© Springer International Publishing Switzerland 2015Melina R. Kibbe and Herbert Chen (eds.)Leadership in SurgerySuccess in Academic Surgery10.1007/978-3-319-11107-0_10
10. How to Manage Difficult Team Members
Department of Surgery, Northwestern Medicine, 251 E. Huron Street, #3-150, Chicago, IL, USA
Nathaniel J. Soper
The punch line for a much-repeated lay persons’ joke about surgeons is, “Oh that’s God; he’s just pretending to be a surgeon”. The unique demands on surgeons – the ability to act decisively even when data are limited, the necessity to improvise when unexpected situations occur, and excellent eye-hand coordination – created somewhat of a mythical aura about surgeons. Surgery as a profession has also been closely linked to the battlefield and the armed forces. Up until the late twentieth century, these influences often reinforced the so-called ‘surgical personality’, one which is overbearing, hierarchical, and frequently treats subordinates in an abusive manner. Given the dictate for ‘managing the ship’ of the operating room, the need for quick compliance with orders and intolerance of delay reinforced these attributes, this behavior was tolerated. It has become clear over the last few decades, however, that the best surgical outcomes are associated with good teamwork and a flattening of the hierarchy within a surgical team. This concept has been reinforced with introduction of crew resource management techniques into the operating theater, ‘sign-ins’ which introduce all participants to one another, ‘time-outs’ to identify potential errors in the making, and an acknowledgement that all members of the team should have the ability to ‘stop the line’ should problems occur. Self-defining characteristics of surgeons – to do what is necessary within time constraints, to project a calming confidence under stressful conditions and the ability to rise to the occasion are still necessary, but the brash and arrogant caricature is no longer necessary nor desired.
Nevertheless, and as in all areas of human interaction, multiple personality types exist in the surgical environment. Within a group – team, section, division, or department – many different personalities will co-exist and need to be managed effectively by leadership. These personality types, when carried to the extreme, may result in ‘difficult’ or ‘disruptive’ members of the team. Numerous different classification systems attempt to categorize personality types. One such system is the Meyers-Briggs Type Indicator®, which identifies 16 specific types of personalities. Each of these types has a different outlook on life and way of dealing with issues. From the leader’s standpoint, when hiring decisions are being made, the underlying personality of the individual must be taken into consideration. An incredible curriculum vitae and list of accomplishments are enticing in a potential recruit, but a personality that doesn’t mix well with others on the existing team is a recipe for disaster. Background and reference checks specifically asking about interpersonal interactions are important when considering a new hire, as one of the most time-consuming, and least productive, aspects of a leader’s job is moderating disputes among team members who ‘can’t play together in the sandbox’.
For those in leadership positions, it is also important to understand the local institution’s by-laws on rules governing behavior – most state that practitioners must “adhere strictly to the ethics of their …. professions, to work cooperatively with others ….” and that the member may be considered for removal were he or she to act in ways that …. “are believed to be detrimental to patient safety or inconsistent with the efficient delivery of patient care” (Northwestern Memorial Hospital Bylaws). Finally, leaders should understand that if team members cross the line into the category of ‘disruptive’ that all subsequent dealings with the individual should be documented and records be maintained for future considerations.
10.2 ‘Difficult’ Team Members and a Leader’s Response
Multiple different personality types will undoubtedly populate any team or group of which one is a member. Leaders must learn how to best manage these personalities. That management style is necessarily dependent on the specific situation, the number of people in the group, and the group’s purpose. A leader must rely on his or her emotional intelligence and experience to navigate these sometimes tricky personality waters. In Chap. 6 the concept of emotional intelligence was explored. The leader may need to call upon self awareness, social awareness, self regulation and, certainly, social skill in dealing with the difficult team member. Furthermore, as discussed in Chap. 4, there are at least six leadership styles that can be invoked in any given situation. It has been said that a successful leader will use the different leadership styles as a professional golfer uses the clubs in the bag, choosing clubs based on the demands of the particular shot .
There are several specific personality types that may negatively impact a team. Those with difficult personalities have developed their traits over years and generally learn that they can wear down others to ultimately get what they want. The leader must identify specific personality characteristics, realize the ways in which these attributes may complicate the functioning of a team, and learn techniques that may temper the expression of these traits. The passive-aggressive personality type may undercut the leader’s authority by sniping, using sarcasm, and engaging in non-playful teasing. These individuals generally don’t like being the center of attention, however, and don’t like open confrontation. A strategy that may work with them is to redirect their attention to the issues rather than to other team members, and ask them to come up with specific action items to contribute to the team’s activities. A second, easily recognizable personality type is the chronic whiner (‘Eeyore’), who sees the glass as always half empty, points out the difficulty in every opportunity and blames others for every problem that arises – “I told you so” is their common refrain. The leader must stay positive, but realistic, with these individuals and be quick to point out positive outcomes from decisions made by the team. Diametrically opposed to the negative personality types are those who always try to please others, over-committing themselves and unable to give an honest opinion when the observation is not positive or popular. The leader must carefully delegate tasks to these individuals, help them learn how to say ‘no’, and specifically call them out to give candid opinions when the facts are unfavorable. There are also those who are unresponsive and disengaged and who refuse to reveal their true motives. They often will not participate in a formal meeting and reveal little about themselves. These people must be drawn out to participate in group meetings. Finally there is the traditional ‘surgical personality’ who is hostile, abusive, domineering and arrogant. These individuals can engage in bullying activities and must be treated differently than the remainder of those mentioned above.