There’s no ‘me’ in team… is there?

Br J Cardiol 2008;15:299–300 Leave a comment
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We continue our series in which Consultant Interventionist Dr Michael Norell takes a sideways look at life in the cath lab… and beyond. In this column, he considers team building.

As the summer, if that is how we still regard it, reached its height I found myself joining a bunch of hardy colleagues for a trek up Mount Snowdon. This had become an annual event, having originated soon after our centre opened, and was one of a number of so-called team-building exercises.

The slog up and down was sufficiently lengthy to allow not only an appreciation of the impressive – if somewhat moist – scenery, but also more than enough time to muse on the purpose and benefits of this type of method in establishing the desired sense of camaraderie and ‘esprit de couers’.

The idea that a workforce can be enthused to function more effectively by promoting a family atmosphere and thereby establishing a unified ethos, is not new. We have become familiar with such an approach emanating from enormous Japanese corporations that organise massive, mid-morning yoga classes for all grades of employees, instead of the more usual British ritual typified by a mug of tea, a bacon roll and The Sun.

Historical precedent

Our own history also provides similar examples in which senior managers have tried to connect with the workers in order to encourage optimal performance. In the Napoleonic era a daily ration of rum was enjoyed by the numerous and jolly, ‘jack tars’ toiling on – and below – the decks of His Majesty’s men o’ war. This farsighted idea was the brainchild of one Admiral Edward Vernon who introduced the twice daily (noon and 6 pm) issuing of grog in 1740, in an attempt to (wait for it) reduce drunkenness. Sadly the evening dose was removed in 1824 and from then on this laudable initiative was gradually eroded until 1970 when the entire concept was abolished.

One can see that applying this particular approach to an Acute NHS Hospital Trust might, shall we say, be practically questionable. However, you will appreciate that there is, nevertheless, a certain principle that has been established and, what is more, it is in the ‘best traditions of the service’. So what other opportunities are available to the fluffier managers who wish to galvanise their teams?

Galvanising weather

It is unfortunate that many of these morale-boosting exercises always seem to involve less than perfect climactic conditions and rarely take place in idyllic environments. I have not seen advertisements for ‘corporate bonding days’ in St Moritz or Verbier, and nor can I recall an ad for a team-building week on a 52 foot ketch cruising the French Riviera or Antigua.

Nevertheless, if well thought out and planned, even a grey, miserable, rain-sodden morning in the Peak District, setting up a tent amid a biting northerly gale, can provide both inner enlightenment as well as enhanced professional development … apparently. And it is not difficult to see how.

Although we work side by side with a host of different disciplines we often do not see these colleagues beyond their professional roles. When trudging across a soaking peat bog with the mist and drizzle making the admiration of any scenery rather pointless, you have nothing else to do but chat to your compatriots, and you would be surprised what you learn. So, it turns out that the scrub nurse you have always regarded as hopeless, has a black belt in Aikido; the pharmacist who is – to be honest – a bit of an anorak, spends most of his weekends sky diving and that impressively dynamic operations manager is up all hours of the night on his computer playing internet chess with a like-minded soul in New Zealand.

And then you discover the single parent, the carer or the widower. You are exposed to the complicated – if not, unimaginable – domestic and social arrangements with which some of your colleagues have to grapple on a day-to-day basis. This can undoubtedly put your own home situation into ‘perspective’, so to speak.

The enlightenment

I am all for enlightenment about how individuals communicate, what makes us do what we do and how past experiences can dictate our present and future behaviour. Therefore, I can see how a small group of similarly interested ‘workmates’, if facilitated by a sufficiently experienced professional, might benefit from interacting in a non-workplace environment where traditional professional hierarchies become irrelevant. Problem solving in an arena far removed from any healthcare setting may perhaps allow longstanding or more sensitive issues to be teased out, exposed and discussed. The hope would be that departmental communication and working relationships might thereby be enhanced.

The ‘outward bound’ types of activities used to bond teams are limitless and can take the essence of adventure to a new level. Abseiling down some escarpment by entrusting your safety into the hands of that estates manager you swore at last week is certainly a humbling experience, but the benefits of these activities go well beyond the physical. Congregated around the dying embers of a campfire and lubricated by a small scotch, inhibitions fade and people tend to ‘open up’.

Reassured by the outer glow of the former and the inner glow of the latter, deep personal issues become the topic of conversation, and are chatted about as routinely as one might discuss the ups and downs of the Premier League. However, my own enthusiasm for the exercise tends to wane at that stage. I suspect that being encouraged to relive my birth experience is unlikely to shorten inter-hospital transfer times or increase out-patient capacity.

The challenge

So here is a typical scenario: there are six of us tasked to cross a deep, fast-flowing river with nothing more than our combined ingenuity, three lollipop sticks, two plastic carrier bags and a jam jar.

Our cardiac physiologist starts by helpfully pointing out that, “Just because we happen to have been given these objects, it doesn’t mean to say we have to use them all” (and as an afterthought) “or even any of them”. I ponder; it was a struggle to work out the solution to this problem armed with the peculiar array of tools we already had, but to solve it with even less…

The ever-practical porter suggests a more direct answer. “I reckon we throw the lolly sticks in to see exactly how fast the river is flowing” (pause for further contemplation) “and then we just make a jump for it.” I acknowledge the direct nature of this approach, but somehow I am convinced we are still missing something.

Our business manager, who up until now has been deep in thought, now shares with us the fruits of her previous silence. “Are we sure about the instructions we were genuinely given? There may be a clue in the wording; does it say we all have to get to the other side?”

Again I muse on this contribution; if the correct use of the kit with which we are supplied is actually successful in getting one person across, then it’s likely to work with all six.

Our ward sister emerges with a fairly sensible suggestion. “This is ridiculous. We haven’t been given the right tools, let alone enough of them. Frankly I am not happy to even attempt this with the sort of resources we’ve got.”

Thoughtful and quiet thus far (unusual for me) I feel obliged to proffer my sixpenny worth. “What concerns me is that if we do succeed, and show that we can accomplish this project with the ludicrous items supplied, then we will be asked to do it again – but with less.”

My long-suffering secretary can stay silent for no longer. “That’s typical of you, isn’t it? You always say things like that. Why don’t we all just have a think about it, see if we can come up with an agreed solution and then try it?”

I am not going to tell you how things worked out; can I instead suggest that readers send in their own suggestions? There is just one further requirement that was stipulated in the instructions we were given, which is why this inter-personal gelling exercise was devised by an NHS Trust in the first place: you have to be able to do it within 18 weeks.