THERE IS NO “I” IN “TEAM”:THE SOCIAL PSYCHOLOGY OF TEAM FUNCTIONING IN HEALTH CARE

Zubin Austin BScPhm MBA MISc PhD

Professor and Murray Koffler Chair in ManagementDirector – Centre for Practice Excellence

Leslie Dan Faculty of Pharmacy

University of Toronto, Canada

What is a “team”?- “A group of people with a full set of complementary skills

required to complete a task, job, or project…”- “A collection of people with a strong sense of mutual

commitment, creating synergy and thus generating performance greater than the sum of its individual members…”

- “A group operating with a high degree of interdependence, sharing authority and responsibility for self-management, accountability for collective performance working towards a common goal”

No, really, what is a team?• Free riders on the coat-tails of others• Ego-driven power-trippers• Politically correct way of neutering certain individuals• Mechanism for diffusing responsibility• Hideously inefficient, horrendously costly

No, really and truly, what is a team?• A reality of contemporary life in all fields• A central organizing principle for modern society• A mechanism for encouraging cognitive shifts leading to

behavioural change (“social perspective taking”)• A way of breaking down misconceptions and stereotypes

(“social contact hypothesis”)• A test of personal character and a clue to those around us

as to what kind of people we truly are (“social signalling hypothesis”)

Who are these “team players”?

What does it take to function effectively, efficiently – and happily - in teams?

Understanding health care teams means understanding the playersA few key assumptions:

a) Health care professionals are generally intelligent, well-intentioned individuals

b) As individuals, they are people who bring an entire “back-story” to their day-to-day practice

c) Despite being intelligent and well-intentioned, this personal back-story is the filter through which interpersonal life is lived

Understanding ourselves

The “Big Five”: broad domains/dimensions of personality used to describe human beings

1. Openness (inventive vs consistent)

2. Conscientiousness (organized vs easy-going)

3. Extraversion (outgoing vs reserved)

4. Agreeableness (friendly vs aloof/suspicious)

5. Neuroticism (sensitive vs confident)Want to learn more about your own “Big Five”? There are lots of freely available tests on-line, such as: http://www.outofservice.com/bigfive/

How do “people” become the “professionals” they are?• Intersection of personality/temperament and socialization

process (including education)• Social identity theory: group affiliations are essential to

self-understanding and self-esteem• Social identification theory: group affiliations are

supported through in-group favouritism and out-group denigration

Clinical reasoning- How we “think” is shaped by our personalities, our

education, and our socialization/environment

- Reasoning from first principles- Application of rules- Pattern recognition

Problem vs. Story OrientationCommunication Technique Problem-orientation Story-orientation

Attentiveness to non-verbal cues and signals

Low High

Reliance on anecdotes and contextualization to understanding

Low High

Use of logical speech connectors

High Low

Emphasis on emotional significance/congruency between verbal and non-verbal

Low High

Speech Patterns

Problem OrientationSpeaker 1: XXXX XXXXXX XXXXXSpeaker 2: YYYYYYY YYYYYYY

Story Orientation:Speaker 1:XXXX XXXX XXSpeaker 2: YYY YYYY

How does this affect our ability to be team players?

Trust: “firm belief in the reliability, truth, ability, or strength of someone or something”- Cognitive model of “trust” for story-oriented individuals more frequently shaped by externalities (e.g. degree, status, stature, non-verbal cues) than for problem-oriented individuals who are more influenced by history and personal relationships

How does this affect our ability to be team players?

Communication: “the imparting or exchanging of information or news”- In a well-intentioned but spectacularly misdirected attempt to be polite, respectful and deferential to authority, story-oriented individuals frequently communicate indirectly – which may appear to be uncertain or unwilling to actually take responsibility

How does this affect our ability to be team players?

Responsibility: “the state or fact of having a duty to deal with something, of being accountable or to blame”- For story-oriented individuals, responsibility is about doing everything possible within the rules and respectful of processes, while for problem-oriented individuals it means willingness to put one’s own neck on the line to break a rule when necessary to solve a problem

How does this affect our ability to be team players?

Self-confidence: “assurance, belief in oneself and one’s abilities”- For story-oriented individuals, clinical confidence means certainty in having the RIGHT answer, while for problem-oriented individuals it means serenity in believing that if/when things go wrong, they will cope and deal with it at that time

Building teams

• The intersection of professional culture and individual personality/temperament produces individuals who may have different working definitions of critically important concepts

• Not recognizing your own “definition” in another’s behaviour leads to out-group denigration and in-group favouritism: “us vs them”

Case: “They just won’t listen to me….”

Sandy is an ASP clinician growing increasingly frustrated with trying to build a program. Despite lip service from senior admin, data indicating value to recommendations made, and smiles and nods from prescribers, there seems to be no buy-in to the model, sporadic uptake of recommendations and consequently a loss of momentum. Sandy is getting demoralized and wonders what the problem might be…

Building a common definition

• Easier said than done• Cultural changes within and across professions will be

needed to truly generate a new interprofessional culture• Personal evolution is needed to help individuals

transcend comfort zones imposed by their personality traits

• Common denominator for common definitions appears to be interpersonal relationships: pivotal to developing trust and cooperation

• What can we all agree upon? The patient….

Lessons from Social Psychology for Health Care Teams

• Health care teams are but one example of the way humans organize themselves….we can learn a lot from other kinds of teams (e.g. musical ensembles)

• Self-awareness is the first and arguably most important step towards both cultural and personal change

• Relationships are pivotal to success and involve “chemistry” between individuals

Chemistry in interpersonal teamwork

• Propinquity: the more we see each other the more likely we are to form a relationship

• Familiarity: the “exposure effect” as we learn and predict each others’ idiosyncracies

• Similarity: confirmation of beliefs/values/behaviours important; threats to similarity frequently result in disliking

• Complementarity: after similarity, as a way of strengthening (but not forming) strong relationship bonds

• Reciprocal liking: situations which prompt judgment or correction antagonize reciprocal liking

• Reinforcement: “social exchange theory”, a mechanism for each person to answer the question of how costs and rewards of this relationship balance each other out

Time to sing Kumbayah…

• Calling it a team won’t make it a team• Sometimes teams function effectively and

individuals don’t even know they are members• There are many opportunities for creating strong

teams and subversion within weak teams• Strength and quality of relationships that underlie

successful team functioning is usually based on a chemical reaction that simply takes time and nurturing and cannot be rushed, engineered, or forced

Some additional readings

Groopman, J. (2007) How doctors think.Austin Z et al. (2007) Negotiation of interprofessional culture shock. J Interprof Care 21(1): 83-93Hall P (2005) Interprofessional teamwork: professional cultures as barriers. J Interprof Care 19(1): 188-196