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Givers & Takers

Bolwell, Brian J., MD, FACP

doi: 10.1097/01.COT.0000549784.03033.d9
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One of the keys to a successful cancer center is generating and sustaining high-functioning teams. Clinically, the team generally consists of those dedicated to a given disease specialty—for example, the breast cancer program. Within the Cleveland Clinic's breast cancer program, multiple teams exist. The physicians—ideally, a multidisciplinary group of medical oncologists, surgeons, radiation oncologists, imaging physicians, pathologists, and more—comprise one team. Aligning such a team to focus on common goals—robust tumor boards, reducing time to treat, and more—is no easy task. It takes work, and it takes leadership.

Then there are the teams that include clinical nursing of the breast program, and a team of research personnel that coordinate many clinical research studies, led by the physician program leader. More teams: a team of scientists that are studying the biology of breast cancer; and a team of social workers and others addressing the psycho-social aspects of our breast cancer patients.

This is repeated with every disease program. Not to mention the teams looking at overall quality and safety, compliance, and other operational indices of the cancer center.

As I reflect on my medical training, the subject of how to work in a team environment was never addressed. If anything, medical education was predominantly solitary. Taking tests was of course an individual exercise, and later, taking boards. (In fact, the medical community is now challenging the entire concept of taking board exams as an individual since so much of medicine is now practiced in a team environment). Academic success is very individualistic. Your CV is about you—not a team. Little education was ever dedicated to learning how to effectively work in a team environment. There are some places today that emphasize teamwork in their curriculum, but not many or nearly enough.

And it is obvious that some teams work better than others. Why is this, and what can we do about it? Well, we can study it.

Recently, a book about successful leadership of organizations was suggested to me entitled Give and Take by Adam Grant. This excellent book studies workplace takers—those who take more than they give, constantly self-promote, and claim more credit for success than they deserve; and givers—those who help others and do not expect anything in return. Givers are rare. It turns out that givers also achieve the most organizational success when compared to takers, and their organizations tend to thrive.

There are two themes in this book that I find immediately relevant to all of us. The first stems from a quote from Samuel Johnson, a philosopher from the 1700s: “The true measure of a man is how he treats someone who can do him absolutely no good.” I have heard this sentiment before—integrity is what you are when nobody is looking. If you are a giver—you will treat everyone with respect and courtesy. Takers will give those below them little time or courtesy, and treat those people with disdain or indifference. They treat people above them with respect, and make sure others are watching while they do so. Takers are two-faced.

How is this relevant to oncology? Well, physicians are authority figures. Physician leaders more so. Servant leadership is all about supporting the team, which means everyone on the team. I believe that all physicians need to try to be helpful to each person on the team. Unfortunately, many are not. Successful scientists can be tyrants to their post-docs. Physicians can treat secretaries or admins poorly. Physicians can be dismissive to nurses. These behaviors destroy culture. They are examples of the lowest form of authority—Level 1 leadership (see Learning the Leadership Levels in Your Cancer Center, Oncology Times 2018;40(3):20-21). All these negative examples are behavioral traits of takers.

Such behaviors go beyond being a jerk. For example, suppose you need something done for an important meeting on Friday, and you need the help of your secretary (or equivalent). So many physicians will give the material to their secretary Thursday afternoon and expect him or her to stay late to get the task completed for Friday morning. Such behavior may be a result of an inability to plan, or absent-mindedness, but in my mind it is inexcusable. This behavior is entirely insensitive. It's your job to plan. Give them the task to complete with ample time to adjust their workload and assist. Most organizations have a lot of people who want to help physicians out. Secretaries in general want you to be successful. Work as a team with your secretary, your post-doc, or your nurse. They want to help you. Let them do so.

Let's expand on this. How should you (we) work with those who are trying to help us?

First, talk to them, and listen (see Talk to People, Oncology Times 2017;39(20):17). Mutually agree on what the key issues and tasks are, and map out an operational plan that defines responsibility—who owns what. I cannot overemphasize the importance of listening. I recently received this note from a fabulous person who has helped me greatly in a variety of ways. The note said: “When I'm in your office, what I have to say is the most important thing...I don't know how you balance it, but as a leader you have to give EVERY person in your organization the time, energy, and focus and make them feel like their contribution is the most important thing.” As a leader, I try to do this.

The point is that, as a leader, many people want to help. Let them. Step one is to be present and attentive when you meet with them. Ask questions. Look them in the eye. Treat them with respect. Give them credit. Believe in them. This is more than being polite. The fact is that you do not know everything about everything. On any particular topic, it is a given that some members of your team know more about a topic, or how to achieve a result, than you do. So let them do their job. Stay connected, but believe in them and let them thrive. And, importantly, give them credit. The rewards are obvious. Loyalty is generated and becomes a sort of connection glue. Results improve. Culture is elevated. Things get done. Success is real.

The second theme from Grant's book that struck me was the issue of group dynamics and how to elevate the performance of a team. A team is, among other things, a delicate structure of disparate egos and personalities. But the group personality is potentially malleable. A poorly functioning group can be elevated. Here the distinction between Grant's takers and givers is key. Takers are lousy collaborators. They are consumed with their own viewpoints. They do not listen well. They do not see things from the perspective of others.

In contrast, givers excel at group work and collaborations. They seek input from others. They respect the opinions of those who disagree with them. They share credit for good ideas. And, importantly, one key to successful collaborations is to believe in others. Givers see the potential in everyone.

Acting as a giver can be contagious. This was the one point in this book that, for me, was crucial. Grant said, “When the groups included one constant giver, the other members contributed more. The presence of a single giver was enough to establish a norm of giving. By giving, participants were able to make their group member better off and managed to get more in the process.”

The obvious risk of being a giver is being taken advantage of. But when you are a leader, in my mind, this risk is minimized. A leader has an enormous opportunity to be an example of a giver. In doing so, the entire organization will be able to work together better as collaborators and as teams.

It takes some courage to be a giver. I think you need to be willing to be vulnerable (see Moments, Oncology Times 2018;40(20):27,38-39). You may feel alone. You risk ridicule by takers who may try to take advantage of you. But, the ability to be vulnerable takes courage. I think trying to be a giver is worth the risk.

Ideally, a cancer center attracts people who are givers. Cancer center staff want to help those in the most need. As a leader, you are able to work with such people daily. What an opportunity! They want to help—help patients, help the cancer center, help their co-workers. Let them do so. Support them. Recognize them. Listen to them. Celebrate them. And, more importantly, demonstrate that you are a giver. Others will follow.

Straight Talk: Today's Cancer Centers

BRIAN J. BOLWELL, MD, FACP, is Chairman of the Taussig Cancer Institute and Professor of Medicine at the Cleveland Clinic Lerner School of Medicine. Cleveland Clinic is a top 10 cancer hospital according to U.S. News & World Report.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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