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The Missing 'I' From Health-Care Teams


When unexpected curveballs lead to a paralysis of analysis by teams, having a small subgroup in place with executive authority can have a genuine impact.

I have known folks who come from medical families with two or more consecutive generations of physicians, and/or other assorted health-care professionals decking out the family tree. Sometimes, there is even a medical skew among their social contacts.

This is certainly not the case for me. With the possible exception of remote family I have never met, I believe I was the first doc in my lineage. Further, aside from peers in medical school or subsequent work, almost none of my friends have been health-care types.

For most people I know, I serve as a rare window for peeking into the medical world. Their perceptions, in turn, give me some interesting insights into what non-docs believe about us, both flattering perspectives and, er, not so much.

You’re probably familiar with at least the flattering stuff. We cram an amazing amount of knowledge into our minds and understanding it to begin with was no mean feat. We can endure ludicrous hours, filled with stressors many would never imagine for themselves. Our actions can result in the improvement and, at times, saving of lives.

However, we have our blind spots and frailties. For example, you can’t go too far in the health-care world without hearing someone quipping about how physicians make lousy businessmen.

Some of the docs’ less than superhuman qualities don’t strike me as being any more prevalent than within the general population. Yet they stand out because people expect better of us. If docs are so smart, why aren’t they good at (insert random thing most other people aren’t good at)?

I have taken particular note of this phenomenon when it comes to multiple docs working together in groups. No doubt, we can do some great things en masse. We can cover hospitals 24-7-365, represent a gamut of subspecialties, and put our heads together to puzzle out diagnostic zebras … but some stuff showcases our fallibility all too well.

The latter category, I find, is the sort of circumstances when it’s detrimental that there is no “I” in “team.” You’ve surely heard that expression and in a lot of cases, it’s a desirable feature. Everyone pulls together for a common cause without breaking ranks to expend time/effort on selfish pursuits.

Sometimes, though, an “I” is what is called for, and teams can have trouble with that, no matter how smart, capable, and hard working the members of the team. Indeed, such qualities can make “I”-type functions even more difficult to perform. The medical (and academic) fields in which I have lived have shown me this time and time again.

There are things that may come naturally to an individual. This may involve taking in and considering information, coming to conclusions, deciding on a course of action, course correcting as needed, and assessing results. I find this is especially the case when there is a time crunch, an emergency or a suddenly presented “this needs to be done yesterday” task.

It seems like the more people you add to a situation, the lower their team intelligence gets. That goes for emotional intelligence and maturity too. Put enough smart adults together and they have a funny way of collectively acting like selfish children.

Today’s sociopolitical climate is rife with examples. Take Congress for instance. Say what you like about the political players you oppose but you would probably be hard pressed to pick out one who wouldn’t impress the heck out of you if you met that person individually. They didn’t get where they are without being smart, capable, and charismatic.

Still, put them all together in a room and give them problems to solve. Suddenly, these individually impressive folks can’t seem to get anything done. Instead, they generate a stream of quotes and soundbites that make them seem dumb, petty, and incompetent. When they actually do something, it seems blatantly wrong to at least half the population.

Bringing things back to our humble health-care realm, our teams and organizations do fine under “normal” circumstances. If things fit nicely into flowcharts and go according to expectation, it can be like a series of well-oiled machines on an assembly line.

But throw one unexpected curveball into the mix, something that could easily be handled by an individual empowered to act decisively. When there is something that requires thinking on one’s feet or a quick pivot from normal procedures, things slow to a crawl, if they don’t go off the rails completely. The matter must be kicked up and down the chain of command. It will be on the agenda for next month’s meeting but probably not immediately solved. It will be assigned to subcommittees, argued about but possibly never acted upon if agreements cannot be reached.

The thing is most of us like having a say in what’s going on. Democracy is about “we,” not “I,” but that has a way of bogging things down. Dictatorships are run by an “I,” and even oligarchies can be small and tight-knit enough to act “I”-like. A lot of us, if we are not at the helm, rankle at the idea of ceding that much power over our professional livelihoods.

This isn’t much of an obstacle in very small rad groups in which everyone can have a seat at the table, and it is relatively easy to convene a meeting of the minds. Increase the head count to even a few dozen, let alone hundreds, and that stops being so easy.

The best compromise I’ve seen is for a regularly elected subgroup (a Board of Directors, for instance) that is small enough to effectively act as an “I” when necessary, given strong executive authority. By all means, let the group at large override grossly unpopular decisions, and even remove Directors between elections with a vote of “no confidence.” For most matters, though, the Board of Directors can handle business swiftly and almost as effectively as a single “I” could. Although from what I have seen, it’s even more effective when the Board’s president is given ample “I”-authority on an even higher level.

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