While I was in junior high, Florida schools desegregated. I remember the adults' anxiety, and how we kids felt confused. I remember the "us" versus "them" dynamic that felt awful to my friends and me. We naively tried to ignore racial categories. I told my parents I wanted to go to college to understand stereotypes, then majored in cultural anthropology. I wanted to understand other cultures and the dehumanizing "us" versus "them" dynamic that can occur when people or groups are under pressure. Why do we manage anxiety with blame? This early experience with desegregation underlies my professional mission to build bridges across different cultures, different roles and different perspectives. It drives me to collaborate across difference to enrich practice, research and education.
As modern dancer and choreographer Twyla Tharp said, collaboration is "a way of working in harmony with others" that begins with a point of view. Whether an artist, business leader, pilot or health professional, collaboration moves from "me" to "us," from traditional hierarchy to team sport.
Collaboration in health care is especially relevant because chronic illness management often requires health behavior change and mental health care. The biopsychosocial model, introduced in the 1970s by University of Rochester internist and psychoanalyst George Engel, proposed tending to psychosocial and biomedical elements of health to gain greater understanding and more successful treatment. However, one person cannot be expert in all aspects of physical, psychological and social health. That's why interprofessional teamwork has become normative in primary care. Collaboration is slowly becoming a habit. This trend has been supported by the Affordable Care Act's emphasis on increased access to health care, including mental health care.
In family medicine at the University of Rochester, we ensure that patients and families work with the professional on the team best suited to address their problem. This requires understanding each professional's expertise. Comprehensive care requires role clarity among different professionals, as well as effective communication within the care team and with the patient and family. Electronic health records can facilitate this communication when the documentation reflects what the team needs to know and what the patient wants shared.
Interprofessional teamwork has spawned new forms of collaborative, adaptive leadership. For example, one person may provide leadership about clinic operations while another facilitates optimal team functioning through appreciative inquiry and conflict management. Leadership may be fluid, held by the person with the longest relationship or the most expertise with the patient's primary problem. The leader may be a psychologist, nurse practitioner or physician, since it is not dictated by one's degree.
We know from psychologist Eduardo Salas and others that successful teamwork does not occur accidentally. High-functioning teams experiment to determine what works. Collaborative habits are built from activities such as simulation, small pilots, feedback and evaluation. Teamwork is enhanced by ongoing development of self-awareness through small group experiences, 360-degree evaluations and mindfulness training, as well as exposure to the science of successful teams. My colleague, Tziporah Rosenberg, PhD, provides an hour of monthly team training for everyone in our large family medicine practice. After a five-minute "lightning talk" on an important topic (such as patient-centered pain management), teams engage in a skill-development exercise. Back in the large group, team members report on the experience. Everyone then practices the skill over the next month to anchor the learning.
The collaborative habit is a focus at APA — among staff and members, between APA's board and council and across the organization. We are a complex, adaptive organization with many talented people. We need to grow partnerships within and among various psychology specialties — across science, practice, education and public interest. Through collaboration we reveal our core values and demonstrate integrity, accountability and our commitment to improving human rights and public welfare.
I look forward to working with you to strengthen this collaborative habit within psychology and our association.
