How to upgrade an organisation’s tribal culture

Immature tribal cultures create silos and distrust, and sustain undesired behaviours. How can we change a dominant culture and become more effective?

My mother spent years of her childhood in Tjideng, a Japanese internment camp for women and children run by the cruel Captain Kenichi Sone.

She was born in the former Dutch East Indies, now Indonesia. The Dutch occupied and exploited the country for over four hundred years, but in 1942 things changed dramatically as a result of the Invasion by the Japanese imperial army.

The women in the Japanese internment camps are sometimes called the ‘forgotten women’ of the war in the East. These camps, as well as Dutch colonialism, are some of the worst examples of tribalism.

Tribalism comes of course in many shapes and forms including, as we all know, in the medical world.

Tribes & organisations

Most leaders know that tribal cultures are a key factor in the performance of organisations. Some leaders are experts at creating close-knit cultures, but only a few can change a culture that doesn’t perform optimally.

Tribalism is the natural way we organise ourselves into social groups. Our ‘tribes’ are part of who we are. They offer support, security and a sense of belonging an there’s nothing wrong with that.

However, tribalism can also refer to a false sense of superiority, sometimes leading to exclusion, bullying and discrimination.

We can change a dominant tribal culture and upgrade our organisations to more collaborative, healthy stages. History shows that goal-oriented groups and organisations that work well with others are more successful.

5 tribal cultures

In the book ‘Tribal leadership’, Professor David Logan et al describe five stages of tribal culture. As he points out, the medical profession is only half way, at stage three of five.

Five tribal cultures
The five tribal cultures. Source: Tribal leadership. David Logan, John King, Halee Fischer-Wright 2011

Logan’s tribal stage one is the mindset of gangs and war criminals – people who come to work with weapons. There is hostility and violence and no cohesion.

People working in a stage two culture may have coffee mugs with slogans like: “I hate work,” or “I wish it was Friday”.

There is often a high suspicion of management and authority in general, and team-building efforts are not effective in this culture.

Stage three is the dominant culture in almost half of all organisations, including many professional workplaces. Quite often doctors fall into this category. In stage three it is all about personal success and being the smartest. Stages four and five are the collaborative cultures.

Let’s have a closer look at the most common culture, stage three.

I’m great (and you’re not)

The mantra of stage three is ‘I’m great’, often followed by the unspoken words ‘and you’re not’. There’s a long history in medicine of stage three cultures with a strong focus on individual expertise and success.

Anatomy lesson
The Anatomy Lesson of Dr Nicolaes Tulp, by Rembrandt. Source: Rembrandt Huis.

One of the earliest examples I could find is this well known Rembrandt painting titled, ‘The anatomy lesson of Dr Nicolaes Tulp.’

Dr Tulp was a highly respected surgeon in Amsterdam in the seventeenth century; he is clearly the central figure in this painting. He’s the only one wearing a hat. Sadly but not surprisingly there are no women present.

You could argue that this scene demonstrates the dominant culture of the exclusive Amsterdam Guild of Surgeons. These days, almost four hundred years later, the dominant culture in medicine hasn’t changed all that much.

Professionals working in a stage three culture are often very good at what they do as individuals but what they don’t do is bringing people together.

They may think they are. Interestingly people in stage three often think that they are at one of the collaborative stages. They may talk about collaboration and teamwork – hallmarks of stage four and five – but their actions firmly put them in stage three.

The issue with a stage three culture is that it cannot be fixed – it can only be abandoned. The solution is to move your tribe to the next stage, stage four.

How to upgrade

People working in a stage four culture don’t talk about themselves. They first start listening. It’s no longer about being the smartest or about personal success.

There’s a move from ‘expert’ to ‘partner’. The language used is not “I’m great” but “We’re great”. There’s tribal pride.

Eventually, later in stage four, organisational boundaries become less important and cross-pollination between organisations may occur.

So how do we upgrade our culture from stage three to the more collaborative stage four? Logan describes several principles, including:

  • Focus your team on tribal success instead of personal success
  • Point out the superior results of stage four tribal cultures
  • Describe role models in the organisation that show stage four behaviour, for example people who are talking about ‘we’ instead of ‘me’
  • Encourage transparency and sharing of knowledge & information as much as possible.

There’s one main problem with stage four, reflected in the unspoken sentence that often follows “We’re great,” and that is: “… and you’re not,” referring to other groups or organisations. That’s where stage five comes in.

Stage five is the dominant culture in two percent of work places. In this stage there is no ‘they’.

‘Them & us’ thinking has gone out of the window and there is a focus on inspiring purposes. These are often universal values, taking away the need to compete.

People working in stage five cultures can work with any group that has a commitment to universal core values – even if these values are different from their own.

Effective followership

More collaboration in medicine has many benefits, including for direct patient care, mental health of doctors and healthcare reform.

We always talk about leadership but effective followership is just as important.

Effective followers don’t blame their leaders when things don’t go as planned; instead they offer support and gently, but persistently, steer their leaders in the right direction to help them achieve the organisational goals.

What the medical profession needs is people who build bridges.

I’d encourage you to review your own organisation(s) and look for opportunities to collaborate. Don’t accept non-collaborative cultures.

Find role models and like-minded people, people who talk about ‘we’ instead of ‘me’, and together take your dominant culture to the next level.

This is an adaptation of a presentation given at GPDU18.

If only we worked together (instead of competing)

Many GPs feel disempowered in the current climate of cuts and freezes. It is indeed hard to comprehend why governments slash funding to the most efficient and cost-saving part of the health system.

We are all concerned about the lack of continuity of care and increasing fragmentation in our healthcare system, but what about the divisions within our own ranks?

Part of what makes general practice attractive is its diversity, but it also makes general practice prone to divisiveness. Think, for example, of the stereotypical dichotomies: generalists vs partialists, private practice vs corporates, rural medicine vs metropolitan general practice, etc.

GPs are highly respected in the community, but have become an easy target because of marginalisation and fragmentation. It is a well-known secret that governments play different GP groups off against each other, choosing to include or ignore organisations in their deliberations and negotiations.

Lack of unity also opens the door for disruption by third parties.

Our culture

It is clear that general practice needs an urgent cultural change. Just like surgeons are working on improving the bullying culture, we must address the disharmony and division that afflicts us.

How good would it be if practices worked together instead of competing? If GPs could get together and agree on issues important for their area? If peak bodies would team up and better coordinate strategy, policy development, campaigns, conferences and membership services?

There is a whole generation of GPs that don’t understand why we have so many representative organisations. These young doctors are concerned about the disadvantages. Why don’t general practice organisations support each other, why are there multiple memberships and so much duplication? I believe they are right.

We have much more in common than what sets us apart, so why are we so tribal?

Why tribalism?

I can think of a few reasons. The first that comes to mind stems from social psychology; our brains may be programmed to organise us into small tribes because of evolutionary advantages, such as social bonding and survival.

There are also economic motivations, for example, GP clinics currently compete for patients. Our peak bodies are based on membership and need to offer benefits; this encourages competition rather than collaboration.

Reform fatigue may be another reason why some of us have stopped caring about achieving common goals. Experienced GPs can tell us the tales of the many system changes they have witnessed over the years; reform comes and goes and often disrupts our day-to-day practice. The risk is that we become cynical about what our profession can achieve in Canberra.

Perhaps there is also a selection bias. It is possible that GPs prefer more autonomy than our hospital colleagues, and although we work increasingly in teams, we may be less group-oriented or prefer smaller tribes.

Finally, doctors are trained to be leaders. We’re masters in problem solving and good at making difficult decisions, often in challenging and stressful situations.

We’re independent thinkers, skilled at arriving at our own conclusions and giving strong opinions. But we are not a profession of followers. The success of organisations depends on how well their leaders lead and how well their followers follow.

More unity

United General Practice Australia (UGPA) could connect the dots here. It’s an umbrella group for all the main groups, including the RACGP, ACRRM, AMA, RDAA. Those taking part have shown a desire to put aside their differences to a certain extent.

However, the status and governance of UGPA is somewhat vague. There is also no website or official spokesperson. But it is a start, and I would love to see this organisation be given the opportunity to grow and represent us all.

Lastly, we need to find common ground and partner with patient health organisations, as governments listen to the public more than they do to doctors.

The time has come to stop and think about where we want to go. More unity would require a cultural shift, excellent skills in following others, trust and willingness to compromise — not just from our leaders, but from all of us.

This article was originally published in Australian Doctor Magazine.

Are you a leader, a follower, or both?

Are you a leader, a follower, or both?

To lead people, walk behind them ~ Lao Tzu

When talking about the success of organisations, businesses or political parties, we often focus on leaders and leadership, but what about the followers? I’d argue that followers are just as important. There are no leaders without followers, and good leaders often have great followers. Yet, followership is an undervalued concept.

Robert E. Kelly was one of the first researchers who pioneered the theory of followership. He proposed 5 categories of followers:

  1. The sheep, who are passive and look to the leader for directions and motivation.
  2. The yes-people. They are more active and positive, but still look to the leader for direction and vision.
  3. Alienated followers think for themselves, but lack positivity. They often come up with many reasons why their leader or organisation is going in the wrong direction.
  4. The pragmatics are fence sitters. They will follow, but only if others follow first and it is clear where the leader or organisation is heading.
  5. Star followers are positive, independent thinkers. They are effective followers who will support their leaders if they agree, but will also challenge leaders if they disagree, offering constructive feedback.
Followership matrix
Followers in the upper right corner of the matrix are just as valuable as leaders. Source: In Praise of followers (Kelly, 1988)

Are you a good follower?

The success of an organisation depends partly on how well its leaders lead, but partly also on how well its followers follow. Most of us spend the majority of our time following others in one way or another. But we’re not always good at it. So how do you know if you are a good follower? And can we become better at it?

Star followers are sometimes viewed as ‘leaders in disguise’. According to Kelly, effective followers share the following qualities:

  • They think independently and can work without close supervision
  • They are committed to their organisation and to a purpose, principle, product or idea
  • They build their competence and focus their efforts for the greatest impact
  • They are courageous, honest, and credible.

Effective followers keep their leaders honest. Yet, followership has a negative connotation, almost to the point where it is seen as a weakness instead of a strength. But being a follower is more than just doing what you’re told. Kelly: “(…) our stereotype is ungenerous and wrong. Followership is not a person but a role, and what distinguishes followers from leaders is not intelligence or character but the role they play.”

Followers are leaders

In addition to the many available leadership courses, we should consider creating more followership training opportunities, focussing on topics like:

  • Improving independent, critical thinking
  • Self-management
  • Disagreeing agreeably
  • Building credibility
  • Aligning personal and organisational goals and commitments
  • Acting responsibly toward the organisation, the leader, coworkers, and oneself
  • Similarities and differences between leadership and followership roles
  • Moving between the two roles with ease.

If an organisation does not succeed, often its leaders are publicly criticised or changed. But there are alternatives. Having read Kelly’s classic publication ‘In praise of followers‘, it seems that becoming a better follower is an empowering experience.

Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.