As doctors, doctors-in-training and allied healthcare professionals, we have all completed training on communication skills, teamwork and leadership. Many training courses allow us to practice working in multi-disciplinary teams, sometimes within simulated scenarios. However, too few stress the life-and-death consequences of a team in disarray. Research has shown that maintaining a cohesive team dynamic improves patient outcomes, and many of us have seen in our own experience how badly productivity is affected when one is surrounded by in-fighting and miscommunication.
Social dynamics, sometimes also referred to as sociodynamics, is the behaviour of a group as it results from the interactions and relationships between individuals. In this article, the latest in our F|Docs series, we discuss principles you can use immediately in your working life to lead your team to a more positive and productive dynamic. Though many of the techniques described here are often done subconsciously, gaining an understanding of the fundamental principles of social dynamics can help you hone your social skills and emotional control as well as understand how to lead a group by improving morale, managing conflict, and nurturing a space of open communication.
Modelling behaviour & anchoring
Members of a team should always attempt to model the behaviour you desire to see in other team members. Lead by example – whether or not you are the “official leader”. Be the one remaining calm when other members of the team are allowing stress to push them towards conflict.
Anchoring is a simple technique that roots positive attitudes into your mind to be recalled later in stressful situations. It involves using a unique movement or action during moments of success and strength to build an association deep in your mind with the feelings and mindset of those moments.
For example, some people adopt a hand movement such as touching a specific knuckle. By using this action during times of success, you ‘anchor’ the action with the emotions and attitudes associated with victory. Later, during moments of high stress, you can ‘activate your anchor’ to tap into a previous resourceful state.
Building rapport
Whilst we often refer to building rapport as a skill we use with patients, it is also important to build rapport with other staff members, and the nature of shift work means you may have to build this rapport very quickly when moving in and out of different teams.
Remember to ask for the names of other people in the team, building rapport and improving communication. Some trusts have adopted techniques to make the names of staff more visible to facilitate this, such as named scrubs or named theatre hats.
If you believe yourself to be bad with names, don’t merely accept this as your reality. Practice memory techniques specific to remembering names and soon you’ll be pleasantly surprising people with your infallible knack for names.
Mirroring and matching are principles of building rapport by adopting similar body language to the other member(s) of the team. Mirroring is the simultaneous, real-time ‘copying’ of the body language of another person. Matching is similar, but has a time lag – you adjust your posture to reflect that of the other person, but only after a suitable delay. When done with discretion and subtlety, both mirroring and matching can be useful techniques to subconsciously communicate to others that you are on the same page.
You can also build rapport with verbal cues by matching another person’s manner of speaking. Make note of the sensory imagery they use when speaking, and reflect it back to them. Most people have a preference for one of the four modes of sensory language to describe their worldview:
Visual – for example, ‘I see what you mean,’ ‘Paint a picture for me,’ ‘Is that clear?’ ‘Let’s stay focused.’
Auditory – for example, ‘I hear what you’re saying,’ ‘That rings a bell,’ ‘I’m tuned in.’
Kinaesthetic – for example, ‘Grasp this opportunity,’ ‘Get in touch,’ ‘make contact.’
Auditory/Digital – for example, ‘I think so,’ ‘How does this feel?’ ‘Figure it out.’ ‘That makes sense to me.’
If you are able to pick up upon some of these phrases in the speech of another member of the team and echo by using phrases from the same sensory modality in your own speech, you can communicate in a way that is meaningful and comfortable for those you are conversing with, building rapport.
Sharing the mental model
Any leader needs to be crystal clear with their communication. Ensure that everyone else in the team is on the same page at all times. This should be done during handovers; particularly if you are using the SBAR (Situation, Background, Assessment, Recommendation) rapid handover tool, where the Assessment and Recommendation prompts should allow you to share your mental model of the situation with the clinician to whom you are referring; and allow them to share their expectations of next steps.
However, when working in large teams where lots of people are working on different tasks towards a common goal, it is crucial to ensure complete clarity on the common goal. Remember that asking questions if you are unclear on your role or task is not only acceptable, but essential for patient safety.
De-escalating conflict
Conflict is bound to happen from time to time. A good leader should employ techniques to quickly diffuse and de-escalate conflict wherever possible.
If the conflict is arising from members of the team feeling they are not being adequately listened to, try using active listening, both in the moment of stress, but also when things are calm. Active listening involves signalling that you are truly listening to the other person’s point of view (rather than simply waiting for your own turn to speak!) by providing non-verbal ‘feedback’ to the speaker such as nodding, keeping eye contact, and encouraging cue words or sounds (like ‘ok,’ ‘yes,’ or simply ‘mm’). And don’t forget to actually listen, and prove you’ve been paying attention by repeating key words or phrases in order to clarify what the other person meant.
Finding points of agreement is another useful way to de-escalate conflict. Whilst conflict, by its nature, often includes areas of disagreement, you’ll often find substantial areas of agreement. By honing in on these areas of agreement you can guide conversations to a more positive atmosphere that is more conducive to producing an agreement. It is always useful to acknowledge the other person’s position and point of view, even if the conclusion goes in a different direction.
As previously mentioned, modelling calmness is key in ensuring an overall calm team dynamic, and developing cohesiveness between team members. Particularly in situations of conflict, it is appropriate to be conscious of your body language and other non-verbal cues, and actively take steps to use non-verbal communication to convey this calmness. In conflict situations, assess your own body language and take steps to relax where you can – uncrossing arms and legs, relaxing shoulders and adopting a more open stance. Tying these non-verbal cues into active listening is a powerful combination that can act to calm conflict.
This is one situation in which matching and mirroring body language may not be the most appropriate step!
Don’t underestimate the power of stopping a conversation if you feel the level of conflict is becoming unacceptable. Stopping the conversation for all parties can allow you to reset the tone and return to a level of civility.
Creating Productive and Controlled Conflict when Necessary
It is important to remember that even in situations in which conflict is occuring, our responsibility as healthcare professionals is to the best interests of the patient; so if you feel that the wrong decision is being made you should speak up. This can be extremely difficult to put into practice, particularly if you are questioning the decision-making of more senior members of the team. One approach that can be used in these situations is graded assertiveness. Graded assertiveness is the process of stepwise escalation of verbal interventions into a situation about which you are concerned. One such technique that can be used to address any concerns you may have is called the PACE technique.
The PACE technique
The PACE technique consists of four “grades” of conflict, starting with the most minor and gentle. Being familiar with these basic categories may help you judge the appropriate level of assertiveness you should employ in a given situation, particularly if your personality type naturally prefers to avoid conflict.
1. Probe
This is the lowest level of assertiveness, and involves expressing concern in the form of a question; for example, ‘I’m not quite sure why you’re doing that – could you explain?’
2. Alert
If you need to continue giving push-back, alert your colleague to your own uncertainty about the situation. For example: ‘Could we repeat the primary survey, please? I have concerns over continuing this way,’ or ‘I should alert you to the fact there is something that you may not have considered about this case.’
3. Challenge
The actions of the other person are more explicitly challenged, particularly with reference to the safety of the situation. Example: ‘Please stop what you’re doing for a moment. I think we need to consider if this is the safest way to manage this patient.’
4. Emergency
This is the highest level of assertiveness and should be used if other approaches have failed and you are seriously concerned about the actions of another member of the team. Communication should be as clear as possible. An example would be: ‘Stop what you’re doing.’
Conclusion
Social dynamics and how they can be useful to members of medical teams is discussed further in Medics.Academy’s Leadership in the Crash Team video course. It’s part of Medics.Academy’s new F|Docs course library, which provides video courses on clinical scenarios you may encounter as a foundation doctor, as well as the ‘hidden curriculum,’ with videos on understanding your contract leadership as an FY doctor and more.
Have you ever used any of these techniques in day to day life? Tell us about your experiences by emailing our blog team at anna.harvey@medics.academy.
Want to talk to other students who are about to start the foundation programme in August? Join our Facebook community of final year medics and junior doctors here.
About the Author
Anna Harvey is a soon-to-be final year medical student and
Medics Academy Fellow. She is interested
in women’s health, education and journalism.