Training the Innovation Team

The Stanford Byers Center for Biodesign brings together talented engineers, medical professionals, and business specialists to work together to develop new health technologies. Trainees in its Innovation Fellowship spend nearly a year learning and applying the biodesign innovation process; a step-by-step approach that starts with identifying an important unmet healthcare need, inventing a novel technology to address it, and then preparing to bring that solution into patient care.

Having interdisciplinary teams is essential, noted founder Paul Yock because, in order to create disruptive health technologies, innovators must understand everything from physiology and medical care delivery to engineering, business models, and healthcare economics. “No single individual can effectively cover that waterfront,” he said. As a result, Stanford Biodesign has learned that managing the team dynamic is as essential to the success of an innovation project as choosing the right problem to solve in the first place.

The person in charge of this mission is Doug Rait, Stanford Biodesign’s director of team learning and design. “We treat team training as an overlay to the fundamental innovation process we teach,” described Rait. “I work with our teams throughout the entire year to teach collaborative and interpersonal skills that will enable them to perform at a high level and to help them navigate the challenges they may encounter as they move through each stage of the innovation process.”

Rait has built his professional career around understanding the ways social systems enable and constrain people. His interest in this approach was piqued while working in mental health at Butler Hospital in Providence, RI after graduating from Brown University. “The chief psychiatrist at the hospital, who also happened to be the Chairman of Brown’s Department of Psychiatry and Behavioral Sciences, was a family therapist and he would not meet with individual patients – he only met with patients if their family members came with them,” recalled Rait. “It really impressed me – the importance of family interactions in terms of maintaining and contributing to problems, and also the possibilities of working with more than one person to create change that might benefit everyone in the family.”

Since then, Rait has focused his 30-plus year career on the dynamics of couples, families, teams, and other social groups. Currently, he divides his time between clinical work as the chief of Stanford’s Couples and Family Therapy Clinic and working with teams across Stanford Biodesign’s portfolio of programs and courses.

Candidate Selection

For the Innovation Fellowship, Rait’s involvement starts at the very beginning – candidate selection. Since joining Biodesign in 2014, the criteria for this process have evolved to reflect an increasing focus on team dynamics. “When I first came here we were looking for the ‘best athletes’ with the belief that we could put them together and somehow they would push each other to do great things,” Rait said. “Now we also think about team design and function as a primary consideration. We’re looking for really capable, competent, energizing people who can work together well.”

He acknowledges that although the selection committee does look for people who will fill certain roles, like the “builder” and the “organizer” for each of the four-person teams, there is no magic formula. “No matter how much thought we put into composing the teams, they are always still a little like a blind date or an arranged marriage,” he said. “There are things you just can’t see or predict ahead of time.”

Building Belonging

When the twelve fellows selected for the program start their training each August, Rait’s first priority is working with other Biodesign faculty and staff to create a sense of inclusion so that the fellows think of themselves not only as teams of four, but also as a cohort of 12 that has its own integrity. To this end, the fellows participate in multiple experiences designed to solidify a sense of belonging in the larger group. “These include a ropes course and other community-building activities that get everyone thinking about how they can participate, grow, and add value to one another’s experiences,” said Rait.

While some of this bonding occurred incidentally in the past, Rait believes the focused approach has an impact that resonates throughout the fellowship year. “In the past, as the year progressed, the teams tended to become segregated and to sometimes work in ‘stealth’ mode. They weren’t always open to discussing their projects or talking to each other about what they were learning. But now the boundaries are more open – there’s much more sharing of information and expertise. This is really important because one of the greatest assets of this program is the many ways we support the engagement and connection of the fellows with people both inside the program and externally so they have a strong network after graduation.”

Creating an Intentional Team

After the initial bonding period, Rait begins working with the teams individually, using design thinking principles to help them create what he calls “their very first invention” - an intentional team. He explained, “Like in any relationship, if you just bump along and assume that the team is going to carry you, it doesn’t always work out. But being intentional can make a real difference. I encourage our trainees to think about the team itself as an innovation that matters, because the team they are creating is the vehicle that will make it possible for them to achieve their larger project goals.”

As an important step in designing that innovation, Rait has the team develop a formal charter, an explicit commitment to a way of being and working together. “This document states the team’s goals for the culture of their team, which might include authenticity, clear communication, integrity, or other concepts that are abstract and aspirational. But they also have to write down specific behaviors that will support those goals and identify early signals that would indicate things are beginning to break down,” explained Rait. The fellows are encouraged to consider the process iterative, revisiting the agreement if they encounter problems or become aware of new goals they want to include.

Along with the team charter, Rait provides ongoing training on guiding principles such as transparency, appreciation, respect, viewing diversity as an asset, and making time to check in with each other regularly. He also focuses on being accountable for one’s own behavior. He gives some examples:

• If you are passive, you will be asked to speak up.
• If you mistreat others, you will be asked to cut it out.
• If you are disrespectful, you will be asked to show respect.
• If you stand by in allowing dysfunction to occur, you will be asked to examine your complicity.
• If you withdraw, you will be asked to re-engage.
• If you avoid discussing important things, you will asked to talk about them.

Taking Risks

Additionally, Rait encourages team members to share all of who they are rather than just their professional personas. “Bringing your ‘whole self’ to work helps teams realize their fullest creative potential and navigate difficult issues because the team members really know one another,” Rait noted. “The idea is to create an environment that feels safe so that team members are willing to not only take professional risks but also personal ones in terms of being vulnerable, or asking for help; all of which can be very difficult for high-performing people.”

He added, “The interesting thing is that you can’t legislate psychological safety; it’s actually an interdependent process. What creates that safe space is when people take risks and find that they are embraced and supported by their team members.” Each year, he observes how meaningful the fellows find it when they share something that they were afraid to bring up because they were worried about being judged or letting people down, and their team responds in a way that is affirming, validating, and loving. “The experience of opening up and finding that your teammates are really there for you is something that many of the fellows have never experienced in a work or educational setting,” Rait said. “And it’s something they hold on to and try to replicate as they go forward in their careers.”

Overcoming Roadblocks

Even with a strong foundation, most teams encounter roadblocks or stress points over the course of the fellowship year.  When this happens, the teams can reach out to Rait for additional support and guidance.

For example, early in the year, the fellows spend weeks in hospitals and clinics directly observing the delivery of care and looking for important problems to solve. Rait points out that in this setting, the medical professionals feel the most competent and comfortable, and it’s not unusual for the engineering and business-focused team members to wonder, “Do I really have something to add? Everyone is so smart and capable. What am I bringing that’s unique?” “I try to help them work through this period of insecurity and then three months later they find they’re the person everyone is depending on,” he explained. “The innovation process gives everyone an opportunity to demonstrate their usefulness, just not at exactly the same time.”

Another challenging time is when the teams must use progressively deeper research and analysis to narrow their list of potential projects from more than 200 down to just two or three that they will take forward into invention. “Sometimes the team doesn’t feel passionate about the projects that have risen to the top. The projects may have strong potential, but the team isn’t sure they’re something they want to work on for the foreseeable future,” said Rait. “Another source of conflict is when this filtering process forces teams to leave projects to the side that some members really care about, but that don’t make the final cut for other reasons.”  

Preventing Flattening

While most teams eventually get past these hurdles, Rait keeps an eye out for teams whose energy and enthusiasm has diminished. “When a team begin to flatten out, overcoming obstacles like these becomes much more difficult.” Rait explained, “It’s hard to go into a meeting when everyone is feeling discouraged, so if teams are beginning to lose momentum, I try to intervene quickly so they don’t run out of gas.” He believes the most common cause of flattening is conflict avoidance. “I work with them intensively to open up more space so they can talk about whatever they are avoiding and move forward,” he said.  

One other predictably tumultuous time is when the fellows must decide what comes next for them as the academic year draws to a close.  “A lot of the fellows want to go forward and leverage everything they’ve learned by launching a start-up,” Rait said. But some may have other plans. In this scenario, Rait advises the teams to dive in and deal with “the messy, hard process of sorting it all out.” He explained, “There’s almost never an upside to avoiding dealing with diversity and difference. The fellows need do the hard work of identifying and valuing each team member’s true perspective.”

A Significant Benefit

Ultimately, Rait believes that regardless of the direction each fellow chooses, one thing that they all take away from the program is knowledge and better understanding about how to build and maintain a strong team. “Even if their final innovation project doesn’t turn out to be patient-ready, they have not only learned the biodesign innovation process, but they have a secondary set of skills in team dynamics,” he said. This skill is mentioned repeatedly by alumni of the program, who often refer to Rait’s team-training as one of the most significant and unexpected benefits of the fellowship year.

“One of the most valuable aspects of the training was the focus on team dynamics,” commented 2018-19 Innovation Fellow Amanda White. “Doug was a huge asset, both in helping us self-regulate and in teaching us a collaborative way of deciding what was important. When we made a decision as a team, with everyone’s input, it increased the group’s commitment to the goals we had set for ourselves.”

While Rait wrestles with feeling personally responsible when a team is struggling, he finds helping trainees work together fulfilling. “I’m there to help them get out of their own way and facilitate their interactions so that they can do life-changing work. Everybody comes into this program because they want to do something that benefits patients but is also personally meaningful. I feel like my work – helping these teams succeed – accomplishes both of those goals, too.”

_{All quotations are from interviews conducted by the authors unless otherwise cited.}