Post on 26-Dec-2015
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