Family Medicine Vital Signs

By SusanPohl, MD

Team performance, when executed with precision, can be breathtaking.  Listening to the Utah  Symphony perform Gustav Holst’s Planets, watching the final drive in a National Football League comeback win, or participating in a complex obstetrical delivery in the hospital remind me of the skills needed to work on teams: effective communication, precisely developed expertise, and seamless cooperation. I train medical professionals that work on teams.  Training professionals to work on healthcare teams is complex.  Despite the complexity that we see in well-functioning team performance, management training frequently teaches the concept that “culture beats strategy.”  Research in healthcare training forces me to reject this dichotomy. What strategy can we use to develop a team’s culture? One of the most powerful tools that shapes culture is vocabulary.

Culture is simply “a set of shared attitudes, values, goals, and practices that characterizes a group” (Merriam Webster).   Culture can define a national or ethnic group.  Schools, companies and clinics also can have a culture. Common language is one element that keeps cultures cohesive. Words and culture can be reinforcing. Common vocabulary can change culture and culture can influence vocabulary.  Words can affect the culture of a university, a company, or a nation.

The University of Utah has many traditions that form a culture for fans that support university athletics.  In 2002, a group of university students decided to change the name of the University Football Fan club. The new name, The Mighty Utah Student Section (MUSS), was derived from the collective history of the university proclaimed in the traditional fight song and the common definition of the word “muss,” meaning chaos.  The name was rooted in university history, but the name seemed to influence the group.  The MUSS now has a collective identity that goes beyond just supporting athletics. The group was voted the fourth best student support section by NCAA.com, the group creates new traditions (like the third down jump), and boasts that their cheering affects the outcomes of the athletic competitions.  A new name or vocabulary influences identity, behavior, and culture of a school.

Leaders in a variety of industries embrace the techniques popularized by the successful Toyota Corporation and try to mimic their culture.  Management theorists describe this method as the Toyota Production System (TPS) and such methods are incorporated into the popular management program known as the Lean Production Model.  Part of the model is embracing key terms and concepts.  Kaizen is a key concept in both TPS and Lean Production Model.  Kaizen is a traditional Japanese word that means, “change for the better”.  When incorporated into management programs, however, Kaizen takes on a broader meaning.  For industrial managers, Kaizen is a daily process that humanizes the workplace, teaches improvement to frontline workers, and eliminates waste.  Managers use the word Kaizen in industry to influence the identity, behavior, and culture of their teams.

National identity can be influenced by vocabulary. Sisu is a Finnish word, and one of the Finn’s favorite words as described by the New York Times. Sisu comprises the ideas of bravery, tenacity, willpower, and persistence – it is a powerful psychological trait that enables people to accomplish tasks, often using mental strength beyond people’s preconceived limits. The Finns have used this word to describe military cunning, Olympic success, and industrial quality, among other achievements. By using this word to invoke an action-oriented mindset , the Finns have managed to – and continue to – influence identity, behavior, and their culture.

Culture and vocabulary are intertwined. Researching culture and vocabulary and the exact effects on medical training and medical teams is difficult.  Anders Ericsson, PhD and Angela Duckworth, PhD have each published numerous articles on specific ways to improve education and motivate learners.  A common theme in their collective works is the effect of deliberate practice and motivation for skill acquisition.  A culture dedicated to practice, improvement, and growth could be defined as a growth-oriented culture.   If words and culture are closely related, then our words can influence our work cultures.

What words can we use in our classrooms and clinics to cultivate a growth-oriented mindset?

In your next team meeting or class, you could try the following questions and statements.

Great work!

How can we improve?

What did we miss?

What strategy can we use?

What strategy should we use next time?

Our team can learn.

We will learn how to do this better.

 

We may not have the chance to create new names or new terms.  We do, however, have the power to choose our words wisely.  Words create culture. Wise words build enthusiasm, build teams and encourage growth in our learners.

Susan Pohl, MD, FAAFP is an Assistant Professor (Clinical) in the Department of Family & Preventive Medicine as well as the Clinical Director for the Madsen Family Health Clinic.