Tribes, tribulation and the elephant in the room

Our profession has come a long way in the past 25 years, but sadly seems to have difficulties eradicating issues of humiliation and abuse of colleagues and medical students.
 
One option to fix the problem is to make junior doctors and students more resilient, which seems like a good principle that is currently being applied by organisations in other areas. For example, beyondblue has released a practice guide for professionals to help children deal with the adversities they experience early on to prevent mental health conditions later in life.
 
But teaching resilience alone is not enough.
 
Another option is to increase awareness and understanding among senior doctors and educate them about bullying, discrimination and sexual harassment. A good example is the mandatory education module, ‘Operating with respect’, from the Royal Australian College of Surgeons (RACS).
 
The elephant in the room, however, is our culture – or at least certain aspects of it.
 
David Logan, a professor at the University of Southern California, said it a few years ago in his New York Times bestseller, Tribal leadership: On the tribal culture scale of 1–5, most professionals around the world score a meagre three. This includes lawyers, doctors and professors.
 
According to Professor Logan and fellow authors John King and Halee Fischer-Wright, a stage-three culture or tribe is built around knowledge, personal accomplishments and individual expertise. The emphasis is often on winning. Although there may be talk of teamwork, the group interactions usually resemble those of a master–servant relationship.
 
The mantra of a stage-three culture is, ‘I’m great’. The language used is often along the lines of, ‘I’m good at my job’, ‘I try harder than most’, and ‘Most people can’t match my work ethic’, and key pronouns used are ‘I’, ‘me’ and ‘my’.
 
This creates several problems. Professionals operating in this type of culture often feel unsupported, undervalued and frustrated, and those around them feel like a support cast.
 
Stage-three cultures cannot be fixed, but they can be abandoned. The answer is to upgrade the culture and move away from the ‘I’m great’ mantra to ‘We’re great.’
 
Instead of relying on personal achievements and expertise, at stage-four it becomes all about the accomplishments of the group. Partnerships, communication and transparency are recognised as essential ingredients for success. This is a healthier environment in which people feel more valued and supported.
 
Professor Logan’s top level is stage-five. Highly functioning teams focus on maximising achievement – not in competition with other groups or tribes, but with what’s possible. Stage-five teams can work with anyone.
 
Australian research has shown that hierarchical and stereotype behaviours largely dissolve when healthcare professionals are working in a more collaborative, multidisciplinary environment.
 
Resilience training and anti-bullying education are essential, but if we really want to make a difference we have to move our tribal cultures to the next level.

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