Some teams appear to come together effortlessly, while other groups
cannot seem to coalesce even with major interventions devoted to
the task. The process of forming functional teams can be one of the
hardest tasks within an organisation. Becoming a successful team happens more easily when members establish good communication patterns and acknowledge the qualities and abilities of colleagues. At that point, a common purpose seems achievable. But, although it sounds very straightforward, the
unfortunate reality is that teams that are both happy and successful
are uncommon. This is not due to mutual exclusivity of these two markers, but because excellent teams are rare. Therefore, outstanding teams must be cherished and further examined for clues around what it was that allowed the group to coalesce.

Perhaps, rather than a hospital team, we should consider what is required in the formation of a successful sporting team. Within sports, success is more easily defined, and the necessary ingredients appear more visible. Sports teams rarely achieve success without unified commitment to a team goal and positive regard for all teammates. Overly individualistic self-focus, or a dominant ego, weakens the team ethos.
Medical groups can be a little like high-level professional sports
teams. Most of the individuals are talented operators with great skill
and self-belief. Each group of doctors will belong to a team or unit
that has joint responsibility for many patients. Within this structure,
however, are also many instances of individual decisions or actions
that a particular doctor can take. These outcomes, for instance with
surgical procedures, can also be easily tabulated and analysed, as
can the overall departmental data. Cricket seems to be the sport that most closely parallels specialist medical teams within hospitals. As previously alluded to, while a cricket team consists of 11 team-mates, in some people’s eyes the
team is actually a group of 11 individuals. Players are judged on
their individual achievements (such as runs scored), and the team’s
total score is cumulative of each player’s individual tally, rather than
coming from joint team achievements. Indeed, each delivery bowled
is essentially a one-on-one contest. Within the construct of the sport
of cricket, individual statistics are highly scrutinised.

However, many of the greatest bowlers of all time, the highest
wicket-takers, largely operated in tandem with a particular bowler
from the other end. This other bowler was not as successful in terms
of wickets taken but played a different role. This ‘less-successful’
bowler kept pressure on the batsmen through tight reliable bowling
which restricted run-scoring. The build-up of pressure from slow
scoring often led the batsmen to take more chances against the star
bowler and resulted in them losing their wicket. In this instance, who
deserves the glory? The wicket-taker? Or the bowling partnership? Or perhaps the fielders who saved runs, also generating pressure? Tight fielding, saving runs, and taking catches all add to team success.

Within a hospital, who deserves recognition? Should it be the surgeon performing an operation? Attention could also be directed to the role played by the anaesthetist maintaining the patient’s oxygenation and life support while anaesthetised, or the theatre nurses handing the appropriate instruments at exactly the right moment. There is also the critical role of the GP who first diagnosed the problem, and the dietician optimising the patient’s nutrition status to facilitate healing. Clearly this list goes on. There is obviously a large group of people, constituting a complex system, involved in every episode of care for each patient. The overarching goal of the organisation is for the patient to be cured, to heal, and to recover. The system by which patients receive care requires the input of many individuals with different complementary skills. What is the term that we use to refer to this system? Most would call it a team. Just as with sports, medical team success is dependent on many factors and many people, not just one. If any of the roles are not performed well, the outcome is less successful.

Returning to the cricket analogy, what if the team is not united
but still has several established world-class performers? Recognised
champions or stars who make the newcomers ‘earn their stripes’
before begrudgingly accepting and integrating them into the team.
In this scenario, an inexperienced player who does not feel valued
will be more nervous, and therefore will most likely not perform
at the peak of their abilities, perhaps leading to a dropped catch.
However, in a team where a young player is immediately accepted
as a full member upon selection, with their qualities recognised, the
debutante will feel more relaxed and possibly able to stretch a little
more, enabling a difficult catch to be taken. Another wicket for the
star bowler, and the resultant outcome of team success.

A saying often heard in youth sports is, ‘There is no ‘I’ in team’, which implies that one’s own agenda and desire for personal recognition should be set aside and the team goals be considered paramount. While this may be true in team sports, is it so in medicine?

If we consider medical teams in a similar light as a cricket team,
perhaps the most venerated surgeons, for example, would be the
‘high-flyers’. Within this environment, like cricket, if the whole team
is not performing optimally and smaller steps are missed, it impacts
team success. And then the most vaunted performers will be at risk of
poorer outcomes for their patients. Unfortunately, within medicine,
there can be an external sense that self-interest is causing individuals
to compete against other members of their own team. This reduces
success for both the individuals concerned and for the collective.

Perhaps a better saying that allows for individual goals and striving for personal excellence while still recognising the need for tight and supportive team bonds and an overarching desire for group achievement is:

“The strength of the wolf is the pack,
and the strength of the pack is the wolf.”