The Teamwork Imperative

Over the last few years, we in radiology have faced incredible and unprecedented challenges in our day-to-day work, and this is true regardless of our specific work environments. Why? The pandemic, which has touched everyone and has had a profound impact on the workplace in general. It has changed how we work, approach work, and shaped our opinions of work. And it is not just the pandemic. It is political polarization, social unrest, changes in home life and education, the remote work life. The pandemic and its effects led to a great resignation, and as a result, many of our sites are now understaffed. It has been reported that one in five doctors plan to leave their current practice in two years; two in five nurses plan to leave their practice in two years; one in three doctors expect to work less next year.

Health care workers have far greater demands now than in the pre-pandemic times. The delivery of health care has changed dramatically and quickly over the last few years. There is unprecedented “consumerism” in medicine now with a mandate to improve and rethink patient access, to provide more and better mental health services to our populations, and to have transparent pricing. Many health systems are facing financial challenges.

In radiology, whether you work in a large or small private practice, remotely by yourself, an academic department in a medical center, or part of a mega-radiology practice, there has been a palpable shortage of radiologists. This shortage is fueled by a trend toward exclusive subspecialization with declining numbers of radiologists who can handle general work, ever-increasing expectations for service to our patients, referring docs, hospitals and health care systems. There is a desire by radiologists to have more flexible work hours or, simply stated, to work less hours overall compared to previous years. There is a concern about what role artificial intelligence and machine learning will play. Will we be displaced? And reimbursement has been decreasing relative to inflation and compared with other specialties. As a result of these realities and others, there is clear evidence of burnout among radiologists, similar to health care workers in other specialties. In addition, sometimes we find that the leaders in our organizations may be distant, or too corporate, or suffer from “toxic positivity,” which may be worse than “toxic negativity.”

There has been a steady headwind for years, but it now feels like a gale-force wind. And a lot of this feels out of our control.

One strategy to manage the headwinds and one that we can embrace and control is to develop a culture of teams within our workplaces. Establish teams as a core value within your workplace. If we have a culture of teams, we can mitigate and shield ourselves from some of these headwinds.

When I refer to teams, I am specifically not referring to the “macro teams” that many of us find ourselves in. For example, at Duke Health, my hospital system, it is said that the 30,000-plus employees are my “teammates.” That very well may be true. But no, I am referring to your local and focal team. I am referring to the individuals that you rely on daily or weekly to deliver your work product. It’s the folks you huddle with. And the teams develop where you huddle. If you are in training, I am referring to your team of co-residents, your chief residents, maybe your program director or coordinator who you lean on. If you are in a private practice, I am referring to those that you share physical space with, or perhaps switch call with, or the individuals you show difficult cases to, or the referring docs you have developed close relationships with, and who rely on you to deliver care.In an academic environment, it might be the members of your subspecialty division. If done well, the division pulls together as a team to deliver care, service, teaching, and research. Those divisions that have a culture of team are far more effective than those who are unable to act as a team. It’s The Teamwork Imperative.

If you are lucky enough to have these local and focal teams (and these often form and evolve organically), many challenges at work open up and become more manageable and attainable. The clouds begin to lift. Specifically, your deliverables, whatever they may be, are far more easily and effectively achieved if you have your team, and approach your work from the perspective of a team. Work becomes more efficient, fulfilling, and, frankly, more fun. The work becomes more manageable—with more aspects in your control. You become more engaged. And that then becomes an antidote to burnout. Teams, therefore, contribute to retention.

Communication in the workplace is critical to developing teams. Of course, communication is about sharing news back and forth, accurately and honestly, but more importantly, communication is to be able to probe, to be able to respectfully question, and to be able to expect honest answers from your teammates. Sometimes, the questions aren’t easy, and the answers may not be easy either. To foster an effective team requires the ability and the safety of pointing out the opportunities—those ones are easy.More important, it is to have safety in pointing out deficiencies—those are more difficult. It is critical for teammates to be able to receive and internalize the information coming from within the group, whether it is a kudo or whether it is an observation, or whether it is a deficiency or a criticism.

You have to talk to each other. Actually talk. And in a world of remote work and texting, we don’t talk enough. Maybe the talking occurs in a partner meeting, in a defined clinical case conference, or in a resident, division, or department meeting. Maybe it is your team taking a coffee break or going for a midday walk to achieve “steps” goals. Hopefully, the team dynamics are such that one can tap a teammate on the shoulder and engage in an effective and safe conversation.

Communication needs to be practiced. That is why standing, regular, in-person meetings, even if the agenda is light, are very important. The opportunity to come together regularly promotes the importance and expectation of communication. It is habit forming. You get better at it.

The communication must be honest with an expectation for mutual trust. Trust means telling the truth, and telling it sooner rather than later; knowing that within a team, that can be hard.It can be hard because so many of us struggle with confrontation and conflict and try to avoid them.

Honest and fair difficult conversations almost always produce results. If you can get through the first 30 seconds of a difficult conversation, often the clouds lift and a very productive conversation follows. For me, I need to write down the key first few sentences for that opening 30 seconds and the rest flows. If difficult conversations don’t produce results, you have learned something.

Communicating in person is far more effective than in an email or text. Personal communication often fosters human connections and colleagueship. Time spent with each other, sharing aspects of ourselves, results in caring. The time may be as simple as grabbing a cup of coffee together or asking someone about their weekend. Caring strengthens the interconnective web between team members, making the team softer in a positive way, and more personable, yet, at the same time stronger.

And this is whyI worry about remote work. I understand well thatthe pandemic has shown that we can do radiology effectively, even remotely. People like it and expect it. And we have learned that we can teach remotely. But it seems far more difficult to foster a genuine, caring environment when work is dispersed in many geographic locales and individuals work essentially independently, free of meaningful, direct interactions with other teammates, other humans.To me, the same applies to Zoom meetings. All the nuanced talk and greetings pre- and post-meeting are lost. The body language is lost. The sense of community is lost, or at least different. And I think the effectiveness of the meeting suffers. Indeed, on a Zoom meeting, you can’t even have real eye contact. I worry that with remote work, the culture of our teams may be eroded.

So, work to develop teams in your workplace. Together, as a team, we are stronger. And this is something within our control. There is an imperative to create, sustain, and grow teams in our radiology workplace.

Erik K. Paulson, MD

Chair, Radiology

Duke University

The opinions expressed on RadTeams are those of the author(s); they do not necessarily reflect the viewpoint or position of the editors, reviewers, or publisher.