If you’re inclined to think teamwork is just a practicality, a straightforward response to the need — in a time of increasingly complex care — to connect people and ensure they cooperate, think again. Research shows that teamwork is one of those rare situations where the whole is greater than the sum of the parts. At least, it can be.
In a 2016 article in the American Medical Association Journal of Ethics, Anna Mayo and Anita Williams Wooley say teams have the potential to improve care “because they can aggregate, modify, combine and apply a greater amount and variety of knowledge…and execute tasks more effectively and efficiently than any individual working alone.”
However, they add, “teams are fraught with failures to use their diverse set of knowledge, skills and abilities…as well as they could.” Their goal in writing the article was to rectify that, by identifying structures and processes that will make the best use of all the expertise of team members.
Mayo and Williams Wooley start by challenging a common belief: that the best team is going to be the one that has the smartest people. There is, they say, a distinction between having smart people on a team, and having a smart team. The difference lies in the collective intelligence a team generates.
What is collective intelligence? Mayo and Williams Wooley say research has shown members of smart teams have strong “social perceptiveness,” which is their ability to sense other peoples’ beliefs and feelings through subtle cues. Smart teams’ members are also very active participants and more equal participants than people on less successful teams. Both characteristics enhance the quality of information-sharing, likely because the teams are better at incorporating multiple perspectives. That, in turn, means they are operating with more and better information — and that means a smarter team.
None of this is to say teams should not include smart people. In another article with different colleagues, Williams Wooley says teams need expert members on teams if they are to perform well. But the paper also talks about the challenges introducing experts to a team can bring. Mixing people with different social status (which experts, with more education, recognition and pay may have) “can create significant difficulties in collaborative work.”
Even if social status isn’t an issue, designating some people as experts can trigger tensions that undermine the benefits of extra knowledge, the authors add.
Perhaps that’s linked to the idea, found in other studies, that hierarchical teams don’t work as well as those that are more equal. A systematic review, “Multidisciplinary collaboration in primary care,” lists four components of collaboration. One is role flexibility: “We found that teams with a non-hierarchical structure, where the role of leader was not explicit, were more flexible.” Another article, on efforts to improve communication at Kaiser Permanente, says “Hierarchy, or power distance, frequently inhibits people from speaking up. Effective leaders flatten the hierarchy, create familiarity and make it feel safe to speak up and participate.”
Mayo and Williams Wooley have recommendations for overcoming reluctance to share knowledge, whether that comes from perceived lack of status, or what they call the “common knowledge effect,” where people on teams are more likely to talk about information they all already know, and tend to ignore information only one person knows.
The key, they say, is collaborative planning, to develop a strategy for the task to be done. However, they warn, it usually takes external intervention to get teams to hold these “explicit discussions about how they will carry out their collaborative work and…how they will capture and use well the contributions of individual members who have special task expertise.”
The expression “you don’t know what you don’t know” is overused. But when you’re searching for the best way to care for a patient, it’s clearly essential to find out what you don’t know — and the team member beside you may have the answer.
This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule. Feel passionate about physician-led innovation? Please connect with us at firstname.lastname@example.org.
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