Build Collaboration that Plays to Each Team Memberʼs Strengths

Great leaders have great flaws, and so do you. So do I. But, that's not the point, is it? All of us could be better somehow, yet we manage to serve and succeed to some degree most of the time. Yes, our flaws may bring us low or even bring us down, but they are part of the package. Much of the advice historically offered to developing leaders was along the lines of, “Learn to go to your left.” In other words, work to improve your weaknesses. Today, most psychologists, teachers, and researchers of management principles instead point to the importance of playing to your strengths and working with others in collaboration to support your personal weaknesses. Such collaboration, if robust and focused upon the mission at hand, is not brought down by personal differences when all participants have agreed to and are aligned around the same agenda. In clinical practice that mission statement may be simple: “Practice high-quality medicine for which we receive fair compensation while supporting the mission of our practice site — our community's hospital.” An academic practice may incorporate its academic missions of research and teaching in its one sentence statement. Regardless, adhering to the mission is sure to require the collective efforts of the entire practice if for nothing else than covering the schedule. Yet, even at this level, swapping shifts after the schedule is published requires a degree of collaboration and trust that your colleague will do likewise for you when you need it. Staying on Track How does one build such collaboration, particularly in a small single hospital group practice, and keep it on track as the individual personalities all pursue individual priorities? The many small courtesies such as swapping shifts on short notice and working together to the same standard of practice build this bond over time, but what about the situation where someone who has been part of the collaboration seemingly leaves the fold? Rarely manifested through a single startling deviation but more likely through a (too) protracted series of small infractions, how do you address the trouble? Unfortunately, some physician leaders, myself among them, may prefer to minimize or otherwise cover for the colleague whose behaviors create difficulties in the larger collaboration. Wanting to wish the bad behaviors away is all too human — and flawed. Confronting our colleague's deviations with them is the only solution. Challenge the behaviors and not the individual is easy advice but difficult in practice. Postponing the confrontation — waiting for the pressure to build — and tackling the conflict after upset has turned to exasperation and anger is a sure route to the feared commotion that may lead to substantial, prolonged, or even complete disruption of your practice. Whatever the inciting event or events, whether you fear your colleague's behavior originates through a substance abuse problem, personal or family upset, or even the manifestation of a character flaw long suppressed, confronting the behavior is the essential first step. Do not roll this confrontation into the fact-finding phase if the precipitating event requires an investigative process. Complete the investigation, and have all the facts before confronting your colleague. If possible, gain your colleague's agreement to the facts separately and prior to scheduling the confrontation. Tackle the confrontation in a private circumstance. While your impulse may be to address the problem in a restaurant, it is probably better to meet your colleague in a more structured and formal environment. An office is not necessary and may be counterproductive, but a hospital conference room could be a good choice. Make sure you have sufficient time, don't schedule yourself for half an hour between other already scheduled meetings. If possible, schedule two hours even if you only plan for 20 minutes. Be Specific Begin by acknowledging how difficult it is for you to have “forced this meeting.” Recount the specific event or events that troubled you so much that you scheduled the meeting. Focus on the behaviors that distressed you, and explain your distress. Speak in the active voice, and put yourself on the line. Don't accuse or attempt to explain the behavior. State your shock and distress and why the behavior is not acceptable. Confrontation, though difficult to initiate, is the only route to resolution In the past, I have suggested that a practice leader could adopt the pyramid of medical staff development, even at the department level. I pointed to the interlocking components of setting expectations, measuring, and giving feedback as the key components of the change process. Like you, I believe that most physicians want to do the right thing. Unfortunately, most of us are increasingly uncertain about what the right thing is these days, which is why clearly setting expectations is so important to beginning measurement. The exact same statement of expectations is the key to either remedying the commotion in your practice or identifying the magnitude of the problem so that you can confidently take definitive action. You're giving feedback now, perhaps without having done so previously so reaching the occasion where you can take definitive action will take additional time, which must be expended. When addressing behavior, acting on past events — unless heinous or of imminent risk to patients or staff — is not sustainable. For a colleague and collaborator, the chance to right themselves must be offered. Whatever the “bad behavior” you must describe, demand that it stop, describe the behavior that is desired, and observe for the correct behavior. If found, praise it; if the behavior reverts, then you must discipline your colleague or otherwise intervene, perhaps in accordance with JCAHO Standard MS.2.6, if appropriate. Delayed response to disrupting behavior within a close-knit group of collaborators is a far too common flaw in leaders. It risks the entire collaboration. Confrontation, though difficult to initiate, is the only route to resolution.