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Feature: Teams as Tools for Changing the Culture of Academic Medicine

By R. Kevin Grigsby, D.S.W., and Diane Magrane, M.D.

Teamwork is the ability to work together toward a common vision, the ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results.—Andrew Carnegie

The organizational leaders, professionals, and staff of our academic health centers  face complex challenges. The necessity to confront these challenges calls to mind Albert Einstein’s observation that “We can not solve problems by using the same kind of thinking we used when we created them.” Those of us in academic medicine need to consider new approaches and tools as our culture evolves to one that is more dynamic and responsive to social and economic changes.  The “wisdom of teams” (Katzenbach & Smith, 1993) offers the necessary brainpower and talent to provide an alternative approach to traditional individual efforts for organizations to operate successfully in this new world of complexity.  In fact, teams may be one of the most powerful tools we can use to improve the organizational performance of academic health centers.

How do teams differ from other groups and committees?

The implementation of teams requires that individuals learn new skills of group work and that our culture changes from one of independence to that of interdependence.  Working as a team member is different from working alone or from working as a committee or work group member. Team members, in contrast to committee members,

  • Represent diverse experiences, perspectives, and skills, yet work to serve a common purpose;
  • Share accountability for collective work products. Each member contributes to the creation of the product, but the final product is owned by the team;
  • Change leadership depending on the task at hand—as such leadership “moves” from member to member.
  • Establish ground rules for working together and work to understand and appreciate the skills and perspectives (as well as various roles) played by team members; and
  • Value interactions that incorporate conflict into team decision-making.

Katzenbach and Smith distinguish single leader work groups from “real teams” with shared leadership in the online article, The Discipline of Teams External Link. Grigsby makes important distinctions between formal committees and teams in his January 2008 article in Academic Physician and Scientist, Committee, Task Force, Team: What’s the Difference? Why does it Matter?  These differences are compared in the chart below.

Comparing Characteristics of Committees, Work Groups, and Teams

Characteristics

Committees

Working Groups

Teams

Relationship of members to the final task

Independent

Independent

Interdependent

Composition

Representational

Expert skills/knowledge in a needed area

Highly developed Skill set and diverse perspectives

Leadership

Single and appointed or elected

Single and assigned

Shared roles; leadership may shift depending on the task

Approach to conflict

Reactive; may suppress extreme opinions

Reactive; may moderate to a group mean

Creative and adaptive to shared goals

Decision-making

Vote

Vote or consensus

Consensus

Best suited for . . .

Formal decision making as a subset of a larger organization

Single objective assignments requiring expert knowledge

Multiple objectives requiring collective work products

The Role of Teams in Cultural Change

In his November 2007 AAMC presidential address, Culture and the Courage to Change , Darrell Kirch, M.D., argued that organizational culture is every bit as important as organizational strategy for academic medical centers. Kirch called for a redirection of our culture to one that is focused upon "collaboration, shared accountability, and team performance."

Transforming the Culture of Academic Medicine (Adapted from Kirch 2007)

From a Tradition of…

To an Emergence of…

Individualism

Collaboration

Autonomy

Transparency

Expert-centeredness

Community-centeredness

Competition

Shared Accountability

Hierarchy

Teams

Culture change does not come easily.  In his classic work, “Leading Change,” John Kotter outlines eight essential change steps, beginning with a guiding team and culminating with reinforcement of a new culture.  Readers may enjoy reading about these steps in Kotter’s parable version of change in Our Iceberg is Melting (2006), or on his web site, Changing and Succeeding Under Any Conditions.

References

1. Katzenbach JR, Smith DK. The Wisdom of Teams. Boston: Harvard Business School Press, 1993.

2. Kotter JP. Our Iceberg is Melting. New York: St. Martin’s Press, 2006.

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