Less experienced team members may be better positioned to show others how to use new technologies. | iStock/PeopleImages
If you’ve watched Grey’s Anatomy, then you’ve gotten a peek into the complex hierarchies that rule a hospital. Over 17 seasons, the show’s eponymous heroine, Meredith Grey, ascends from a lowly intern to chief of general surgery, learning from the presiding residents and older surgeons along the way. There’s rarely doubt about who is in charge, who has more expertise, or who should be supervising and training other staff.
Grey’s fictional journey illustrates the complicated dynamics of a health care setting, whether it’s a local clinic or a bustling city hospital. Doctors, nurses, other clinicians, and administrators are part of a system where tenure, expertise, and training dictate the chain of command. Those hierarchies can help teams provide care efficiently, but what happens when those traditional roles are disrupted?
“These status barriers are tricky,” says Sara Singer, a professor of organizational behavior (by courtesy) at Stanford Graduate School of Business and a professor of medicine at Stanford University School of Medicine. And, she says, they can get in the way of medical professionals learning new skills, particularly when junior employees are asked to show more senior coworkers how to use a new technology. But, as Singer and her coauthors reveal in a recent paper, upending these complex hierarchies can be a useful training strategy — and the fix for the disruption it causes can be surprisingly simple.
Trickle-up Teaching
As technology becomes a bigger part of the learning curve, younger, less experienced team members might be better positioned to learn new tasks and to train others — a reversal of the traditional top-down model of on-the-job training. Young, digitally native medical assistants may learn a new electronic records system faster than their older counterparts. Similarly, surgical residents may learn the nuances of tools like the da Vinci surgical robot faster than older, more experienced doctors. So when a hospital is introducing a new system, administrators may decide to tap younger, less powerful team members to learn the new technology and train others on how to use it. While this strategy might make the most sense from a learning perspective, it can make older employees feel slighted and make it harder for teams to learn.
Singer and her coauthors, Katherine Kellogg and Jenna Myers of the MIT Sloan School of Management, and Lindsay Gainer of Mass General Brigham, studied observations from five different primary care settings over the course of nearly two years. At each, medical assistants and patient-service representatives had to learn several new digital technologies. Even though these positions are fairly low in the medical and administrative pecking order, Singer says that within these jobs, tenure and status are still important. So when younger employees were selected to be trainers, that threw the typical power balance off kilter. At some sites, employees struggled to pick up the skills they needed. “There were some groups where the training seemed to be taking and people seemed to be following on with the work that was intended,” Singer says. “But at other places it just wasn’t working out.”
Drawing on interviews with the trainers and the people learning the new tasks, the researchers discovered that teams that rotated the trainer position fared better than others. Getting to be a trainer comes with certain benefits. These positions give employees a little extra autonomy and responsibility and pave the way for promotions. By creating a system that gave everyone a chance at those opportunities, clinics could eliminate the jealousy and resentment that might come from selecting one younger employee over another time and time again.
Managing Rotating Roles
Singer says she was surprised that this solution worked but also realized it wasn’t an earth-shattering revelation. It just made sense. “Sometimes really good research results in an ‘aha’ that is an ‘aha’ because it is just so familiar to you,” she says. “It was one of those kinds of findings for me.”
But, she adds, how this system is implemented matters. It’s important that managers make it clear that they plan to use this rotational approach to training “just to help people understand the rationale of the choices you’re making,” Singer says. “Everybody likes to mentor the younger people and give them opportunities. They just have to see it benefiting themselves.”
This isn’t the only way to negotiate shifting roles. In another recent study, Singer found that using a more team-based approach to providing patient care helped medical residents, who are less experienced and often younger than the medical assistants they’re in charge of, communicate and learn from their coworkers.
There’s still plenty to investigate, particularly in how gender, race, and ethnicity complicate these dynamics. And there are other challenges to be addressed, such as issues that emerge when physicians, who often aren’t trained as managers, get promoted to administrative or managerial positions. Also, creating effective interdisciplinary teams of experts who work together temporarily and who may be juggling several different teams at the same time can be difficult. And there’s the culture of perfectionism that can get in the way of learning new ways of doing things. “Health care settings are notoriously complex,” Singer says.
But she says all these problems provide an opportunity to find better ways of providing the best care for patients. “These complexities make health care settings really interesting places to test organizational theory” — and, she hopes, to develop workable, common-sense solutions.
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