Tribes, tribulation and the elephant in the room

If we want to change bullying and abuse within the profession we have to move our tribal cultures to the next level.

The medical profession has come a long way in the past 25 years, but sadly seems to have difficulties eradicating issues of humiliation and abuse of colleagues and medical students.

One option to fix the problem is to make junior doctors and students more resilient, which seems like a good principle that is currently being applied by other organisations in other areas. Fore example, Beyond Blue has released a practice guide for professionals to help children deal with the adversities they experience early on to prevent mental health conditions later in life.

But teaching resilience alone is not enough.

Another option is to increase awareness and understanding among senior doctors and educate them about bullying, discrimination and sexual harassment. A good example is the mandatory education module, ‘operating with respect’, from the Royal Australian College of Surgeons (RACS).

Elephant in the room

The elephant in the room, however, is our culture – or at least certain aspects of it.

David Logan, a professor at the University of Southern California, said it a few years ago in his New York Times bestseller ‘Tribal leadership’: on the tribal culture scale of 1-5, most professionals around the world score a meagre three. This includes lawyers, doctors and professors.

According to Professor Logan and fellow authors John King and Halee Fischer-Wright, a stage-three culture or tribe is built around knowledge, personal accomplishments and individual expertise. The emphasis is often on winning. Although there may be talk of teamwork, the group interactions usually resemble those of a master-servant relationship.

The mantra of a stage-three culture is, ‘I’m great’. The language used is often along the lines of, “I’m good at my job,” “I try harder than most,” “Most people can’t match my work ethic,” and key pronouns used are ‘I,’ ‘me,’ and ‘my’.

This creates several problems. Professionals operating in this type of culture often feel unsupported, undervalued and frustrated, and those around them feel like a support cast.

Stage-three cultures cannot be fixed, but they can be abandoned. The answer is to upgrade the culture and move away from the ‘I’m great’ mantra to ‘We’re great.’

The next level

Instead of relying on personal achievements and expertise, at stage-four it becomes all about the accomplishments of the group. Partnerships, communication and transparency are recognised as essential ingredients for success. This is a healthier environment, in which people feel more valued and supported.

Professor Logan’s top level is stage-five. Highly functioning teams focus on maximising achievement – not in competition with other groups or tribes but with what’s possible. Stage-five teams can work with anyone.

Australian research has shown that hierarchical and stereotype behaviours largely dissolve when health professionals are working in a more collaborative, multidisciplinary environment.

Resilience training and anti-bullying education are essential, but if we really want to make a difference we have to move our tribal cultures to the next level.

This article was originally published in newsGP.

Critical thinking in your team

Some time ago I was at a meeting with a great team of doctors and managers. We wanted to solve a particular difficult problem. The issue was discussed at length and we decided to invest time and money to improve the situation. Months later our group’s solution turned out to be a failure. We looked at each other in disbelief and asked: Why didn’t we see this coming? Did we really make this poor decision?

There are many advantages to working in a group or team, but there are also risks. When we’re in a group we often tend to avoid conflict and follow the leading opinion. This ‘groupthink’ phenomenon has lead to many historic disasters such as  the explosion of the Space Shuttle Challenger and even the Vietnam War. Groupthink stops critical thinking and may lead to an unhealthy decision-making process. It can happen everywhere, including social networks such as Facebook and Twitter where group loyalty or group pressure may prevent airing of alternative ideas.

Last week I was watching World War Z. In this movie Brad Pitt fights the latest pandemic: a zombie apocalypse. Ten days before the pandemic is in full swing an intelligence report mentions the emergence of zombies. “Zombies? You’ve got to be kidding me,” was the response. The report was dismissed. Except… in Israel, where the intelligence service followed the ‘tenth man rule’: when nine people agree, one person – the tenth – has to prove them wrong. In the movie this person convinced the Israeli intelligence service to prepare for a zombie war – and Brad Pitt of course finds a way to save the world.

I’m not sure if the tenth man rule is real or not, but in World War Z Israel implemented this decision-making model because the Jews had been caught out too many times in history, for example during the Second World War and the Yom Kippur war. The signs on the wall were ignored by decision makers, and Israel was determined not to let this happen again. Read more in this excellent post: What World War Z Can Teach You About Critical Thinking.

There are many other ways to make better group decisions, such as looking at the risks of each decision or wearing different thinking hats. A good chair encourages critical thinking. Researchers have suggested ways to avoid groupthink. Here are 8 useful tips from psychologist Irvin Janis (borrowed from this article):

  1. Leaders should assign each member the role of ‘critical evaluator’. This allows each member to freely air objections and doubts.
  2. Leaders should not express an opinion when assigning a task to a group.
  3. Leaders should absent themselves from many of the group meetings to avoid excessively influencing the outcome.
  4. The organisation should set up several independent groups, working on the same problem.
  5. All effective alternatives should be examined.
  6. Each member should discuss the group’s ideas with trusted people outside of the group.
  7. The group should invite outside experts into meetings. Group members should be allowed to discuss with and question the outside experts.
  8. At least one group member should be assigned the role of Devil’s advocate. This should be a different person for each meeting.

How does your team encourage critical thinking?