Building a Team Culture in Medical Practice

In most medical practices, much of the work is done by teams. Communication within a team calls for clarifying goals, structuring responsibilities, and giving and receiving credible feedback. The lack of systematic education about how teams work is the biggest hurdle for physicians in building a team culture. The styles learnt most in residency training are ‘command and control’ and the ‘pace setting approach,’ in which the leader doesn't specify what the expectations are, but just expects people to follow his or her example. both of those styles limit team cohesion. “Recognizing one's lack of training is the first step in overcoming the hurdle, then understanding that one can learn these skills. Listening, showing sincere empathy, and being willing to experiment with new leadership styles, such as coaching and developing a shared vision for the future are key.” Stated goals and team values: An effective team is one in which everyone works toward a common goal. This goal should be clearly articulated. In patient care, of course, the goal is the best patient outcomes. But a team approach is also highly effective in reaching other goals in a physician practice, such as decreasing patient waiting times, recruiting patients for a clinical trial, or developing a community education program. Every member of the team must be committed to the team's goal and objectives. Effective teams have explicit and appropriate norms, such as when meetings will be held and keeping information confidential. Keep in mind that it takes time for teams to mature and develop a climate of trust and mutual respect. Groups do not progress from forming to performing without going through a storming phase in which team members negotiate assumptions and expectations for behavior. Clear individual expectations: All the team members must be clear about what is expected of them individually and accept their responsibility for achieving the goal. They should also understand the roles of others. Some expectations may relate to their regular job duties; others may be one-time assignments specific to the team goal. Leadership of the team may rotate on the basis of expertise. Members must have resources available to accomplish their tasks, including time, education and equipment needed to reach the goal. Openly discuss what is required to get the job done and find solutions together as a team. Empowerment: Everyone on the team should be empowered to work toward the goal in his or her own job, in addition to contributing ideas for the team as a whole. Physicians' instinct and training have geared them to solve problems and give orders—so they often try to have all the answers. But in an effective team, each team member feels ownership in the outcome and has a sense of shared accountability. You get a tremendous amount of energy and buy-in when you ask ‘What do you think? Team members must trust each other with important tasks: This requires accepting others for who they are, being creative, and taking prudent risks. Invite team members to indicate areas in which they would like to take initiative. Empower them by giving them the freedom to exercise their own discretion. Feedback. Providing feedback on performance is a basic tenet of motivation. For some goals, daily or weekly results are wanted, while for others, such as a report of the number of medical records converted to a new system or the average patient waiting times, a monthly report might be appropriate. Decide together as a team what outcomes should be reported and how often. Positive reinforcement: Team members should encourage one another. Take the lead and set an example by encouraging others when they are down and praising them when they do well. Thank individuals for their contributions, both one on one and with the team as a whole. Celebrate milestones as a way to sustain team communication and cohesion.