Understanding the Negatives Can Help Your Team Overcome Them As members of a department, division or practice, neurosurgeons function as members of a team. Whenever we perform surgery, for example, we serve as captains of a team. Since the well-being of our patients and our practices depends in large part on the success of one team or another, we all could benefit from a lesson in team building. For such instruction, in this column we turn to Patrick Lencioni, a master teacher with a series of best-selling books.
“Like so many other aspects of life, teamwork comes down to mastering a set of behaviors that are at once theoretically uncomplicated, but extremely difficult to put into practice,” Lencioni explains in the book’s introduction. “Success comes only for those groups that overcome the all-too-human behavioral tendencies that corrupt teams and breed dysfunctional politics within them.”
| “The well-being of our patients and our practices depends in large part on the success of one team or another…” |
One might say that he approaches the subject of team building in a negative way by focusing on the five dysfunctions of a team. However, to illustrate his points Lencioni uses a fable, as he terms it, involving “DecisionTech” and its new CEO, “Kathryn,” who has a gift for team building. Overall, The Five Dysfunctions of a Team is a very positive book that reads like a two-hour novel. Following is a brief synopsis of the five dysfunctions that the author identifies.
The first dysfunction of a team is absence of trust. Trust, the foundation of team building, is the confidence among team members that their peers’ intentions are good, and that there is no reason to be protective or careful around the group. Trust requires honesty between teammates. They must be able to feel vulnerable around one another, and admit weaknesses, ask for help, and accept questions about their areas of responsibility. Without trust there can be no team.
The second dysfunction of a team is fear of conflict. If a team’s meetings are boring, chances are that the teammates fear conflict. Effective, insightful criticism is essential to achieving team goals, and such criticism depends on trust. Criticism needs to be openly aired and should never be sacrificed in favor of artificial harmony. While effective teams listen to everyone, passive, sarcastic comments detract from trust and ultimately, from achievement of the team’s goals.
Lencioni identifies lack of commitment, a function of clarity and buy-in, as the third dysfunction of a team. He says that the two greatest causes of the lack of commitment are the desire for consensus and the need for certainty. Many teams become paralyzed by their need for complete agreement, and thus are unable to move beyond debate. Ambiguity is the opposite of commitment. Teams must learn from mistakes and ought to be able to change direction without hesitation or guilt.
The fourth dysfunction is avoidance of accountability. Every member of a team first must have clear responsibilities to fulfill and when responsibilities are not met, peers should be able to discuss the shortfall, however difficult the conversation. Excessive bureaucracy that encumbers performance management and corrective action is counterproductive and should be avoided. Poor performers must feel pressure to improve.
The final dysfunction is inattention to results. Every good organization specifies what it plans to achieve in a given period, and the results must be measurable. The ultimate dysfunction of a team is the tendency of members to care about something other than the collective goals of the group. In the same way that great basketball players put winning a game ahead of enhancing their own statistics, team members must be able to subjugate their personal goals for the good of the team.
Teamwork ultimately comes down to practicing a few specific principles over a long period of time. Success depends on embracing common sense with uncommon levels of discipline and persistence.
Since our success as neurosurgeons depends so much on building effective teams, reading this book is worth the modest time investment. As with all enduring fables, it is by persistently putting these ideas into practice, a more challenging endeavor, that we will reap rewards.
Gary Vander Ark, MD, is director of the Neurosurgery Residency Program at the University of Colorado and past president of the Colorado Medical Society. He is the 2001 recipient of the AANS Humanitarian Award.