no greater team of collaborators than a group nurses, doctors and other healthcare providers who have developed years of “social capital”. If you have not witnessed this in your career, I really hope you get the opportunity because it is like watching a steady, well-oiled machine that can not be shaken by any amount of stress.

Finally, Heffernan closes the TED Talk by discussing management. Hiring managers via talent contest causes damage to the entire team. Motivating people with money demolishes social connectedness. Therefore, people need to motivate each other. Leadership needs to be redefined so everyone is encouraged to work together. In other words, hiring the best candidate is exceedingly important. Hiring a nurse manager by default because she has worked on the unit for 20 years instantly creates dysfunction.

Heffernan cites three key principles to effective leadership. First, there are no stars on any team, everyone is needed and valued. Next, everyone must agree work toward the best standard imaginable. Finally, the boss has to let the team simply work, because power is disruptive to team synergy. Bosses can keep oversight and listen, but must let teams be.

Of course I instantly thought about my experience with nurse managers in relation with the above principles. If everyone on a nursing team felt needed and valued, I can’t imagine how rapidly social capital would develop. Meaning, whether a nurse works part-time, full-time, is working toward an advanced degree or certification, or works multiple jobs for balance, the nurse manager should recognize the nurse as an asset to the team as long as she or he can fulfill their function. Also, if a manager sat down with me before I took a job and said something like, “We operate to achieve the best possible standard here; for our patients, our employees and our institution. If you work as a nurse here, we expect you to recognize this standard,” it would be hard for me to disregard. When people work to achieve the same standard of care, conflict is decreased. Finally, if the nurse manager would just let the employees work, instead of hovering and instituting a culture of fear, the nursing unit would be a more comfortable place. Working in a more comfortable environment would increase staff retention and create an open circle of communication.

Wrapping this all up… To change the nursing culture we must realize that “super chickens” do not create the best patient outcomes and institutions alone. Everyone should be valued and new ideas and opinions embraced. Nurses’ talents need to be appreciated and leveled with the talents of other team members to create a more cohesive unit. And for heaven’s sake, coffee needs to be free to foster a culture of helpfulness and social connectedness. So if I were in a life or death situation, I sure hope to be surrounded by a bunch of average chickens who developed a trusting relationship while drinking their free coffee, because I predict the group of super chickens will be too busy one-upping each other to care about the situation right in front of them.