Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

We're Great: Why Tribal Culture Matters in Hospitals

1/22/2015 12:34:16 PM | 5 comments

I'm going to be really honest here. I didn't become an emergency physician in order to interact with patients or change lives or make a difference. Not that those aren't incredibly good and worthy reasons to become a healthcare professional. But they weren't driving forces for me personally.

I became a physician because I loved the practice and the study of medicine.

When people would ask me what I enjoyed most about my job, I would answer, “everything!" I loved the pace, the sounds, the smells (well, not all the smells). I loved managing multiple critical patients at the same time, dashing between a trauma in room 1 and a code in room 2. I feel great — truly alive — while doing my job.

Love of medicine for medicine's sake served me well for many years. But then I had a not-so-comfortable experience that made me realize something important was missing from my personal practice.

Last year, at my group's leadership retreat, we were tasked with reading Tribal Leadership by Dave Logan, John King, and Halee Fischer-Wright. Although the title promised excitement and adventure, I was underwhelmed. Tribal Leadership felt like every other management book I’d read over the years — someone else’s version of how to lead, influence and motivate.

The premise of Tribal Leadership is that organizations (and the people within them) operate at five stages of tribal culture:
  • Stage One: "Life sucks." Tribe members are alienated from one another and may actively undermine the organization's goals.
  • Stage Two: "My life sucks." Members are apathetic, unengaged and may resist new initiatives and change.
  • Stage Three: "I'm great." Members act as "lone warriors" seeking personal achievement and fulfillment. (This stage characterizes about half of the organizations the authors studied.)
  • Stage Four: "We're great." Members see themselves as a team with shared goals that can best be realized by working together.
  • Stage Five: "Life is great." A tribe operating at its full potential pursues groundbreaking innovations — and possibly changes the world.
During the second day of the retreat, we regional directors went around the table and shared how this model fit into our personal management styles. Many of my colleagues talked about their exciting evolutions toward a more team-based, patient-centered practice. “We’re great!" they said of their teams. Since adopting this more collaborative approach, many were feeling more fulfilled than ever in their careers.

As I listened to them share, I started to feel a little uneasy. Not one of my colleagues mentioned getting any personal satisfaction out of practicing medicine. Instead they focused on the patient and what a privilege it was to care for them. In fact, we spent a big chunk of the session discussing the ins and outs of patient-centered care, the importance of establishing rapport.

While I certainly wasn't opposed to any of this, I felt that my own motivation was equally valid — and I seriously doubted I was the only one. After all, you don't pursue a career that requires four years of hard science classes and a grueling multi-year residency because you're a "people person." If your main career goal is to help your fellow humans, there are certainly easier ways.

And let's face it: Patient interactions don't always go well, especially in the ED. If you don't truly love what you do, how do you cope with noncompliant patients? Those who actively resist your help? How will you react when a patient screams, "I hate you"? Or god forbid, sues you?

I felt these important points were being overlooked. So while I normally don't get too personal in these sorts of workshops, I raised my hand and I laid my cards on the table.

I told the group that I went into medicine not for the patients but for me. I justified my position by saying that the key to longevity in a stressful environment is to love your job. While I doubted anyone would pat me on the back and agree wholeheartedly, I was sure at least a few others in the group would feel the same way.

To my surprise, not one of my peers agreed. No one defended my position. Their responses could be fairly summarized as, “So, it’s all about you!”

Their reactions really irked me. I felt deflated and selfish (and vowed silently never to speak up again).

However, after taking a few weeks to reflect, I decided to give this "tribal" approach a try. I resolved be more patient-centered and less self-centered in my professional interactions.

The results were truly surprising. I began to love parts of my job that had never seemed particularly loveable. Putting myself in the patient's position allowed me to see our conversation in a different way. The medicine was no different. It was my attitude of service that changed.

At first, I figured the transformation was internal, but my colleagues noticed it too. Nurses came to me saying how well I’d dealt with the difficult patients. Hospitalists told me their patients had raved about their ED visits. I even had one of the community physicians tell me his patient had mentioned me by name when complimenting the ED. And all of this came from a tiny adjustment in my perspective.

Fast-forward to our practice's 2014 annual conference, where Carrie Kish, one of the people who developed the concept of Tribal Leadership, delivered the keynote. As she discussed the Five Stages of Culture, I reflected back to my experience at the retreat. I realized I had graduated from Stage 3 ("I’m great") to Stage 4 ("We’re great"). The “we” was me and the team I work with — which included the patients.

I still believe the key to career longevity is to love your job. I still love mine, but I love it in a different way. I share this story because I know there are those who love their work but who can be more fulfilled — those who can move from “I’m great” to “We’re great."

It takes very little effort — just a small change in attitude, one interaction at a time. Believe me. If I can do it, anyone can.

Annette Avila-Muñoz
Great heartfelt read for change. Thank you.
3/26/2016 12:20:34 PM

Anne Bruce
You have described the evolution of doctor-patient relationships Scott. As the saying goes: "I am you. You are me." As we grow older all of these meanings, as they pertain to culture, teams, business, etc., shift and evolve. Indeed, a "power shift" is taking place and will rock the world into the next decade specifically. Thanks for this insightful piece.
1/24/2015 9:50:01 PM

Cyndy Flores
Interesting to see the change since hearing you talk at the retreat. Thanks for the article!
1/24/2015 4:18:23 PM

Michelle Willis
Thanks for sharing, good read!
1/23/2015 8:27:24 AM

Kevin Riggs
Great article, thanks for sharing Dr Lopata!
1/23/2015 8:12:09 AM