Abstract
Background:
Until now, working with others has been shaped by a style where 1 person made the main decisions at the top of the hierarchical pyramid. These days this one-directional model no longer makes sense. That is why we need to change to a collaborative style.
Methods:
An overview on the change in our surgical work and definitions on the collaborative work, coaching, and teamwork will be discussed and analyzed.
Results and Discussion:
The system is defined by the boundaries that we set; they can often be the type of activity to be carried out or the way it is achieved. Collaboration means accompanying processes with a clear idea of what needs to be achieved and what values need to be followed. In work contexts that are globalized, diverse, virtual, and made up of highly educated specialists, isolation and a lack of collaboration are common. We would like to highlight four of them: (1) Signature relationship practices: The importance of building relationships on the basis of “who I am,” not “what I am.” (2) Ambidextrous leadership: Collaborative work needs to concentrate first on the task and on performing it effectively. (3) Mentoring versus “tit-for-tat culture”: Collaborative work helps the design of individual and team identities. (4) Training in relationship skills: for communication and conflict resolution.
Conclusions:
Working on relationship building conversations generates a systemic view that allows the creation of a communication context that facilitates collaborative work. They are all key skills to achieve a collaborative culture on work.
Background
Until now, working with others has been shaped by a style where 1 person made the main decisions at the top of the hierarchical pyramid. The rest followed orders imparted either compulsively or persuasively, but always in one direction, top down. These days this one-directional model no longer makes sense due to the widespread availability of data that have not necessarily been transformed into information, much less knowledge. 1
Nowadays, the unilateral exercise of power generates anxiety. In many ways—regardless of how highly specialized one is—it is hard to know what to do because everything is new and constantly changing. That is why we need to change to a collaborative style. The leader's role shifts from a provider of solutions to a creator of context.
Moreover, globalization and the effect of many cultures working together with instant access to information require the leader to define the system, the values, and the purpose that generates context. 2
The system is defined by the boundaries that we set; they can often be the type of activity to be carried out or the way it is achieved. Also saying no to certain attitudes and setting limits to behaviors that the leader considers toxic or damaging to the system helps fix the boundaries of the work environment. Defining the boundaries prevents excessive actions aimed at displaying one's superior skills and knowledge, which prevents the team from really getting to know each other. 3 Being unique and the star of the team can lead to isolation when you need the team to pull together in the same direction, even the star player needs the support of the team for everyone to move forward.
Collaboration means accompanying processes with a clear idea of what needs to be achieved (eradicate the disease, our purpose) and what values need to be followed (e.g., transparency, intellectual honesty, and flexibility to incorporate changes quickly). We give life to values and we generate respect for the work environment when we restrict abusive behavior toward colleagues, thus generating safe spaces where the network can flow even if it is vulnerable. 4 I generate purpose when I define what it is important and central to the team identity.
But What, Why, and How are determined by the team. To collaborate the context has to be created and that is the central task of the leader. People's performance is largely determined by the context. The same person with the same skills will act differently depending on the cultural context. Collaboration regulates the emotional map of the team and neutralizes negative emotions. It encourages ambition where there is resignation; it generates harmony where there is conflict. It offers options and action plans that may not be evident. It generates a realistic environment where the vision can be agreed on the basis of concrete facts. People also need to accompany and embrace those who are different, ignoring them will destroy them and the team will be the poorer for lack of diversity.1,3
Methods
An overview on the change in our surgical work and definitions on the collaborative work, coaching, and teamwork will be discussed and analyzed.
Results and Discussion
But how do we do it? Working on the competences and methodologies that will allow us to achieve collaborative work.
We often think that we are born with an innate ability for collaboration and that we only need to remove certain barriers for it to flow freely. In our experience, we have found that we need to work on those competences in the same way as we work on our technical skills (Fig. 1).
Collaborative work in surgery.
First step: competences for collaboration
First competence: inquiry
I take the other into consideration when I speak. How do I inquire concretely and factually about what is going on? Do I know what projects my team is working on? Do I understand their emotional state? These facts will help me understand the system where I work, whether I am the leader or a participant. We often reach conclusions that do not take into account what has been shared beforehand. As powerful as these conclusions may be, they will not be understood if they are based on facts that have not been shared with everyone. Inquiry generates a powerful connection with participants. Inquiry allows me to check my interpretations. Skillful inquiry will allow me to generate criteria that will organize the work.
Second competence: listening
It is interpretation. To listen is to hear and to interpret the person who is speaking. This is the way to achieve collaboration because team members feel secure in their interactions because they feel respected. How do I listen to things that I disagree with? Do I validate the differences? If I don't validate those differences, I don't allow myself to know them, and if I don't know them, I will not be able to manage them. Listening also means listening to the emotional climate and validating everyone's emotions. That is why it is central to persuade the other to accept my ideas. 1
Conveying my ideas with the nuances required by the other implies listening previously. For example, how does a surgeon talk to an image specialist? He who speaks only about the things that interest him is unlikely to be listened to.
Third competence: trust
Trust generates an emotional climate where our presence promotes dialogue and connection with the others. How to generate trust? Trust is built upon dialogue with the others and with oneself. The first step is to know oneself. Knowing where we come from generates a present with a connection to the future. The second step is to know the others. To do this, we must work on the relationship building conversations. Knowing where the other comes from generates a shared work space because it gives me a range of probabilities of what I can expect from them. When I say that I trust somebody, what am I saying? Probably that my well-being will be taken into account when they take a decision and act accordingly. 2
Trust is the feeling of being supported by the other because we know them to be competent, sincere, and dedicated. Trust drives us toward transformational actions, whereas fear drives us toward defensive actions. Every social system needs to generate trust to operate. Without trust systems collapse and disintegrate. A system that stimulates cooperation will develop trust; a system that encourages competition among members will develop mistrust. The leader who recognizes their own limits and relies on their collaborators to empower themselves and the others is highly effective in managing their own and their team's vulnerability, and in generating trust.
Fourth competence: establishing the rules of the game
The rules of the game reflect the criteria that govern the workings of the team. Placing myself as a cocreator of the rules of the game allows me to find the common elements that unite different actors in the team.
Some actions reveal the rules of the game and generate criteria: who controls the agenda, which are the recurrent themes, who are the key actors. It is important to acknowledge the other and establish possibilities and commitments based on shared assumptions made by the team. And to share we need to propose and justify correctly.
Our emotional states define the relationship we have with the world.
Collaboration does not mean following others. To collaborate we need to inquire to base my interpretation on concrete data. To listen is to know how to traverse the world of the other to make proposals using their language.
Collaboration has a systemic effect. When I collaborate, I connect with the other and from their perspective I can see situations and problems than I could not see before. I see the all system and not only a part of it. Collaboration is a virtuous characteristic of high-performance teams and takes place when the leader values and respects the different nature of people.3,4 When only 1 person is asking the questions and giving the answers, results are noticeably poorer and the price paid for not taken all the information into account escalates.
Second step: develop a method of working
When you know clearly what competences to develop in your team, the second step is to generate a method of working that enable you to obtain new and better results. If a collaborative setting that enables participation has not been created, more participation by the team will probably generate chaos and anxiety because a way of processing diversity has not been created. If we do not create spaces for people to interact, they will lock themselves into their own preferences and expertise. Change and creativity emerged between cultures and identities that generate trust by interacting with each other.
Generate a collaborative process
The first step is to generate a methodology that allows errors as learning tools, where errors are quickly identified and corrected because there is a robust network that supports you with constant feedback. 1 Teamwork that is only aimed at validating unilateral decisions taken elsewhere is a waste of time.
A methodology for collaborative working is one that is centered on gaining results from diversity, but with a balance between negative and positive feedback, that generate share vision and commitment. Each member decides what, how, and where to perform the task they are responsible for. These days people do not usually answer the phone if they have not received a previous message nor do they watch a TV program or listen to a radio program live. People have control of how and when to do it. And the same applies to work, it is transformed into a coordinated set of original actions taken by individuals and designed to reach the goal. 3 When we collaborate, we can do it from a position of leadership, where we establish roles, delegate tasks, and set organizational rituals. Participants also have a key role to play because their contribution will determine whether the team will meet its goals or not.
Structure participation: generates a way for diversity to flow
Rituals refresh the collective memory, and they tell us who we are, where we come from, and where we are going to. They generate and nurture organizational culture. The way people are rewarded, and the way promotions are announced are some of the rituals that can generate a collaborative culture. Rituals show expected behavior. How you call a meeting, the number of people who take part, the location, where people sit, the way people behave, how are people introduced, or if they are not introduced at all.
All routines have a meaning that needs to be reinterpreted constantly. Some of them can be:
(a) Brainstorming (where ideas are exchanged freely without following a predetermined structure) (b) Breakthrough (integrating divergent ideas with convergent ones) (c) Establishing predetermined roles: allow the team to process collectively the information produced by the meeting. The leader takes the decisions, the moderator–facilitator prepares the meeting, someone else does the time keeping and the devil's advocate provokes discussion, among other delegated roles.
If the team is trying to establish new work processes, an interesting methodology is for all members of the team to share a strength and a weakness that they experience at work or, more specifically in relation to this team meeting.1,4
Achieve a balance among delegation, empowerment, and control
In horizontal teams, these differences do not usually occur, but in teams where there are different seniorities, responsibilities, and competences, achieving this balance is absolutely critical. Most of the time, delegation and empowerment are also laden with limiting emotions and fears. For example, we may be afraid of delegating because we think we cannot trust the person to perform the task well. We may be afraid of empowering people because we do not want to lose power and we do not trust them not to become a threat. 2
Control is necessary, but in the right measure, if we over control the autonomy of the team, we stifle its creativity and performance. These fears arise from our failure to manage differences and our lack of belief that collaborative work is the best methodology to achieve best results. If I and my team are empowered to know how to inquire, listen, trust, and design action strategies based on collaborative work, these fears are unlikely to take hold. I will have been working on the foundations, not just the surface.
What is the difference between delegating and empowering? Delegating is giving a person the authority to act on my behalf, putting my reputation and interest at risk. Empowering is giving authority and the competences at the same time. When I delegate to an empowered individual, I do not need to show them all the steps because they are constantly going to face different circumstances, I need only to show the scope and the deliverables. 3 However, a good empowerment system includes robust control systems such as daily meetings, product or service review meetings, and team feedback. A strong empowerment culture allows individuals to express creativity and make an impactful contribution.
Inverse delegation and responsibility
In every delegation and empowerment process, the final management responsibility always rests with the leader. However, the empowerment process shares responsibilities among each of the individuals in the team. This delegation is the result of the agreement and promises made when empowerment takes place.
When the leader does not have reports or teams than are up to the tasks delegated, will have what we call inverted delegation. This happens when the work team does not manage itself and does not meet its objectives, devolving explicitly or implicitly the tasks and responsibilities back to the leader. The leader then has to take care not only of their own role but also of the delegated tasks that were not performed. And important questions must be asked and it must be established whether the teams are the right ones. The required changes and/or the appropriate training must take place to achieve the high collective and individual performances for which they were taken on. 4
Third step: leader as team coach
Coaching assumes that the conversation is action, and like every action, it transforms reality. Saying yes or no to a situation affects reality one way or other. The team coach accompanies work processes to make sure that team conversations are highly effective to achieve the objectives. We carry out gap analysis between my current position A and position B, which is where I want to be. The coach plots a path to bridge the gap.
Identifying starting point A is absolutely critical. The coach can detect, through an analysis of the dynamics at meetings, which players want to go to war where some will win and some will lose, and which players want the project to be successful and that everyone takes their place in the organization. Establishing the starting point is fundamental to create the appropriate emotional climate. Whether we are the leader or members of the team, we can accompany the decision-making process by listening to the others. 2
When the leader becomes a team coach, manage fears building a narrative that give sense to what they done, and at the same time designs individual and organizational identities taking into account what the team and the organization needs. 5
Conclusions
In work contexts that are globalized, diverse, virtual, and made up of highly educated specialists, isolation and a lack of collaboration are common. An article titled “Eight ways to build collaborative work” by Gratton and Erickson 4 published in Harvard Business Review reported on research on 55 teams in 15 multinational companies shows 8 key points. We would like to highlight four of them:
Signature relationship practices: The importance of building relationships on the basis of “who I am,” not “what I am.” “What I am” is linked to time and position (chief of department, fellow), whereas “who I am” is related to the intent that drives my endeavor. Why I seek certain goals, what is my purpose.
Ambidextrous leadership (task oriented and relationship oriented): Collaborative work needs to concentrate first on the task and on performing it effectively. It also needs coordination to generate the network that becomes an emotional buffer to mitigate error, give sense to the task, and establish rules of behavior for its members. As I grow in my position, the relationship skills are central to achieve our goals.
Mentoring versus “tit-for-tat culture”: Collaborative work helps the design of individual and team identities. Identity is always built on diversity and takes into account the other and their capacity to affect us and to be affected by us. Mentoring removes fear. The fear of making a mistake, of losing power, of being considered incompetent. These fears are managed by working collaboratively when I allow myself and I allow others to design identities that incorporate values, purpose, and actions into a narrative that gives sense to what I do.
Training in relationship skills: for communication and conflict resolution. Working on relationship building conversations generates a systemic view that allows the creation of a communication context that facilitates collaborative work. A high-performance team is that who has achieved balance between proposing and inquiring, negative and positive feedback and focusing on oneself and on the other to achieve high connectivity within the team.
They are all key skills to achieve a collaborative culture on work.
Footnotes
Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received.