3 Tips for Aligning Cultures

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A Physical Therapist helping a patient adapt

Last month, my classmates and I found that most of the hospitalized patients we cared for could really use the skills of a Physical Therapist (PT). Physical therapy was the only way some of our patients were going to fully heal and return to their past lives. A smart classmate recognized, however, that she was having problems reaching our team of therapists in time to efficiently impact her patient’s health. It was sometimes frustrating to delay a patient’s care or discharge because we couldn’t talk to PT right away. We would type in a consult but it might be a day or two before we got a response?

We learned that if the consult was placed as “stat” or right away, they would send it back to us and ask that we say “routine” instead. That caught my attention. Here is an opportunity to improve care by improving teamwork between two different groups of professionals!

F-15E and F-16 at the tanker

An F-15E and F-16 getting gas over Afghanistan

In 2007 I deployed to Baghdad as a junior officer in charge of team of 16 airmen. We were the vital link between the soldiers on the ground and all of the air and space assets in the skies above. Known as Tactical Air Control Party (TACP); our team directed thousands of hours of surveillance and improvised explosive searches from drones and F-18s. We controlled the strafing attacks of F-16s on insurgents trying to hurt our soldiers. We were a very small team spread out through the city amongst more than 3,000 soldiers. It was challenging to align our cultures in order to accomplish the mission.

PTs go through different training and have a different culture than physicians. We all have the same goal of improving the health of our patients but we may see the problem differently and take different approaches. The same was true of my airmen living with the Army. We were both military and committed to achieving our mission in Iraq but we had different cultures, methods and values.

My TACP were able to do a much better job for our Army customers when the soldiers realized the following three ideas. I hope these might also help the physician trying to coordinate for help from a PT:

  1. Ask for an effect or explain what you want to achieve but don’t tell them what to do. The PT is an expert in reducing pain and improving mobility. It is foolish for me to tell them to walk my stroke victim patient around a couple of times a day. I don’t know what they know! By trying to direct their actions I may be seen as a jerk and I lose the benefit of their creativity and experience. Instead, I can quickly explain that my patient is recovering from a stroke and I hope to get him back to his garden and daily walks as quickly as possibly; please help. Framed in this manner, PT had our patient walking laps around the hospital floor in less than a week!
  1. They are a limited resource so try to focus their efforts on problems they are best trained for. Another gentleman was withdrawing from heavy alcohol abuse and needed a long stay in our intensive care unit. He finally improved but still seemed to have permanent disabilities and we weren’t sure if he could safely get around on his own. We talked about having PT work with him but then my supervisor just asked the patient if he could safely walk. The dude jumped out of bed and jogged with his cane across the room and back. Our hospital only had five PTs on staff. Clearly this guy could move and we were able to leave them to concentrate on our stroke victim instead.
  1. They are “enablers” but they don’t work for us, they work with us. Physical Therapy is another asset that we can call upon to help enable our care plans. They assist and are often our best solution for tuning up a patient. None of us, however, signed their paycheck. Believing that the PTs work for us, or that they should do what we tell them to, fosters a hierarchal and frustrating atmosphere. It can quickly lead to an us-against-them mentality. They are highly trained professionals that are working hard for our patients. A culture of teamwork and mutual respect is always better.
Chillin on the roof

Watching out from a roof in Baghdad

Our healthcare system is incredibly complex. We now have experts and specialists that can and should be leveraged to keep our communities healthy. We can’t afford a culture of animosity or us-against-them. I saw in Baghdad that getting two cultures to align required leadership on both sides to establish trust and clear roles. It needed regular education for both teams and it required respect and compromise. As physicians, we need to use these same tools to build a culture of teamwork with other providers so we can attack health problems as a bigger and better force.

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