When highly trained professionals decide to practice together, whether as an independent group, employees, or an academic department, group dynamics become critically important to their success. Basic issues such as work assignments and hire/fire decisions require a good deal of cohesion as do the seemingly simple day-to-day interactions such as call coverage and whose special stains to do first. Group dysfunction can consume immense amounts of time and energy, lead to increased turnover, and otherwise render a practice uncompetitive in its environment. In the authors’ experience, although some amount of group dysfunction is fairly common, a practice leader who ignores it does so at the peril of the practice. Group dysfunction is often much more of a threat to a practice than external pressures.

Shared values and norms of a practice underpin positive group dynamics. While any individual has wants and needs (e.g., pay off school loans, be active at church, travel and compete in ballroom dancing), each one must interact under a shared contract with the group, a contract which may be in part unwritten. For example, vacation may be part of an employment agreement and decision-making may be enshrined in corporate bylaws, while actual hours at work on a typical weekday may not be explicitly specified. Yet group norms may lead a senior pathologist to quietly counsel a young pathologist who regularly leaves at 3 p.m. that “the pathologists of our practice work until 5 p.m.” to help educate as to the norm.

These principles apply to any group of pathologists, whether academic, hospital employed, or an independent private practice. In the first two settings, the existence of a larger structure such as a medical school faculty practice or hospital leadership to which the pathologists are responsible, may lead to more written rules or tighter expectations. This in turn may create the potential for greater dysfunction in a group of relatively equal pathologists.

One key to good group dynamics is communication: communication of norms, expectations, and, when needed, failure to meet expectations. That which is explicit should be made clear, either verbally or in writing (such as contractual language), while regular and transparent communication can facilitate establishment and maintenance of implicit norms. This communication may be written such as behavioral standards or responsibilities while on call or be established through discussion and decision-making via formal and informal meetings.

Group dysfunction is often invisible to outsiders but obvious to participants. (We have known situations where the converse is true as well, but this disconnect in perception is more uncommon.) But how does a leader monitor the mood of a practice? One could measure pathologist turnover, but this is a lagging indicator and may be too late to avoid a potentially devastating effect on the practice. A better indicator is the quality of communications. For example, if a group of professionals can talk openly, constructively, and without defensiveness, about how the group will handle breast biopsies and, better yet, whether all individuals actually adhere to established practices or not, that is a clear, positive sign. In contrast, an inability or unwillingness to have these difficult conversations may indicate dysfunctions such as a lack of communication skills, or worse, a lack of commitment to the success of the practice. Avoidance of discussions relating to things such as work styles (“pathologist X doesn’t pull his/her weight”) or other fairness topics (e.g., money, schedule, and assignments) generally indicates problematic dysfunction requiring the leader to intervene before unresolved issues turn into conflict situations which may negatively affect group morale and productivity.

Note that a lack of communication, however, is not always an indicator of dysfunction. The authors are aware of a stable situation where a senior partner pathologist routinely started work early (sometimes before 5 a.m.), and left for much of the morning to attend to private nonmedical businesses, returned for lunch, and then left work prior to the other pathologists. This pathologist routinely did significantly more than his share of the sign-out but was not always available for frozen sections or the phone calls that would interrupt the other pathologists’ sign-out. Yet this arrangement was never discussed by the pathologists, nor was it the subject of sidebar conversations by them because they apparently found the schedule tradeoffs acceptable.

Remember that communication is not always a guarantee of success, either. Contrast the victory above with another situation known by the authors where the partners did discuss alternative work schedules for multiple board meetings and innumerable lunch conversations leading only to the development of “opposing sides” and unmet expectations, and not to any creative alternative scheduling practices. In another similar case of unsuccessful communication about this issue, a pathologist felt forced to retire early rather than scaling back to 75% in an effort to balance work/life or work/health issues, leading to a negative consequence for the practice as a whole. When dealing with professionals who have a wide variety of experiences, concerns, opinions, and expectations, even effective communication practices cannot guarantee effective group functioning, However, ineffective communication almost always results in problems. The role of the leader, therefore, is to ensure that all members of the practice are involved, and that communication is constructive rather than destructive, including during the sometimes emotion-laden discussions associated with giving and receiving performance feedback. Books and training programs on effective communication skills are widely available to help the practice leader learn more specifics on this topic, but as a general guideline consider the following basic communication tips.

While as noted above, each group or organization, and even groups within a larger organization, will have its or their own culture, the culture itself may evolve with time as new challenges or circumstances arise. (Remember that organizational culture is defined as the operating “software” for interactions and activity within that organization or group. Norms, expectations, protocols, and policies, along with incentives, rewards and recognition all constitute “culture.”) Perhaps thinking of the situation as akin to the variation in day-to-day weather in contrast to the general climatologic setting would be a good analogy. Culture will help you know what the norms are for approaching weather patterns and what the likely range of outcomes are for those, but each individual “weather maker” will have its own nuances and impact.

However, in contrast to atmospheric disturbances that are generally beyond control, a variety of approaches can be useful to mitigate the impacts and duration of the storms of a cultural mood swing within a group or organization. We might not be able to predict how long a hurricane will stall and dump rain on a city or state, but in an organization we might be able to exert some control over how many workers we have trying to pump specimens through an overloaded system. We might be able to determine whether angry employees are assigned to mission-critical tasks, or whether the incentives for performance appropriately match our group goals.

This analogy is further useful in thinking about the tools used to forecast upcoming meteorological events and considering what tools might be useful in predictive planning within the group culture of a laboratory or pathology group. Wind speed, barometric pressures, relative humidity, satellite images, and so forth might enter into the model being used to predict whether we will have sun or storm for tomorrow’s picnic. Likewise, in a group, certain sentinels might be placed to monitor workflows, revenues, cultural or administrative stresses, regional or national trends along with awareness of individual variables that all might contribute to either the “perfect storm” or idyllic weather.

Healthy organizational cultures tend to have many similar characteristics. They tend to be quite transparent. With regard to matters of accountability and individual responsibility, they score highly on the accountability end. In contrast, on the axis of risk-averse to risk-taking, they are more centrist, enabling, or even encouraging a reasonable degree of risk taking (freedom) to explore new ideas and opportunities. They also score well on matters of choosing to do things right, to high standards, and without shortcuts.

Other healthy organizational characteristics include a learning approach to mistakes, rather than one of blaming and shaming (which remains consonant with the shared accountability mentioned above), an uncompromising dedication to integrity of word and action, a strong pursuit of collaborative, integrative action, and relentless determination in the face of difficulty. Now it may be evident that these characteristics are not as easy to monitor as atmospheric temperature. There is no “integritometer” that one can post on the break-room wall to show the level of truth-telling today and compare that with yesterday. One cannot just stick a wet finger into the air and tell whether the collaborative winds are from the favorable southwest or forebodingly from the north. Nor can one look at the solid and dotted lines on an organizational chart and ensure that there is a high degree of accountability and individual responsibility. So how does a leader assess the organizational health? Cultural mood-forecasters will use a variety of tools to help them assess the state of the organization, and often develop particular patterns for “taking the pulse” of their group. Patterns of behavior often used to this end include: