Inpatient medicine continues its fast-track growth across all the various employment models: private groups, hospital-employed groups, and groups employed by management companies.
But regardless of their employment model, groups all have one thing in common: They are made up individual physicians who need to coalesce and work as a team. We can talk all we want about care pathways, quality improvement processes, order sets and technology, but without a cohesive team, those all come to naught.
As inpatient medicine grows, I wonder how much thought we’re putting into team-building. When any business is expanding–particularly expanding too fast!–how much effort do we need to direct toward enhancing working relationships? And how can we integrate concepts that have a proven track record into the fabric of group dynamics?
Team-building starts, of course, with hiring the right people. Those of us immersed in hiring know that it is all about skill vs. will. Physicians may be technically astute and brilliant. But if they cannot function as a team member, all bets are off; you’re stuck with a lone ranger or a prima donna.
Then there’s the fact that team-building concepts need to be embedded from the start. Team members must be able to outline a vision, share goals and targets, and develop both a team identity and, eventually, a sense of pride from working together.
Team members also need to be able to learn from each other, which happens only when they recognize and respect each other’s unique attributes, strengths and weaknesses. I’m sure all of us have seen individual physicians who can admit and round faster than any of their colleagues, but then go on to quietly–or openly–criticize team members who are not as fast as they are.
This is just the type of situation that corrodes team spirit. Management experts have described this as the Apollo Syndrome, where highly intelligent people–if they are motivated only by their own interests and engage in destructive approaches to conflict–often perform worse when working together than “less capable” members. Unfortunately, many of us have first-hand experience of a team of super performers who can’t function effectively.
Dr. Bruce Tuckman, a respected educational psychologist, first described group development as having four stages. (He later added a fifth.) While most successful groups go through these phases automatically, having an understanding of what the stages are can make team-building less painful and allow a team to troubleshoot problems sooner.
● Stage 1: Forming. During this stage, team members concentrate on sizing each other up, and their behavior is driven by a desire to be accepted by others. Team members avoid conflict and contention. Not surprisingly, not much of significance happens at this stage.
● Stage 2: Storming. Well, the pleasantries can last only so long! Surely but sorely, “issues” arise as work stress takes its toll and tempers flare. The fact that some people take on disparate roles or skewed responsibilities within the group can be other sources of stress.
The culture of your organization may dictate how these initial skirmishes are handled, and may make them worse. Are problems swept under the rug or handled openly? Sometimes, individual team members–if not the whole team–find it comforting to maintain for an extended period of time the illusion that they’re still in Stage 1!
● Stage 3: Norming. For a team to be successful, it needs to make the transition from Stage 2 to 3. Teams that don’t fall through cracks that grow into crevices, fueled by unresolved conflicts and the inability to realize unrealistic expectations.
Teams that do evolve to Stage 3 are characterized by members who are prepared to listen, appreciate and support each other, and are willing to change preconceived notions. They maintain well-defined lines of communication within the group; they codify all rules of engagement; and their leaders facilitate rather than dominate. Because they have been able to constructively air arguments and issues, team members understand each other better and, as a group, can move on to the next level.
● Stage 4: Performing. In the pyramid of success, not all groups or teams reach nirvana. Nirvana is when group identity, loyalty and morale reach a peak. That high level of interdependence and flexibility makes it possible to harness the strengths of the group while minimizing its weaknesses.
Dr. Tuckman did add a fifth stage: adjourning. That phase relates to disengagement, or de-forming, once the group’s task or goal is achieved.
Like many hospitalists, I have been through the formation of four different teams. You would think that, by now, I would have figured these stages out–but, no!
Just recently, my group started talking about team-building, which got me thinking about this concept. As I researched the topic, initially to help my own team, I realized that there are countless other teams, just like us, trying to find their footing in new work environments. If we could share information, we might be able to bring some clarity and structure to this topic.
What has helped me in this process is being very open with my team about our collective hopes, aspirations and goals, as well as the challenges that lie ahead.
I have candid discussions, acknowledging when things are not going right, and continuously share with the team options to fix or improve processes. And I have encourage group members to do the same. When people bottle up negative thoughts, that makes it hard to establish lasting relationships.
I’m sure that many teams out there have transitioned to higher levels of functioning. I hope that we can pool our thoughts and learn from each other about what specific team-building techniques have worked for you and your team.
Here are my questions:
– Are there unique concepts for team-building in the world of inpatient medicine?
– What specific challenges did your team face, and how did you overcome them?
– Did you utilize any consultants or professional team motivators?
– How did your parent organization support you in your efforts to build a team?