Strengthening Team Culture With the 6H Model

Diverse team of medical staff
Photo credit: Steve Debenport/Getty Images

As a healthcare leader, the tasks before you are tremendous. Think of yourself as a captain sailing your ship through murky waters.

Each day of the journey, you must motivate your crew by:

  • Influencing as a coach.
  • Continuously improving processes and physician performance.
  • Supporting team members through external pressures and personal struggles.
  • Maintaining strong ties with hospital administration.

With so many tasks competing for your attention, it’s hard to keep a constant pulse on the team’s morale which frankly, is at an all-time low due to the pandemic.

In a 2020 survey of over 15,000 physicians, 42% of respondents reported experiencing burnout symptoms. Burnout impacts both patients as well as physicians because it’s associated with loss of empathy, impaired job performance, and increased incidence of medical errors.

6H Model of Communication
Burnout and its effects cost the health care system approximately $4.6 billion a year. The estimated annual economic cost associated with burnout related to turnover and reduced clinical hours is approximately $7600 per employed physician each year.

In their perspective piece on burnout, authors Hartzband & Groopman mention 3 essential domains to address burnout: autonomy, competence, and relatedness (the psychological feeling that one belongs and has interpersonal attachments/connection to the organization).

While systemic change to improve healthcare largely depends on hospital administrators, regulators, and legislators, what you can control is improving the day-to-day work environment of your team.

One of the most important jobs a leader has is addressing your team members’ concerns and intentionally improving their feeling of relatedness. Here, I apply a simple tool you can use to surface clinicians’ concerns: the 6H model. Walking through the six steps below with each of your team members — ideally monthly and at least quarterly — is a great way to foster buy-in, accountability and partnership.

Our clinicians want (6H Model): Helpful phrases for leaders:
HEAR my full story
  • What have I missed in my efforts to strengthen our team culture?
  • It’s important to me to hear your thoughts. What’s your perspective on this patient complaint?
HEED my worries/opinions
  • What concerns you most about our team culture?
  • What’s one thing we can do to improve team culture?
  • You always bring up excellent ideas to help us improve. What suggestions do you have?
HELP me navigate
  • Here are three things we plan to do in order to improve our team’s wellness. How does that sound to you?
  • I want to focus on the concern you shared (rude specialist, unfair schedule, poor handoff, etc.)
  • Here is what I’ll do about this. (Be sure to follow up to share your actions and progress.)
  • Here are some resources I encourage you to consider. (Employee assistance program, resiliency course, communication skills workshops.)
Be HONEST with me
  • I doubt we can get more workstation space for the emergency room, but I’ll reach out and advocate for extra computers. How does that sound?
  • I don’t think we can change the schedule this month. But I’ll certainly ask the team if anyone can take your shifts.
  • The multiple patient complaints do need to be addressed. You’re one of our best clinicians in terms of productivity and quality. Let’s work together to see how we can improve your patients’ experiences. Here are a few options to consider.
HEAL my misunderstanding
  • I’m really sorry you had a poor experience with the consultant. I will definitely look into this. Thank you for bringing it to my attention.
  • I apologize for having you work so many shifts this month. It wasn’t my intention and was an honest oversight. Here’s what I’ll do to fix the schedule.
  • (Clinician with multiple patient complaints needing one-to-one coaching) I realize it may seem unfair to put another thing on your plate. I do believe the patient complaints can be reduced with some communications coaching. It helped me connect much better to my patients. I hope you’re open to exploring it for next quarter.
Leave me with HOPE
  • You’re an essential part of our team, and we will get through this together.
  • Your opinions on how to improve this program/department are very important to me. I look forward to discussing all the amazing ideas you bring to us!
  • You have been a core part of this team for seven years. Thank you for all that you do!

By utilizing the 6H model, leaders can help their team navigate the sea of burnout by nurturing relatedness. By working to remedy their team’s individual and collective challenges, leaders earn the trust of their hard-working crew.

Rounding on your team utilizing this approach consistently improves departmental culture, relatedness and leads to a thriving work environment. Rounding with authentic curiosity, reflective listening, and compassion is the much-needed salve for our clinicians’ bruised spirits.

About the Author: Swati Mehta, MD, FACP, CPXP

Swati Mehta, MD, FACP, CPXP is Director of Quality and Performance at Vituity, overseeing patient experience programs. Dr. Mehta serves as chair of the Society for Hospital Medicine’s Patient Experience Committee and is an executive board member of the San Francisco Bay Area Chapter. She also sits on the Physician Council of The Beryl Institute and is a member of Press Ganey’s Chief Experience Officer Council. She is the creator of the 6H Framework for human connection. She was recently awarded the Certified Patient Experience Professional (CPXP) designation by PXI (Patient Experience Institute). She is an adult hospitalist practicing at Common Spirit Sequoia Hospital, Redwood City, California.

This article was originally published by the Journal of Hospital Medicine.

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