Good writing, with a strong point and with life oozing out.

On Collaboration

July 17, 2006

At each step along this journey, we have worked with large teams. Which suits us: we love collaboration and flat structures, and have seen great results from this model of care. When nursing, cardiology, nutrition, physical therapy, occupational therapy, speech therapy, cranio-facial surgery, respiratory therapy, wound care, anesthesiology, cardiac surgery, gastro-enterology, pediatrics, case management, social work, lactation, and many others all have a voice, issues get looked at from many facets, and problems are generally solved in short order. We love it, and feed off of the multilayered energy and expertise.

At the same time, such efforts expose us to a vast network of interpersonal relationships and political interplay. Much of our mental energy and conversational space each day is occupied with concerns about what people said, how they said it, and ‘what they really think’. We try to listen extra hard to the people who don’t speak as loud, and who say things we don’t initially want to hear, to make sure that we’re considering everything. We try to remind ourselves that we’re not the only patients in the unit, and that many of the disagreements which people have with one another are about the patient before, or the one last week, or simply the way the issue was presented. And heck, sometimes people are just having a bad day.

We could strip things down, of course. Yet if we were to limit our contact to– let’s say– the doctor, we might simplify our lives, but we bargain away the goodwill of everyone else, and sacrifice their best efforts on behalf of our son. Besides, we would only reinforce the already existent inequities in the teams, and would of course put too much pressure on any one person to have all of the insight.

What we’re left with are a long list of questions without answers. What do people think? Why? How would they advise us? Are they frustrated with us, or with the other team member, or both? Who is right? Who is being pushed around, or silenced, or otherwise overlooked? Does a particular member of the team just not like us? If so, why? Are their concerns professional, or personal, then? If someone begins to only communicate contrary ideas to us through intermediaries, should we just let them go that way, or go and talk with them? If we feel misunderstood, should be try to clarify our point of view, let things be, or both? Which are the issues where we are, in fact, the best informed? Which are the ones where we have dangerous blind spots?

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