- Army doctors in the field work in a microcosm of contradictions
- Boredom can set it easily among highly motivated people, managing this is essential
- Tensions within teams should be accepted as inevitable
- Creating psychologically safe environments key to making better teams
Effective teamwork should be straightforward: provided people are capable, all they need is something to preoccupy them other than themselves. Something more important than themselves.
For surgical teams in Camp Bastion, Afghanistan, this isn't usually hard to do. When resources are stretched, trauma bays full, and the injuries life-threatening, few teams anywhere else would come close to matching their effectiveness. Rarely does one see a better balance struck between routinization and flexibility, professionalism and compassion.
The problem is that it isn't always busy, and the unpredictability of combat doesn't allow them to fully relax even during quiet periods. Besides there is little else to do to take the edge off. Boredom sets in, and few things are more destabilizing than boredom. High performers after all thrive on being productive. Work is their opium.
This either/or relationship signifies much of their lived experience, as I discovered during a six-week deployment with combat surgeons in Helmand, and two months of observation of pre-deployment, in cadaver labs, classrooms, simulators, and barracks.
Like many of you, these surgeons live examined lives. They routinely compare themselves to others and expect this to be reciprocal. They are purposeful and tenacious. They are hungry for feedback, their achievement their principal addiction. What makes them good can make them difficult too.
While on tour, their world is a microcosm of contradictions: they compete even as they cooperate, they take pleasure in complex cases yet feel guilty about wishing for more of it. They tend to find their work meaningful yet are acutely aware of a sense of futility in treating Afghans who, by protocol, are transferred to local hospitals where their chances of successful recovery or even survival are often greatly reduced.
They prize perfectionism yet recognize the premium this places on fault-finding and on their, and others, willingness to own up to mistakes. Their tenacity can drive colleagues to exhaustion. Their restlessness allows them to be productive but risks them becoming easily bored. They understand the importance of diversity in teams, yet are annoyed by the range of behaviors and opinions diversity produces. Boredom can exacerbate these tensions enormously and destabilize ordinarily effective teams.
Why is this important for you? First, because the management of boredom is as important as that of resource allocation during busy periods when demand outstrips supply. Perhaps more so. Second, because even highly effective teams are likely to feel dysfunctional for at least some of the time as a result of these contradictory tensions. And one needs to be extremely careful not to confuse what feels dysfunctional with what really is dysfunctional.
Like most things this is easier said than done. A quick-and-dirty distinction between healthy and unhealthy tension is to distinguish between the stuff that's out in the open and what is not. The unhealthy bits tends to lurk in musty corners, such as gossip or private politicking or water-cooler attempts to belittle the work of others. Healthy tension often expresses itself in banter, teasing or impromptu competitions, like wheelchair hockey or a game of soccer.
Also, one must be careful not to fall prey to a common assumption, namely that of harmony as a precondition of team success. This assumption helps explain why so many invest so much in making sure team members "get along", not realizing that research strongly suggests that harmony is more likely to be a consequence, than a cause, of performance.
As the late Richard Hackman pointed out, even if interpersonal difficulties occasionally undermine team performance, it does not follow that the best response is to help team members fix their relationships. It is often far more effective to give them something challenging to do. Something to feel good about collectively.
Of course there are other ways of resolving tensions. Make people understand why tensions are a natural part of the fabric of team life, what behaviors are permissible at work, and which are not. Or one can take a leaf from Stan Preczewski's book. As chief coach of the U.S. Army Crew, he forced his dysfunctional varsity rowing crew to wrestle each other four days before a major race. It was a bold decision in that wrestling risked injury, but worked wonders in restoring a sense of confidence within the crew by allowing each to experience first-hand how strong and competitive the others really were.
Dialogue is another option. However, this is only ever likely to be effective if those involved feel psychologically safe, meaning they will not self-censor for fear of being seen as obstructive, negative, incompetent, not a team player, or for putting an otherwise amicable working relationship at risk. Medicine has particularly well-documented cases of self-censorship as having directly contributed to major incidents.
So how does one solve a problem like self-censorship? One way, clearly, would be to make the relevant environment feel safer psychologically, for example, by encouraging dialogue, by physically de-ranking, by insisting on rank-blindness, by relating past accounts of courageous behavior in face of opposition, by welcoming "donkey questions", or questions that those doing the asking should probably know the answer to, and generally by helping team members see the merit of abandon.
Or one could follow the example of aviation and, more recently hospitals, in implementing checklists, or lists of steps to take en route to accomplishing certain procedures and the sort of things everyone has pat down. Here junior team members are required to intervene when they see doctors skipping a step, however mundane, during a procedure. It is their job to do so, and possibly the next best thing to psychological safety.
The management of psychological safety and boredom are, I suspect, the most underrated, yet also most powerful, means to effective teaming.