complex system header
Kristan Jacobsen, University of Utah Health
Complex Systems—Four Ways to Combat Culture Clash
Complex systems require complex cross-functional teams who often experience culture clash. Director of Patient Safety Iona Thraen joins nurse leaders Emily Salisbury and Doug Clapp to examine a recent safety event through the lens of “Wicked-Problem Solvers”—drawing insights from successful cross-functional teams.

The code

During an endoscopy procedure, a patient went into cardiac arrest. The code team was called, but an anesthesia provider who was on the unit provided initial support while the code team was arriving. The situation was chaotic and stressful, which is common with cardiac arrest. It’s a lot of emotion, and a large group of people from multiple cross-functional teams trying to help the patient. In the chaos, it wasn’t clear exactly who was in charge. Everyone had the proper training, and was working hard to bring the patient back, but everyone was also jockeying to take the lead. That, combined with all the adrenaline, created an environment rife with frustration. It ultimately led to a bad outcome for the patient. 

The cross-functional clash 


very company and organization operate as a little ecosystem. Team members learn to work together and function effectively with many moving parts—suppliers, partners, customers, and even competitors. In these complex systems there is potential for innovation and collaboration, but just as much potential for systems to clash. 

Even within the same industry and organization—such as a hospital—there are varying levels of expertise and experience. People with diverse backgrounds, varied levels of training, and different technical languages and experiences might struggle to bridge the gaps in behavioral norms and expectations.   

Most people assume that someone from another team, another medical specialty, or another industry will operate the same way you do. We have assumptions about how people should and will act, and those expectations shape our approach to every situation. But each team also has its own norms and behaviors, so when cross-cultural teams get together, even minor differences can set up a clash of cultures. 

When our teams entered the procedure room to help the patient, these differences were amplified by the stress of the situation and the consequences of getting it wrong. There was no interdisciplinary agreement or consensus on the standard of care, but the wrong time to try and establish those norms is in the middle of a cardiac arrest. 

After that experience, we knew we needed to incorporate key leadership principles that would prevent cross-cultural clashes in the future. We, as part of an interdisciplinary group, came together as part of a patient safety review to create institutional-wide changes to ensure this event did not happen again. 

#1: Foster an adaptable vision 

No matter your industry, team size, or end goal, every team needs a shared vision. People commonly think a vision is static and unchanging, but cross-functional teams operate differently. The complex nature of these teams in a dynamic and evolving environment requires adaptability. Cross-functional teams should be built on specific values with room for growth as new possibilities and opportunities come to light. To evolve effectively, leaders should: 

Outline explicit project values 

While the vision and the goals may shift over time, the underlying reasons and motivations for working together do not. For our team, the bedrock value was ensuring patient safety. Everything we do as a health care organization puts the patient first. Bringing together this cross-functional team was no different.

It’s not about which discipline has more skills or experience, it’s only about what is best for our patients. 

Invite input from all stakeholders 

In our first meeting to discuss what happened with this patient, we noticed the anesthesia team wasn’t in the room to share their perspective. Without all our stakeholders, we can’t come up with an optimal standard of care. With every team represented, we could have discussions about who should lead, and how we can all work together for the best possible outcome. 

#2: Promote psychological safety 

Psychologcal safety means creating an environment where every member of the team feels safe: 

  • Presenting their ideas, no matter how crazy they might seem 

  • Asking questions 

  • Admitting to mistakes or errors 

  • Disagreeing or debating in a constructive way 

Leaders must create an environment where people can take risks without fear of ridicule or reprisal. This is even more important with cross-functional teams whose members have little or no history working together, and have no basis for trust or team bonding at the outset. 

We decided to begin with a formal systems review, elevating this beyond just the individuals who responded to the cardiac arrest patient. That removed the element of blame for one person or a handful of people, allowing us to get deeper into the specific issues. We were reminded that expertise in patient situations is domain-specific. Without an existing relationship, team members often encounter misunderstandings about others’ expertise, leading to suspicion and lack of trust. 

#3: Enable knowledge sharing 

Experts in a medical specialty or industry get used to the way they do things, and may not appreciate the expertise of others. Sharing knowledge and thought processes at a very basic level puts everyone on the same page. It helps foster relationships built on understanding and respect.   

Patient safety concerns often have multiple layers. Each team member brings different perspectives and must share their own reasoning and thought processes behind why they approach a situation in a certain way. Others should listen and adapt their own approach based on new information. Ultimately this leads to policy changes and standards for better care. 

#4: Foster execution as learning   

In cross-collaborative situations, there may not be a blueprint from which to work. Teams that succeed will need to test things out, then share ideas, debate, and adapt as they go. There is no easy solution in a complex system, you must tease it apart and follow each thread throughout the organization. 

At U of U Health, we’re still working on how to sustain the change. When things get stressful, we tend to fall back into old systems and habits that are comfortable. The uncertainty of COVID-19 interrupted our cross-functional teamwork, but we have a few things in mind to continue the process and will keep working on it until we get it right. 

Optimizing Cross-functional Teams 

“The role of leaders is to enable diverse team members to grasp one another’s perspectives and productively share their insights.” – Amy C. Edmondson, Harvard Business Review 

We took valuable lessons learned about the advantages and potential shortcomings of working in cross-functional teams, and created better and more standardized processes that will improve care in the future. At the end of the day, everyone at U of U Health wants to provide great care to our patients, and optimizing cross-functional team dynamics helps us do that. 


Iona Thraen

Director, Patient Safety, University of Utah Health

Doug Clapp

Nurse Manager, Huntsman Cancer Hospital

Emily Salisbury

Director of Clinical Operations, Endoscopy, University of Utah Health

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