Pediatric cardiologist Daniel J. Penny, MD, PhD, FACC, will discuss team-building and innovation during today's Dan G. McNamara Keynote. A native of Ireland, Penny has been chief of pediatric cardiology at Texas Children's Hospital since 2010. Before that, he worked at Royal Brompton Hospital and The Great Ormond Street Hospital, both in London, and the Royal Children's Hospital in Melbourne, Australia. He also helped raise funds to start the Hué Central Hospital Heart Institute in Vietnam and has made more than 25 trips to Vietnam, earning the International Service Award at ACC.16. Penny explains his approach to team-building in an interview with ACC.22 Daily.

What are some basic principles to follow when establishing a team in any situation?

A principle I would highlight is that a team leader should not have a single leadership style. Rather, the precise style of leadership has to vary according to the state of the internal and external environment. Sometimes control has to be more centralized, particularly in times of adversity, when one of the most important contributions of the leader is clarity. At other times, the leader has to just agree with the aims and outer boundaries of the work with the team and trust that it is okay to give up control. This adaptability is essential as a team is developing and growing.

Do you start a team with a blank slate or is it important to target key partners and define roles before starting?

I think the leader and executive group must always have a keen eye on the vision for the organization – the North Star. With this as your guide, the next stage is to get the right people on the bus. In many respects, as the leadership team does this, they don't know exactly where the team will end up. They must have faith that with the right people on the team they will get to a place that is better.

To be honest, some of the greatest achievements of our team over the past decade occurred in areas that were not on my radar at all in the beginning.

Are there important goals that need to be set and challenges to anticipate when forming a cardiovascular team?

It's important we all recognize that not everything will go according to plan. To this end, one needs to develop an environment in which there are high levels of psychological safety, an ability to learn from mistakes and high levels of accountability. Our group has worked hard on these, with center-wide discussions about psychological safety and small workgroups studying the science of psychological safety. We also have introduced forums at which suboptimal outcomes or, just as important, near misses, can be explored, allowing us to model psychological safety in action.

How is this team approach best implemented on a daily basis?

I think the #1 thing a leader must do is be present and be interested in the workings of the individual teams for which they are responsible. A leader needs to be available and aware of what's going on, but not in an interfering way. In our specialty I think it's also important to be able to roll up one's sleeves, be in the clinical area and be seen as a credible cardiologist. For me, I would hate to be seen as just another manager.

How does team-based care impact patient outcomes and satisfaction?

The expectations of our families have changed over the past decade. Our profession has traditionally held the idea that the large centers are where the best clinicians work and the best outcomes are achieved. This has led to the development of an "ivory tower" mentality within our large centers. While the volume-outcome relationship is important for some of our work, for much of what we do, what is now valued is more personable, convenient and communicable care. As our bigger centers try to develop this type of culture, we are learning that every member of the team is important, not just the cardiologist or the surgeon, but everyone who interacts with our families either directly or indirectly.