Teamwork Starts at the Top

When the topic of teams and collaboration comes up, many think that this is the domain of people in the middle and at the bottom of the organization. Nothing could be further from the truth. Certainly teamwork happens on the Quality Committee, with direct patient care or in the marketing department. But senior-level collaboration is required to foster and sustain a well-aligned organization able to withstand the pressures evident in today’s competitive, heavily regulated long-term care environment.

This article challenges you, the senior executive, to view your leadership role as that of the organization’s premier team leader, setting the example for collaboration that positively impacts census, employee retention, and revenue.

Collaborative leadership requires certain core competencies, the first of which is humility. While you may hold the highest position in the organization, collect the largest bonus, and have the ability to hire and fire at will, you must develop the capacity to listen, learn, reflect, and acknowledge mistakes. It is through these actions that you will be able to connect with the other senior managers who execute strategy, the middle managers who interpret it, and the care providers who make it real on a daily basis.

The next core competency is the aptitude to build, communicate, and sustain alignment. Collaboration does not happen in organizations that do not have alignment between core values and modus operandi. Alignment, the intentional congruence between all aspects of the long-term care organization, is a constant struggle for many executives. They are pulled between what is expedient to meet demands of regulators, what is best for the bottom-line, and what is needed to meet high standards of care. Reaching the delicate balance, and maintaining it, requires a support system characterized by mutual commitment to core values and consensus on the strategic approach for making those values actions in every part of the organization.

The recently released book Rules of Engagement: Timeless Tips for Team Leaders provides 46 strategies for team leaders at every level.1 They are all applicable in the long-term care environment. Several are most applicable to senior executives interested in transforming stagnant, hierarchical cultures to be more collaborative, communicative, and customer-driven. Three of those rules are discussed here.

Rules of engagement

It is logical that we begin with the rule that addresses alignment, which is critical to successful collaboration. The rule is stated as such: Align behaviors with core values. What do you believe in? What do you, at the core of your being, know to be a truth? What are the essential components of your character? Take the time to answer these questions. They reveal your core values.

When you answer them you may come up with things like honesty and integrity. You may come up with hard work, sacrifice, and humility. A focus on family, maintaining meaningful relationships and connectedness may surface as your critical values.

Whatever your values, your behavior should be congruent with them. Your decisions should reflect the beliefs that you hold true. Your relationships with colleagues must also reflect these principles. This alignment benefits you, your team, and everyone else that you encounter. People know what to expect from you. They know that you will be consistent. More important, they know that when they interact with you that they will not experience hypocrisy or deceit. Your colleagues will know that everything you do is clearly aligned with who you are at your core.

This principle-based alignment occurs when our values are consistent with the organization’s values. When we believe in the mission, values, and strategic intent of the enterprise, we are more likely to experience a connectedness and congruence. Alignment between your values and your actions is the first step.

The next step is being certain that you are working in an organization where your beliefs are consistent with those of the organization. Absent congruence, you will be working at cross-purposes internally and within the larger context of your organization. How can you possibly lead a long-term care organization without empathy for the elderly? You may succeed at revenue generation but you will never be able to take the company to the highest level of care, compassion, and customer service. You will also be very limited in setting a corporate vision that adequately addresses the needs of this very vulnerable population.

The next rule, Have a strategic focus, connects collaboration to the bottom-line intent of the enterprise. The organization’s strategy is the essential guide for any and every meaningful activity. For you to adequately direct strategy, you must first understand it from multiple perspectives. You must understand the differences between the ways a DON, a housekeeper, and an administrative person perceive the organization and its direction. Interpretations of strategy vary based on a person’s position within the organization. As the senior executive, you must be able to communicate strategy in terms that everyone can comprehend. Once staff comprehends strategy, they can make the necessary adjustments to enact it through their daily work.

Executives often assume that if no one else grasps strategic intent, at least senior managers get it. Nothing could be further from the truth. Many CEOs feel frustration when they step back and watch how their direct reports execute strategy. They find that interpretations are askew and, as a result, misalignments abound. They find departments operating at cross-purposes, wasted resources, and widespread inefficiency.

A common example is the long-term care facility that touts care and service but only shapes up its operation in preparation for surveys and other regulatory inspections. While the CEO who is espousing care and service as core values for the company may truly believe this, it is the actions of his direct reports and their teams that create disconnects and misalignments. These disconnects build a level of accepted hypocrisy that negatively impacts not only the reputation of that company, but the esteem of the long-term care profession.

A key leadership responsibility, which can be overwhelming, is to both communicate strategy consistently throughout the organization and to ensure its integration in every activity. Many senior leaders make the mistake of launching hundreds of projects and processes without making clear connections with the organization’s strategy. If that sounds familiar there are corrective measures that you can take.

The first is an organizational analysis that identifies, examines, and evaluates each and every process. The second is recruiting a seasoned organizational development professional who has the capacity to partner with you on creating sustainable alignment. The third, and most risky, is a cease and desist order. When executives issue cease and desist orders, they stop all projects and activities that cannot be directly linked to supporting organizational strategy.

The final rule of engagement that will increase your chances of success at collaborative leadership is simply put: Respond. This means, don’t just respond to attorneys requesting medical records or state regulators and disgruntled families threatening litigation. Get in the habit of responding to inquiries from staff, no matter what their title or position. Respond to suggestions from colleagues. “Responding” doesn’t mean endorsing, agreeing, or committing. A response is simply an acknowledgment.

Skillful collaborative leaders understand that the mere act of responding is a sign of respect. They also are smart enough to take it a bit further by considering requests carefully and providing informed responses. This means that when your Staff Development Coordinator stops you in the hall with her idea for a new in-service session, you will listen with an encouraging attitude. She may not be blindsiding her boss, as a suspicious mind may think. She may, in fact, be excited about the possibilities that this in-service can offer for the company. Your ability to be approachable keeps you in the loop of creative, innovative developments that can not only foster strategic intent, but also position your company as a trendsetter in the long-term care industry.

Another element of the responsiveness that builds collaboration is honesty. Honesty includes everything from admitting that you don’t understand a concept, to saying that you are too busy to deal with an issue at this time. It also includes clearly stating reservations, objections, or feelings of discomfort. Every response will not be in the affirmative. Leaders able to collaborate understand the importance of not just being responsive, but of being authentic in those responses.


Collaboration is as much the domain of senior executives as of middle managers. It requires executives to rethink their interpretations of team development and its importance to strategy and alignment. The rules of collaborative engagement provide a framework for connecting a more cooperative approach to leadership with indicators of corporate success. Executives with the ability to make connections at the peer level and beyond have greater chances of creating enterprises that are not only financially successful, but also able to maximize utilization of the human element. Purposeful collaboration can deliver customer satisfaction, enhanced reputation, and employee retention.

Joanne L. Smikle is a consultant specializing in leadership development and collaboration. Clients include Miller’s Health Systems, Opis Management Resources, Arizona Health Care Association, and more. For further information, call (301) 596-3140 or visit

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  1. Smikle JL. Rules of Engagement: Timeless Tips for Team Leaders. Simpsonville MD:The Practical Press.Available at:

Long-Term Living 2009 July;58(7):30-34

Topics: Articles , Facility management , Leadership