In most ways, Americans are highly individualistic. We believe our achievements are of our own making (yet, somehow, our failures are often due to others). Our society and culture often shun the efficiencies and support of a group approach in favor of independence. This point was driven home to me when I met a tour guide on a trip I made to India on behalf of APA. He clearly saw his life as interwoven with family, friends and other living things. Passing a restaurant, he mentioned celebrating a promotion there. I asked if he had had a party. "No," he said. "When you pray for something you really want and it comes to pass, you must give to your community. I asked my friend who runs this restaurant how much it costs to feed an impoverished person. He said $1. So I took part of my raise and fed 100 hungry people." I pondered over how rare this approach would be back home.
But the American ideal of independence-at-all-costs may have run its course in many arenas. In business in the latter part of the 20th century, U.S. automobile companies realized that the teamwork approach of Japanese car companies seemed to help them make better, more efficient and longer lasting cars more quickly than their American counterparts. In addition, studies began to show that errors in aviation and health care were often linked to traditional hierarchies that shut down communication from anyone but the leader. Teams with diverse membership, flattened hierarchies and rich communication were more likely to have positive outcomes.
Primary care itself is undergoing a transformation from a practice headed by a physician to care rendered by an interprofessional team. The complexities of health and illness mandate team-based over solo care with multiple people targeting the multiple aspects of a chronic illness — a physician who diagnoses and treats acute symptoms; a nurse who administers immunizations, draws blood and checks labs; a pharmacist, a nutritionist or a care manager who connects the patient with social agencies and other health professionals; and a psychologist or other behavioral health professional who consults on the meaning of the illness to the patient and family, their emotional reactions to it, desirable health behavior changes and much more.
Given our attachment — and past success with — using individual paradigms, how can we shift to a relational approach? By drawing on our common experience of growing up in families, with relationships forming our foundation. Family-systems theory is invaluable in studying and consulting to health-care teams. The essential elements are communication, common values, awareness of one's role, flexibility and a clear sense of boundaries. Each member has a characteristic style, talents and vulnerabilities. The art of teamwork involves complementarity that maximizes group strengths and tends to the well-being of all members — not just a privileged few. The science of teamwork reveals that a highly effective team is goal-directed, plans, listens, reflects on its own functioning, encourages feedback and self-corrects in ongoing cycles of improvement. It looks very much like a healthy family connected to each other, tolerant of differences, and looking out for everyone's well-being.
As experts on relationships, psychologists have much to offer the science and practice of teams. In the primary care clinic where I work, we are expanding to nine teams to meet demand created by the Affordable Care Act. In the next year, we will triple our behavioral health workforce, with a psychologist on each team. These psychologists will be expected to care for team members and facilitate team functioning, as well as care for patients and families. Perhaps we are moving toward a culture where team members give to their communities when celebrating their own good fortune. Put another way: Whether in a primary-care office or around the kitchen table at home, we are all aware that the whole is greater than the sum of its parts.