By Jeffrey Myers, MD | December 24, 2018 | Department of Pathology Updates, Vol 4 (3)
Welcome to the latest edition of DOP Updates, a periodic email sent to members of our Department of Pathology (DOP) and interested stakeholders to keep us all on the same page when it comes to topics of common interest. Today’s edition is also [linked] as PDF file to preserve formatting across diverse mobile platforms. Please send me a note if you have comments, concerns or stories to share with me or others in the next edition of Updates.
Teamwork – Sometimes it Begins with Just One Voice
We often pride ourselves on teamwork whether it be in the context of the care we provide for others every day, the ways in which we solve problems both big and small, and the ways in which we value the ideas and contributions of one another. It is perhaps our chief tactic in our quest to transform health through bold and innovative education, discovery, and service.
And yet our increasing attention to the power of teamwork and collaboration has a downside. In a study summarized in a 2016 Harvard Business Review article, Adam Grant and colleagues found that the time spent in collaborative activities by managers and employees has ballooned by 50% over the last two decades. And in most cases, 20% to 35% of the value-added collaboration comes from only 3% to 5% of employees. In our daily work that means we now spend about 80% of our time in meetings, on the phone, and responding to emails which have the potential to erode individual performance and increase the risk of stress, burnout, and turnover. Grant divides the resources invested in collaborative activities into informational, social and personal domains. Informational (knowledge and skills) and social (awareness, access, and position) resources can be shared without depleting a teammate’s supply, but time and energy (personal resource) are finite. He cautions that “each request to participate in or approve decisions for a project leaves less available time for that person’s work.”
This cautionary tale should influence whether and how we build teams to solve problems, including those that cross our silos whether they be departments, divisions, subspecialty-based services, laboratories or neighborhoods. Working with others outside of our own parochial and proprietary views to first understand the problem from a place of authentic inquiry and curiosity is powerful, but it is done most effectively when built on a platform of respect for the time and energy of the “extra miles” who live among us. When done well we imagine something akin to the well-practiced teams focused on problems and tasks for which there is a clearly defined goal and a scope that does not deviate from their purpose. We can point to examples in health care but the principle is perhaps demonstrated more dramatically in this extraordinary clip of a Formula 1 crew achieving a pit stop in less than 2 seconds! Clearly, every team member understands the expectations for a role narrowly defined and for which they have highly subspecialized knowledge and skill. And while each team member comes to the table with an understanding of expectations and a special set of skills for which they are uniquely qualified, collective success is predicated on hours of practice and coaching to make sure that each moving part is seamlessly integrated with its neighbor.
The Formula 1 pit crew may be our idealized mental model of teamwork, but we are surrounded by examples of self-assembling teams banded together around a common cause. Self-assembling teams have an enormous capacity to do good when drawn to common purpose in response to a single voice determined to make a difference. Was thinking about the differences between highly functioning teams like a Formula 1 pit crew and self-assembling teams of the sort perhaps more common in our workplace as I read a story on NPR (A Weed Grows in Toledo, And Residents Hang Their Christmas Hopes Upon It) celebrating the power of a single act of kindness to inspire others in common purpose. It began with two pieces of tinsel draped across a weed growing through a crack in the concrete at a busy intersection. Now the Toledo Christmas Weed has become a local icon that symbolizes the spirit of generosity common to this special time of year. This symbol of good cheer has translated into unprecedented charitable donations of clothing, blankets, and food for those who are in need.
As is true in any story that relies on the goodness of strangers there are those who will see something less beautiful and who, in this case, tried to steal and disfigure the fruits of others’ labors. But [spoiler alert!] they did not succeed! In a tweet the Toledo Police Department said,
We did a little investigating & the #ToledoChristmasWeed isn’t THAT kind of “weed.” All is good & merry, no grinches here, just please BE SAFE & obey traffic laws if you are driving by or stopping to take pictures.
The Toledo story, in which a weed is transformed into shared warmth and food, is reminiscent of an old folk story referred to in a variety of ways using a variety of terms but most easily discovered on Wikipedia as Stone Soup. Like the story in Toledo, it speaks to the power of collaboration to transform something that is seemingly worthless into something with the power to nourish basic human needs. The fact that this story has multiple versions reflecting diverse cultural influences speaks to the universality of sharing and collaboration as fundamental values that speak to the better parts of the human experience. The version shared on Wikipedia follows.
Some travelers come to a village, carrying nothing more than an empty cooking pot. Upon their arrival, the villagers are unwilling to share any of their food stores with the hungry travelers. Then the travelers go to a stream and fill the pot with water, drop a large stone in it, and place it over a fire. One of the villagers becomes curious and asks what they are doing. The travelers answer that they are making "stone soup", which tastes wonderful and which they would be delighted to share with the villager, although it still needs a little bit of garnish, which they are missing, to improve the flavor.
The villager, who anticipates enjoying a share of the soup, does not mind parting with a few carrots, so these are added to the soup. Another villager walks by, inquiring about the pot, and the travelers again mention their stone soup which has not yet reached its full potential. The villager hands them a little bit of seasoning. More and more villagers walk by, each adding another ingredient. Finally, the stone (being inedible) is removed from the pot, and a delicious and nourishing pot of soup is enjoyed by travelers and villagers alike. Although the travelers have thus tricked the villagers into sharing their food with them, they have successfully transformed it into a tasty and nutritious meal which they share with the donors.
It has been a year of collective successes too numerous to count as many of those engaged in our clinical mission relocated to NCRC and others remained at UH, Mott, CVC, and the medical school in anticipation of a major renovation in our hospital-based operations. Along the way, our teams have transformed weeds into something beautiful and stones into soup. But it was not without cost and unanticipated challenges that have tapped the time, energy, and problem-solving skills of many while eroding for some a sense of purpose and joy in the important work that we do. This has been wrapped in institutional challenges increasingly common in health care including strategies to fund a future that sustains our position as the place that others imagine when it comes to transforming health through bold and innovative education, discovery, and service. And on a national level conflict and disagreement have become our new normal, turning teamwork and collaboration with those who think differently from ourselves into a vulnerability that subjects us to the harsh judgments of our peers who are increasingly suspicious that diversity may not be the thing to which we should aspire.
As 2018 – a year of great change, successes, challenges, threats, and opportunities – draws to a close it is a good time to ask what we can do individually to make 2019 a better year for all of us. Perhaps it seems that individual contributions have less to add in an age in which collaboration is valued differently than it might have been before. To that, I would say that many great stories that speak to the durable power of collaboration begin with one voice. In a June 2015 interview with Malala Yousafzai, Jon Stewart hears first hand from a Pakistani born activist the power of one voice. Her journey began as a young girl when, in 2008, the Taliban banned education for girls in her town. Her father was a teacher and so perhaps her passion for education came naturally as she publically advocated for the rights of girls and women to learn. In 2012 she was targeted by a masked gunman who boarded her school bus and shot her in the head. She was transported to England where she underwent a number of life-saving surgeries as the rest of us looked on with a mixture of horror and awe at how one person had captured the attention of the world through her own individual courage and sacrifice. Out of that was born the Malala Fund which makes possible education for girls in parts of the world where it might otherwise remain forever out of reach. For her work, she became the youngest recipient of the Nobel Peace Prize which was awarded to her in 2014 at the age of 17. And it began with one voice, an 11-year-old girl in a small town in Pakistan who was determined to make a difference. And hers is the story we know. There are others whose names will never merit a Wikipedia page but who still make a difference in the lives of those around them every day. As Malala said in her Nobel Peace Prize speech, “I tell my story, not because it is unique, but because it is not. It is the story of many girls.”
In his eulogy for his brother, Ted Kennedy read from a speech that Robert Kennedy gave in South Africa in 1966 to a gathering of young people on a day of affirmation.
“Few will have the greatness to bend history itself, but each of us can work to change a small portion of events, and in the total of all those acts will be written the history of this generation. Each time a man stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice, he sends forth a tiny ripple of hope, and crossing each other from a million different centers of energy and daring, those ripples build a current that can sweep down the mightiest walls of oppression and resistance.
Ted Kennedy ended his eulogy with one of the quotes that have stuck with me more than any other when it comes to the power of one child, one woman and one man to change the world.
If we can imagine what’s possible, driven only by our twin goals of doing the right thing for the right reason and doing better tomorrow what we may already do well today, we can change the world. Each individual contribution a tiny ripple that combined with the power of others stands to build a current ability to overcome whatever stands between us and our vision for tomorrow.
Whatever you celebrate and however you spend this special time of year, may you find something to celebrate and a sense of wonder as you anticipate the birth of another New Year. It is my sincere wish that 2019 proves for you a year of possibilities, a year of wonder, a year of hope, and a year of unanticipated opportunities to make a difference, whether as one voice to which others listen or as a team member dedicated to world-class performance in the service of others. And as you change the world, let’s be careful out there as always.
Happy New Year!