1. Prestia, Angela S. PhD, RN, NE-BC


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Teamwork grows more important to the modern healthcare landscape every day. Diversity now permeates our global consciousness; instead of dividing our world, the acceptance of differences can be leveraged to create innovative solutions that weren't previously possible.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Today's teams face unprecedented challenges as they work on issues often beyond their scope of practice. It's become necessary for healthcare providers to innovate ways to improve individual patient outcomes, develop solutions to optimize healthcare delivery, create awareness of and actions to tackle public health emergencies, and decrease spending disparities.1-3 These goals require strong nurse leaders to effectively and diplomatically manage their teams. Here, we dissect the nine essential attributes of a diplomatic team leader.


Steering clear of disaster

Team dynamics may sometimes impede innovation. Teams frequently encounter the following obstacles: lack of clear vision, communication issues, limited career progression opportunities, inefficient resource use, need for role clarity, and service development.4 Giving a leader authority over a team may seem incongruent to the foundational elements of teamwork-group consensus and team collaboration-but a strong leader is pivotal to every team's success.


Excellent leaders understand the importance of diverse team composition, which includes generational, cultural, professional, and experiential representation. Leaders must be adept at nurturing strengths, fostering cohesiveness, creating a sense of curiosity, and recognizing the role of positive reinforcement in the team's continued success.5,6 This requires a leader skilled in the art of diplomacy.


Diplomatic leaders are acutely aware of the importance of communicating with tact, intention, and comradery. Miriam-Webster defines diplomacy as an art by which affairs are handled without hostility.7 Diplomatic leaders embody a caring, compassionate cadence that promotes teamwork by holding themselves and team members accountable for their engagement in the process. A diplomatic leader at the helm of a diversified healthcare team can create synergies so that ideas can flourish and the team can produce results benefitting the patient population.


The culmination of a literature review resulted in the creation of a user-friendly outline of required diplomatic leadership skills. Nine equally essential attributes were identified: 1. culture development, 2. collaboration, 3. connection, 4. centeredness, 5. clarity, 6. communication, 7. candor, 8. consistency, and 9. curiosity. (See Figure 1.)

Figure 1:. The nine ... - Click to enlarge in new windowFigure 1:. The nine "C"s

Culture development

A culture of inclusivity is the underpinning of successful teamwork.8 The diplomatic leader works first to create a team with diversity among its representatives. Membership should reflect differences in gender, ethnicity, experience, and subject matter knowledge. In situations where the leader doesn't select the team, creating an environment in which everyone's opinions matter becomes even more important. In a study on positive work outcomes of organizational teams, researchers discovered that teams require a leader who involves all members in the decision-making process.8 Additionally, the research suggests that leaders need to attend to employees' socioemotional needs by providing "individual consideration and reducing psychological strain."8


This idea of culture development that reduces psychological strain or improves psychological safety for team members was the most significant finding in a study conducted by a research team at Google.9,10 The data were more supportive of the leader's role in establishing and influencing group norms than the role of assembling diverse team membership. The diplomatic leader's ability to uphold conversational order helps create an environment that encourages team member expression and the optimization of free, innovative thoughts.



True collaboration is one of the six standards identified by the American Association of Critical-Care Nurses as being necessary for the creation of healthy work environments.11 These standards call for nurses to be "relentless" in their pursuit of true collaboration. The standards further outline the need for team member commitment to integrating differing opinions and resolving competing interests. True collaboration occurs when team members actively help others beyond the minimal job requirements.2 This isn't as easy as it may seem. Diplomatic leadership is required to keep the team on track, moving past individual goals and guiding the team toward a common vision.


Experienced collaborators with proven track records are a valuable commodity. Being in high demand, they're at risk for experiencing disengagement, burnout, and potential resignation.12 A diplomatic leader recognizes collaboration overload as a real phenomenon and proactively works to safeguard against it. This is yet another way that leaders can help decrease the team's psychological stress.


It's important for the leader to include him- or herself in collaborative team processes as a participant, not just as a leader.2 Team members want to know that their leader is exerting as much time, effort, and energy into a project as they are. Through direct participation, leaders can connect with their teams.



The leader/follower dynamic is crucial to successful teamwork. If team members don't connect with each other, and with the leader, then true project engagement can't exist. Team members will just "go through the motions," being present because they're required to, not because they desire to. The literature describes authentic leaders as those who cultivate relationships with their followers to develop a sense of "we" and commitment.13-15


Diplomatic leadership is an expression of authentic leadership. Diplomacy and tact, reflected in a leader's willingness to participate, listen, build consensus, and protect team behaviors, garner team respect and trust.



Further impacting team success is the ability to stay focused on team objectives. Competing priorities often derail teams before synergies can create momentum. The diplomatic leader recognizes this potential pitfall and centers team members on the vision. Centeredness is described as maintaining team behaviors within boundaries.16 Because wandering can occur when there's a lack of meaning, the diplomatic leader assists the team in maintaining centeredness by helping establish short-term objectives on the path to long-term goal attainment.


Additionally, the skilled diplomatic leader insists on time for self and team reflection. Creating a safe environment for the team to consider their performance can enhance team cohesiveness, professional identity, and centeredness.4 It's at this juncture that the diplomatic leader invites an objective evaluation of team performance, celebrating successes and encouraging improvements. This mutually developed evaluation can lead to the refinement or reorganization of goals and objectives, and give clarity to team initiatives.


Clarity and communication

A pivotal skill of the diplomatic leader is providing clarity to all aspects of team processes.9 The foundation for this is clear communication-the refinement of skills related to tone of voice, body language, and holding the team's attention when speaking.17 The American Organization of Nurse Executives identifies communication as one of its five key competencies of the nurse executive.18


Communication is a multidimensional skill that can inspire behavior when diplomatically deployed. Additionally, when there's clarity in communication, intentions are understood and the team gains a precise sense of purpose.



The leader's ability to speak in an honest, direct manner to create understanding and acceptance requires the tact of a diplomat. This is a crucial attribute when leading teams. The team's psychological safety depends on an environment conducive to truthful messaging handled with poise and polish, and without hostility.


The results of Google's Project Aristotle revealed that team members are more likely to admit mistakes, partner, and take on new roles in environments where camaraderie flourishes.9



Team members expect their leader to be consistent.19 This is exemplified not only through messaging, but also through actions. Messaging must be consistently specific to team direction, values, and goals.20 Consistency behaviors are seen when team meetings are calendared in advance to occur on the same day and at the same time, frequency, and location.


Another example is the leader's preparation before the meeting with respect to an agenda, relevant resource materials, and current knowledge of the team's progress to date. These behaviors help confirm that the work of the team is important to the leader. This consistency of action must be evident for the duration of the team project. Diplomatic leaders are cognizant of the importance of consistency. They understand that their reputation can be tarnished if actions and behaviors are contradictory.



Curiosity is an important phenomenon to consider when leading teams. The science behind a human's curious nature is the brain's ability to calculate and seek the most knowledge in the least amount of time.21 The more knowledge that the team has, the better able they are to make choices and/or adapt to changes. The diplomatic leader fosters a sense of curiosity about the initiative at hand, encouraging team discussion and reframing the question. This requires asking, "What can we do differently?" versus the analytical approach of "What was done incorrectly?"6


The common objective

Team effectiveness depends on the leader's ability to diplomatically nurture, guide, and support the process. When skillfully refined, the leadership attributes of culture development, collaboration, connection, centeredness, clarity, communication, candor, consistency, and curiosity positively impact teamwork. (See The diplomatic leader in action.) Diplomatic team leadership is imperative to the creation of innovative solutions and quality healthcare improvements.


The diplomatic leader in action

The human resources officer presents the retention statistics to the group of nurse managers and nurse directors as she does every month. Retention rates for first-year new hires continue to plummet. Chelsea, a newly promoted assistant CNO concerned with this repeat metric, volunteers-with her supervisor's support-to assemble a team to address the issue.


Her team is a committed group, diverse in experience, education, gender, culture, and age. Harvey, a nurse educator, is a baby boomer with over 20 years of experience in nursing. Stephanie, representing human resources, has a degree in organizational management and considers herself a millennial of Hispanic ancestry. The final team member is Cara, a young clinical nurse with 1 year of experience who's representing the unit with the lowest retention rate, medical-surgical. Chelsea garners information from the group, including communication preferences, date and time availability, the expected duration of each meeting, and a recurring meeting invitation on their calendars, before the first formal meeting.


During the first meeting, Chelsea establishes the vision for the group, clearly stating that she doesn't have all of the answers and is depending on the team to help develop an innovative solution to the retention issue. She discusses boundaries for expected behavior related to group conduct and accountability, a standard to which she holds herself accountable. Then Chelsea does the unexpected. She poses the following question to the group, "How are M&M's made?" This out-of-the-box question has the expected result: group creativity and curiosity for problem solving. Answers range from the analytical to the humorous. She governs acceptance of all responses, providing equal opportunity for everyone to share their ideas. She skillfully connects this exercise to the team's task.


During a particularly eventful meeting, conflicting ideas create a stalemate. Chelsea calls for the team to take a 10-minute break to reflect on the reasons behind the tension. Once reconvened, Chelsea shares her appreciation of all ideas, but candidly expresses her desire for a collaborative approach to problem solving.


Before the adjournment of every meeting, Chelsea engages in leader and group reflections, considering what the team did well and what they can improve. She clarifies and reconfirms assignments. As the leader, Chelsea participates through self-assignment of often arduous tasks. Over the course of 2 months, the team artfully creates a mentorship program to present to the executive team for review. A pilot program is initiated on the medical-surgical unit, and positive outcome measures are expected.




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