This premed often worked in teams during her past life as a marketing professional, but it wasn't until shadowing a team at a community health center that she learned what it takes to make a team work.
By Meredith Steuer
After I got my business degree, I worked in marketing at a large retailer. I had gotten into marketing because I wanted to think deeply about people’s needs, wants, and desires. However, I quickly became dissatisfied with my work. I wanted to think about more than people’s material needs, and I wanted to see the results of my actions in people’s lives. And I realized that doctors get to do these things. Soon I found myself lured toward the idea of having patients rather than customers, of making treatment plans rather than marketing plans. So I went back to school to take the prerequisite classes for applying to medical school.
At the same time, I began shadowing a doctor and attending care team meetings at Union Square Family Health. While the promise of providing direct care for patients first drew me to medical school, I’m now equally excited about one day joining an interprofessional team.
In marketing, I worked with both functional and dysfunctional teams. Sometimes team members seemed more focused on proving their worth to their bosses than solving the actual problem the team had formed to solve. Other times, meetings seemed to include and exclude precisely the wrong people. For example, every week the internal media team and the media agency held a meeting to review all media plans and ensure they fit the needs of upcoming programs. Many lower-level employees from various teams attended the meeting, but they spent the entire time on their laptops checking email because their supervisors hadn’t delegated any decision-making power to them. The supervisors kept all the decision-making power for themselves because they feared they would otherwise seem dispensable. The meetings became so inefficient that some of us began holding our own meetings to review the media plans. But during these meetings, we ordered changes and revisions without the necessary approval that we could have gotten at the official meeting. If the team had only included the key media decision makers and the authorizing supervisors in the first place, meetings would have been more efficient and productive.
By the time I started attending team meetings at Union Square, I think I had become accustomed to being a member of dysfunctional teams. That’s why the team at Union Square inspired and excited me. It was there that I observed the essential qualities a team needs both to function and, in this case, to provide the best possible care for its patients:
The team remains focused on the true priority—the patient. The well-being of the patient lies at the heart of health care teams; therefore, the team only has its other qualities because of this defined, focused objective. Neither hierarchy nor profession matter as much as the patient. As a result, all team members feel comfortable offering insight into particular patients. During one meeting, the team discussed a patient who had missed many of his recent appointments. The doctor mentioned that the patient lived far away from the clinic and asked the nurse to refer the patient to a provider closer to his home. The medical assistant, however, had spoken recently with this patient and knew that the patient, a Brazilian immigrant, was not comfortable going to another clinic because he was afraid that the staff would not speak Portuguese. Without this insight, the nurse would not have been able to address this patient’s concerns and get to the root of the problem.
All members of the team have a specific and integral role. In the care team’s meetings, everyone has a crucial role to play in the patient’s care. Everyone looks at the same diabetic patient chart projected on the screen, but the pharmacist provides insight into the patient’s drug regimen, the RN provides background on a series of no-shows since she spoke with the patient by phone, and the physician provides analysis of vitals and tests. Relying on each other’s expertise and training, the group generates solutions and action plans that no one person could have done on his own.
Team members will bend roles in order to best serve the needs of patients. Because the team puts the patient first, members will perform duties outside of their normal proscribed roles when necessary. I witnessed this most often during meetings focused on particularly complex patients with multiple social and health challenges. Team members would switch off who would reach out to these patients when they were due for a visit in order to ensure that the patient spoke in his native language with someone he knew and trusted whenever possible.
All team members believe in the mission. I once took a management class where I learned that direct supervision has limits in complex environments like health care. A doctor could not possibly oversee every patient’s arrival, rooming, and vitals for instance. How, then, can a leader ensure all team members make appropriate decisions in nuanced and ambiguous situations? The leader and his team must agree on foundational values for the entire organization. Employees, when faced with intricate problems, can then refer back to these principles when determining the appropriate solution or action. The values act as a sort of North Star; the employees must use their own navigation skills, but they know where they’re headed.
I witnessed this principle most clearly in the team’s medical assistant. After a poster session one evening, she told me she wished all families could receive the type of care that Union Square provides. She passionately believed in the team’s central goal—to improve the well-being of the patient. The passion clearly translated into her work with patients; she acted as a team goal-keeper, checking the charts of patients then alerting providers to overdue screenings and vaccines.
As a post-baccalaureate premedical student, I can’t imagine a better introduction into primary care innovation than a well functioning team. The direct impact that I have on my future patients won’t only be felt through the mole removals that I perform or diabetes screenings I order, but through the work of my entire team. I can’t imagine a more effective—or fulfilling—professional environment.
Meredith Steuer graduated from Harvard College in 2010 with a degree in History and Literature of North America and Latin America. After graduation, she worked as a ski instructor in Vail, Colorado, before earning a Master of Management Studies from the Duke University Fuqua School of Business. She worked in marketing for Walmart.