Monday, 10 October 2011

Teamwork and the revolving doctors.

There is of course only one thing to talk about this week - the Welsh rugby team are in the semi finals of the rugby world cup. As you may recall, Mama Dharamshi is in fact Welsh, and she got in there early with my sporting education, and I have been watching Wales mostly lose for as long as I can remember.

The range of emotions I have been through watching Wales play have ranged from ecstasy and exhilaration (I have twice seen them win the Grand Slam in the Millennium Stadium) to despair (virtually every year they haven’t won the Grand Slam).

I learnt about disappointment watching Wales, and I learnt what it means to really invest emotionally in something, only to find oneself disappointed. Therefore, the experience of seeing Wales win, and win well, is doubly good - they haven’t just won, they have won by playing with skill and with enjoyment.

This contrasts starkly with the England rugby team, who have spent the last month playing badly, behaving badly, and failing to reflect honestly on the way they have performed. That bunch of lads have clearly forgotten how to enjoy playing the game.

Now I know that many of you will be switching off and tuning out, but bear with me - it has been a few months since I used a sporting analogy, and this one does work.

What we have seen from the Wales team that we haven’t seen from the England team is a sense of collective - they respect each other professionally, they enjoy each other’s company socially, and it clearly matters to them all how they as a team are perceived.

Tuckman describes the stages of team work with the terms ‘forming, storming, norming and performing’. Any new team that comes together has to go through a formation process, where they learn about each other, behave well with each other and avoid conflict. Guess what happens when teams start storming? This can be a rough ride, and this is where a lot of the behaviours play out.

The goal of course is performing, which is the team that results when the individuals have a clear grasp of what each person brings to the group: everyone is motivated, capable and autonomous. This frankly is where the Welsh rugby team is, and why they have exceeded the expectations of even their most ardent fans. They have developed a trust in each other, by sharing some pretty painful experiences together (there was a famous training camp in Poland, where they all stood in freezers after training sessions to help with the recovery and thus allow them to do more training), and spending a lot of time together.

But I work in a system that almost precludes ‘performing’ teams by virtue of the fact that some of its members rotate every 3-4 months. It can be disheartening and exhausting to start again with new house officers and SHOs so often, and I have often wondered whether such frequent rotations undermine the level of performance of the team as a whole.

It’s a difficult question to answer but what I have noticed is that when there are highly performing teams in a hospital, that level of performance is usually a function of the more senior doctors working well with the nursing staff and therapists. A far more common experience, however, is to work in poorly performing teams, where the communication between members is either absent or unhelpful, and where team members do not value the contribution of their colleagues.

I have no doubt that my most productive and effective periods have been made possible by the people around me. The question I constantly ask myself is whether I have returned the favour. We each have a responsibility to do what we can to help our colleagues reach higher, and in turn, we can reasonably expect a leg up in return. It does not take long for new comers to a team to recognise when they are working in an environment in which individual contributions are valued. So when I think about how to incorporate new junior doctors in to the team, I think about what my relationships are like with the nurses and therapists are like. If I have paid enough attention to these relationships, then my new house officer will have no trouble settling in, because a conducive team environment will have already been created.

But rather like following the Welsh rugby team, one’s fortunes can turn in an instance: these relationships need constant nurture, and there is no such thing as completed work in maintaining the performance of a team.

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