Many of you are asked to take a leadership role in leading a team, whether it’s for research, administration, or even clinical. It is easy to feel unprepared for these roles, and there are many pitfalls waiting to sabotage your team’s productivity. The ALiEM Faculty Incubator has created a series of 10 case-based teaming problems to provide you with evidence-based advice and solutions for tackling some of the more common problems encountered in our professional team experiences.

Case 5

[box]You’ve assembled a Clinical Competency Committee (CCC) that’s a well-oiled machine—except for Carl. You’ve had to ask him repeatedly for his reports, and they’re still not submitted. When you ask him why, he answers, “This is not a priority for me.”

What are some strategies can you use to help energize Carl to work as a productive member of the CCC?[/box]

Accountability

Accountability applies both to teams and to individual team members. The best, most effective teams hold their members accountable on a continual basis, automatically, often without the formal intervention of a team leader.1 However most of the time, as in this instance, the individual collaborator will be held accountable by a team leader—you!

Motivation

Carl is likely to have other important tasks that are causing him to “deprioritize” our important collaboration on the CCC. Clinical work, home life, teaching, research, and other service commitments abound. The reason behind his allocation of resources may be lack of motivation which may be improved through autonomy, relatedness, or competence.2 The first step is to take a deep breath, stay calm, and ask Carl, “Why?”3

“Too many other commitments” is an easy response, but why are those taking priority over the CCC? Bringing Carl’s response back to autonomy, relatedness, or competence may provide an acceptable solution to improve his motivation.

  • Autonomy (i.e. he needs to feel he has choices and is acting of his own free will): Could it be that Carl just isn’t interested in your deadline? If he finds it arbitrary and more of a “performance measure” rather than a useful tool to hold him accountable, the lack of autonomy he feels can cause him to deprioritize “your” work.
  • Relatedness (i.e. he needs to feel that he is contributing to something greater than himself): Beyond just the need to relate to the rest of the committee, Carl needs to feel that his work relates to a problem of importance; specifically, he needs to feel that his reports are an important part of resident assessment (and that the assessment itself is important). Emphasizing that the CCC’s work is indeed a contribution to the “greater good” may be a stretch, but it may help Carl prioritize the CCC.
  • Competence (i.e. he needs to feel that he can successfully accomplish the task): Carl may simply be deflecting this work if he doesn’t feel he does it well or if he’s unsure how to do it effectively. Alternatively, he may feel that his efforts aren’t terribly useful if they aren’t taken seriously by you and the rest of the committee. A bit of education and reassurance may be the inspiration Carl needs to start contributing more reliably.

If you have addressed his reasons why and he continues to deprioritize the CCC, it may be best for Carl to leave the committee.

To avoid the subsequent frustrations and resentment that could even impact your work in general, give 3 chances to your collaborators to get back on track. After 3 chances, if it feels like the collaboration cannot be saved, move on.4

Harsh? Maybe. But if the work’s not getting done (or you’re just doing it yourself), Carl’s already not contributing to the CCC, and it’s “not a priority” for him. It may be that letting go is the best thing for both of you.

Case Conclusion

[box]You schedule a meeting to sit down with Carl. You explain the crucial role his reports play in providing the program director and residents with timely assessments. You ask him to set a deadline that works with his other priorities, and in addition, he eagerly agrees to use his expertise in Quality & Safety education to devise a new assessment tool.[/box]

1.
Lencioni PM. The Five Dysfunctions of a Team. John Wiley & Sons; 2002.
2.
What Maslow’s Hierarchy Won’t Tell You About Motivation. Harvard Business Review. https://hbr.org/2014/11/what-maslows-hierarchy-wont-tell-you-about-motivation. Published November 26, 2014. Accessed September 12, 2018.
3.
Hills L. Fostering collaboration in the medical practice: twenty-five tips. J Med Pract Manage. 2013;28(4):236-240. [PubMed]
4.
Vicens Q, Bourne PE. Ten Simple Rules for a Successful Collaboration. P. 2007;3(3):e44. doi:10.1371/journal.pcbi.0030044

Annahieta Kalantari, DO, FACEP, FAAEM, FACOEP

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