During your career, you serve as staff member and leader to many different professional groups. Some are collaborative, collegial, and supportive. Others are competitive, antagonistic, or even combative. What are the benefits and downsides of each of these cultures and what can you do, as a hospitalist leader, to influence the character of your workplace?

Leonard J. Marcus, PhD

There are arguments favoring each option. For people who prefer a warm, encouraging workplace environment, there is the pleasure and satisfaction that comes with the camaraderie of a friendly atmosphere. It boosts morale, reduces turnover, and assists in problem solving. Others argue that a “kumbaya” tone encourages sloppy practices and wastes time in social interaction and on decisions that favor personal factors over clinical precision. The competitive tone brings out the best in people, it is countered, and encourages excellence.

The field of “game theory” provides insights into the distinction. The first questions to ask are “What is the game you are playing?” and then “Who is the competition?” In a “winner-takes-all” scenario, such as a sporting event, each team seeks strategic advantage over the other team. In baseball terms, the winner gets more points when at bat and denies more points when on the field. However, when competing as a team, winning together requires collaboration to build strategy, execute plays, and reach victory. You compete against the other team and collaborate within your own team.

Scientists who study negotiation strategies and conflict resolution find that collaborative groups spend less time countering one another and, instead, investing that same effort into building constructive outcomes, a force multiplier.

In the winner-takes-all model, the baseball team that gets “outs,” makes plays, and advances team members to home plate, wins. If there is contest within the team, players invest that same effort into seeking their own gain at the expense of others. Benefits derived from shared effort are shunned in favor of benefits accrued to one player over the other. It is a distinction between “I won” versus “We won.”

Hospital medicine is not a win/lose sport, yet over the years, hospitalists have shared with me that their institution or group at times feels like a competitive field with winners and losers. If this distinction is placed on a continuum, what factors encourage a more collaborative environment and what factors do the opposite, toward the adversarial side of the continuum? It makes a substantive difference in the interactions and accomplishments that a group achieves.

My colleagues and I at Harvard study leaders in times of crisis. A crisis makes apparent what is often more subtle during routine times. Our study of leaders in the wake of the Boston Marathon bombings was among our most revealing.

During most crises, an operational leader is designated to oversee the whole of the response. This is an individual with organizational authority and subject-matter expertise appropriate to the situation at hand. In Boston, however, there were so many different jurisdictions – federal, state, and local – and so many different agencies, that no one leader stood above the others. They worked in a remarkably collaborative fashion. While the bombings themselves were tragic, the response itself was a success: All who survived the initial blasts lived, a function of remarkable emergency care, distribution to hospitals, and good medical care. The perpetrators were caught in 102 hours, and “Boston Strong” reflected a genuine city resilience.

These leaders worked together in ways that we had rarely seen before. What we discovered was a phenomenon we call “swarm leadership,” inspired by the ways ants, bees, and termites engage in collective work and decision making. These creatures have clear lines of communication and structures for judgment calls, often about food sources, nesting locations, and threats.

There are five principles of swarm leadership:

• Unity of mission – In Boston, that was to “save lives,” and it motivated and activated the whole of the response.
• Generosity of spirit and action – Across the community, people were eager to assist in the response.
• Everyone stayed in their own lanes of responsibility and helped others succeed in theirs – There were law enforcement, medical, and resilience activities and the theme across the leaders was “how can I help make you a success?”
• No ego and no blame – There was a level of emotional intelligence and maturity among the leaders.
• A foundation of trusting relations – These leaders had known one another for years and, though the decisions were tough, they were confident in the motives and actions of the others.