Creating a practice ‘dream team’ could be closer than you think

Miami Beach, Fla. - Managing group dynamics requires recognizing and addressing a group’s developmental stage and the roles its members are playing - without judgment, an expert says.

“Each group has its own dynamics,” says Tammie Ferringer, M.D., head of dermatopathology at Geisinger Medical Laboratories and associate in the department of dermatology at Geisinger Medical Center, Danville, Pa.

Knowing where your group stands developmentally helps highlight strategies for nudging the group toward its desired outcome, says Dr. Ferringer, who spoke at the annual meeting of the American Academy of Dermatology.

Several years ago, Dr. Ferringer says, someone in Geisinger’s dermatology department accidentally switched labels on two biopsy specimens. “The work flow at the time was that the nurses would take the specimen from the room to the nurses’ station, where the requisition printed out, and they would label the bottle.”

Fortunately, she says, the dermatopathologist who read the biopsies quickly caught the mix-up, and no harm was done.

“Immediately, the dermatology department came together as a group to find out what went wrong, and how it could be fixed,” she says. “After all the brainstorming, the decision was that we would print out a label with the patient’s name whenever a patient checks in, and send it to the exam room with the patient. And if there’s a biopsy done in that room, that label goes directly on that bottle. The department communicated effectively and did a wonderful job as a group.”

Conversely, Dr. Ferringer says, a group that communicates poorly might succumb to the sentiment that when such a problem arises, “Someone else will handle it. Everybody’s sure that somebody will do it. Anybody can do it. But nobody actually does it.”

A group of people together on an elevator doesn’t constitute a team, she says. “A team forms when that elevator gets stuck. Suddenly that group of people must work together to figure out how to get out of the elevator - they share a single goal, and everyone is accountable to the whole group, not just themselves.”

Along with sharing a goal, Dr. Ferringer adds, “The process of getting there is just as important - and often not thought about.” This requires understanding the stages of group development.

From forming to performing

In this regard, she describes “forming” as the polite phase in which people get acquainted. Next comes “storming,” in which people air concerns and criticism as they seek to understand their roles. “Norming,” or building trust and cooperation, follows. Finally, the “performing” phase involves communicating freely and respectfully toward a goal.

“There’s still conflict, but it’s handled well.” It’s also common for groups to bounce back and forth between various stages, she adds, and/or get stuck in one stage.

Understanding individuals’ roles within the group can help group leaders identify strategies to restore or maintain focus. Individual roles can include the devil’s advocate, the blocker (who torpedoes everyone’s suggestions) and the aggressor (who attacks personally rather than considering the merits of others’ ideas).

Although some roles may sound inherently negative or positive, she says, this is largely a matter of context. For example, being a brainstormer (generating “outside the box” ideas) is generally helpful - unless the group needs to conclude deliberations and reach a decision.

Moreover, Dr. Ferringer says that a group leader is not the only one responsible for managing group dynamics. In this regard, she explains, individual roles often shift, and anyone can step up as needed. For example, a “summarizer/clarifier” may ask questions or restate suggestions to ensure that everyone’s on the same page - regarding anything from the substance of someone’s idea, to what the group should be doing at that moment.

To get back on track, Dr. Ferringer says, sometimes it’s necessary to ask a “blocker” to provide a positive suggestion. In other cases, an overly dominant leader might need feedback - sometimes with a touch of flattery. Often, “Leaders don’t get any feedback, because of fear.”

At the same time, she says, people with dominant personalities may be masking insecurity. Starting with a compliment helps to ensure that your constructive criticism is heard.

Conversely, a group’s “followers” often need prompting to speak up - or perhaps write their ideas down. Ultimately, “Participation is the key. To get buy-in for whatever the group decides, you need to get everybody’s ideas out.” This way, whether or not someone’s suggestion is adopted, all members feel they've been heard.

Disclosures: Dr. Ferringer is a member of the American Academy of Dermatology leadership development steering committee.