Tap Into Your Team’s Superpowers

By Stuart Foxman

In the past, Dr. Brian Goldman, an ER physician at Mount Sinai Hospital in Toronto, admits he was “a solo act.”

“I didn’t know how to ask for help and didn’t take kindly to appearing as if I needed it, to the detriment of my own well-being and perhaps that of my patients,” he writes in his new book, The Power of Teamwork.

Dr. Goldman, who hosts CBC Radio’s White Coat, Black Art on the culture of medicine, has authored four books. His previous one, The Power of Kindness, examined the importance of empathy. Now, he has turned to the idea of teamwork as a way to foster healthier patients, happier professionals and more efficient healthcare operations.

Why focus on teamwork as a key to those outcomes? In an interview with Dialogue, Dr. Goldman described how team wisdom and team cognition can be sidelined in medicine.

He says for doctors, the “I alone” approach isn’t about ego or narcissism. If anything, it’s the opposite. In this profession, Dr. Goldman suggests there can be feelings of shame if you have to rely too much on others, like you don’t belong. That can lead to distrust of the team ethos, partly because the buck stops with you anyway.

As he wrote in his book: “In healthcare, accepting help is sometimes seen as a sign of weakness, and offering help is seen as a veiled accusation of incompetence.”

Yet, there can be an illusion that teamwork still occurs. Dr. Goldman cites a survey of operating room personnel at 60 U.S. hospitals, which asked them to rate the quality of collaboration and communication they experienced. Surgeons said it was “high” or “very high” 85 percent of the time, while nurses came in at 48 percent. “Clearly, there’s a disconnect.”

Dr. Goldman told Dialogue there’s a big difference between “team” and “group,” and that people in health care can confuse the two. With a team, everyone:

• works cohesively towards common goals;
• has a “superpower” that’s recognized;
• feels comfortable to speak up; and
• volunteers whenever anyone else on the team needs help.

“A group is just short-form for a group of individuals,” says Dr. Goldman.

To see a highly efficient team in action, look at the sky. He writes about Canada geese flying in a V-formation, which makes it easier to reduce wind resistance, coordinate changes, communicate and save energy. The geese also take turns at the front. With animals, he says, teamwork is instinctive; for people, it’s a choice.

Dr. Goldman recounted a time he made that choice. An older man came to the emergency department with shortness of breath, an irregular heartbeat and failing kidneys. His lungs sounded wet, indicating heart failure. Dr. Goldman ordered medications to stabilize the man’s heartbeat and reduce his potassium level, then started seeing other patients.

Soon, the man’s blood pressure fell dangerously low, his heart was close to stopping and he developed seizures. By the time Dr. Goldman rushed back, a younger colleague had taken charge. Around the cubicle was a team of attending physicians, residents, students, nurses and respiratory therapists. Dr. Goldman said the colleague who had responded wanted to defer to him. Other times, that would have happened. Not now.

“Instead of feeling embarrassed by the idea I’d failed as a leader, I felt relieved I had a great colleague to back me up”

Dr. Brian Goldman

“Instead of thinking about myself, I found myself thinking about the team. I saw a young, yet astute leader, communicating the plan to a room full of competent professionals and learners — some with vast experience and some just starting out. I knew what to do. ‘Why don’t you lead the team and I’ll whisper my suggestions into your ear,’ I told her.”

A resident intubated the patient and Dr. Goldman focused on the potassium level. “Everyone on the team did their jobs superbly. We got the patient stabilized and into the ICU in record time. Everyone felt a shared sense of accomplishment.”

And how did Dr. Goldman feel? “Following the resuscitation, my colleague apologized for appearing to take over without asking me. I told her she had things under control and it would have been detrimental to the team to have changed leaders. Instead of feeling embarrassed by the idea I’d failed as a leader, I felt relieved I had a great colleague to back me up. I felt elated to practise emergency medicine as part of a team.”

To illustrate the power of teamwork, Dr. Goldman draws in examples from other sectors in his book. He tells the story of Niall Downey, a commercial airline pilot in Ireland, who was a cardiothoracic surgeon before becoming a pilot with Aer Lingus.

Downey touts crew resource management (CRM), a model for collaboration between all personnel — pilot, co-pilot, cabin crew, ground engineers, air traffic controllers, etc. — to ensure safety, cut errors and boost efficiency. With CRM, everyone offers their own expertise and perspective. While the pilot is in charge, the broader crew has input that’s valued, information flows freely and troubleshooting is shared. It all helps Downey, as the captain, to solve problems and make decisions.

The CRM model is used in other high-risk, high-stakes fields as well. Downey sees the relevance in medicine. He said CRM formed his guiding principles, so much so that he started a company called Frameworkhealth Ltd. to bring its pillars to healthcare, taught by pilots.

Dr. Goldman says that, in medicine, teamwork is “a cognitive journey from me to we.” Patients and their families can also be a critical part of the team too. Frequently, they’re not seen that way.

“As happens all too often, there’s very little communication, a rapid download of information and not a lot of follow-up. That’s the beginning of the treatment plan beginning to unravel. A team-oriented culture will place the consumer somewhere in the middle,” says Dr. Goldman.

He hopes the lessons in his book will help health care professionals to go from solo artist to team player. That can create exceptional experiences for patients and doctors alike.

“Medicine has become so complex that it’s hard to deliver proper clinical care and implement a treatment plan without a team,” he says. “You need to learn to play well in a team.”