Try this for a thought experiment- you're about to have life-saving surgery. Before you go under the knife the hospital gives you a choice. You can choose one of two surgical teams.
The first team comprises the hospital's best surgeon, their most talented anaesthetist and their most experienced surgical nurse. However the three of them are known for communicating poorly and often see things differently when it comes to work.
The second team is averagely competent yet all the members get on well, communicate clearly and tend to see eye to eye on how to carry out a good operation. Which team do you choose?
It's probably not an easy choice. The stakes are about as high as they can be, your personal risk is at maximum and both teams seem to contain obvious flaws that may become full blown cracks under the glare of the operating theatre lights.
Recently I posed the dilemma over a family dinner (conversation was running low). Both sides had their advocates, each with logical arguments for their choices and each one unmoving in their commitment to that logic. Myself I honestly don't know... I lean slightly towards team two but nothing quite removes the discomfort of knowing you are choosing an average surgeon.
Specialism or a shared mental model? Which one is the trump value when it comes to performance? Or to put it in a way that every sports fan will understand, do you choose your best players and then make a team or do you develop a team strategy and then pick the players who suit it best?
These are fundamental questions for organisational consultants to ask. So much time is spent trying to maximise performance so it seems only right to spend some time thinking about the right balance between specialism and a shared mental model. And (if we aim really high) we might start to think about a balance that isn't just precisely calibrated but which also contains the magical alchemy that allows teams to go beyond maximising productivity in a zero sum game and start being that much sought after thing - 'more than the sum of their parts'.
"Some kind of a whole beyond its parts" Aristotle, Metaphysics
For years specialism has had the whip hand. Industrialisation, the division of labour, the creation of professions and the increase in technical education have galloped forward as the heavy cavalry of human progress. Two hundred years ago there were simply no such things as oncologists, recording engineers or seed drill operatives. Such roles would have been entirely subsumed by the umbrella terms of doctor, musician and farmer.
And if we're minded to wonder whether this charge to specialism has been a 'Good Thing', it's worth remembering that Adam Smith was undoubtedly right in his analysis of the apocryphal pin factory. Division of labour does increase productivity many times over. It's hard to argue against the advances of specialism. Would you want your tumour treated by the latest drugs and therapies or by leaches and holy vapours?
A pin factory... labour divided (and not a single health and safety poster in sight)
Obviously specialism and all its attendant miracles are not something that we would want to rewind. But neither can the lack of a shared purpose be entirely compensated for by finer and finer technical knowledge.
So what about the other side of the coin? What about the shared mental model? The newness of the term is a giveaway that this is a more recent concern. The google Ngram for "shared mental model" is clear to say the least.
In the last thirty years use of the term has spread from the circles of organisational academics (Chris Argyris and Peter Senge notably) into the parlance of consultants, executives and now organisations as a whole. The fundamental idea is obviously not new but what is new is the feeling that this is something significant requiring explicit articulation, a seat at the table of organisational priorities and activity to add strength.
Perhaps this is a response to the rise and rise of what might be called social atomisation, the phenomena of being always among people and yet less and less connected (driven probably by the virtual nature of our online lives). Or perhaps it was always going to be a conversation that late-stage industrialisation and hyper-specialism needed to have with itself. Whatever the antecedents, more and more people are talking about it.
Take midwifery for example. A recent edition of the Royal College of Midwives' magazine for member (Midwives Summer 2018) devoted a four page article to the subject. Entitled "Breaking Down Barriers?". The article identified the lack of a shared mental model as one of the main effects of "tribalism among healthcare professions".
The opposing views of obstetricians and midwives reflected the very different mental models which their disciplines had inculcated from basic training onwards. The fact that universities rarely if ever combine some aspects of medical training with midwifery training means that the two tribes don't meet until after they qualify at which point they work shoulder to shoulder but see things very differently. Specialism wins out. And schools of thought diverge dramatically...
A palpable example of that came last year in the debate between two champions of the tribes: Hans Peter Dietz (professor of obstetrics and gynaecology) and Lesley Page (professor of midwifery and president of the Royal College of Midwives).
When two tribes go to war... Professor Dietz vs Professor Page
The debate was essentially about when and when not to persevere with a normal birth and when to introduce more medical measures such as induced labour and caesarean section. As a broad rule of thumb midwives tend to resort to these measures later than doctors. For professor Dietz (representing doctors) mothers and children needed protecting from the "normal birth ideology". While for professor Page (representing midwives) that way of thinking flew in the face of "evidence-based policy and guidelines."
While the debate was largely conducted in academic papers and politely avoided emotion we shouldn't be fooled - these two well-respected professors are fundamentally at odds. Yet they represent two professions that essentially do the same thing - help mothers to give birth.
Doctors and midwives work in the same hospitals, are employed by the same organisations, serve the same patients and work alongside each other shift after shift, year after year. To a mother in labour what is more important, that the obstetrician and midwife are true to their respective professional philosophies, or that they work together to care for her?
Interestingly the author of the article in Midwives, Sue Brailey, puts forward seven practical steps to develop a shared mental model without endangering technical skill or standards of care.
1. Teach effective communication strategies - and here she takes inspiration from the story of Korean Air who turned a poor safety record into an outstanding one by introducing a number of measures including using first names to reduce subservience.
2. Train teams together - ideally during both initial qualification and later on-the-job training days.
3. Train teams using simulation - where the pressure to resort to professional tribalism may be less.
4. Define inclusive teams - in which the value added by each discipline is understood, articulated and evidenced in day-to-day work.
5. Create democratic teams - in which a variety of disciplines all work together by adopting a single, overarching identity, e.g. 'healthcare professional' rather than 'midwife' or 'obstetrician'.
6. Support teamwork with protocols and procedures - which compel separate tribes to consider information that their own mental model might devalue.
7. Develop an organisational culture supporting healthcare teams - through the embedding and continuous improvement of the points above.
What strikes me the most in all this is the importance of shared learning and modes of communication that don't recognise professional tribes. Something as simple as everyone adopting first names on their badges and both sets of specialists attending each others' training days might go a long way to solving the problem.
Where I might go even further is in getting explicit about the mental model itself. Peter Senge uses the example of Hanover Insurance in his book The Fifth Discipline. Here, the problem of mental models was addressed through "internal boards of directors". Their job was to bring together senior management and local management on a regular basis. The aim was to challenge long-held assumptions, establish greater interaction between the two groups and forge common principles and values.
What hospitals experience between midwives and obstetricians, Hanover Insurance experienced between accountants and sales managers. It would be foolish to think that other fields don't face the same problem. So I suppose a good question for all of us would be 'What tribes exist in our organisations and what barriers separate them?' Then perhaps we can start to figure out how to bring them together. Whether it's something as simple as name badges or something as involved as a super-group dedicated to challenging assumptions, what are any of us actually doing about it?
Read on:
Bill O'Brien and Hanover Insurance http://www.strandtheory.org/images/The_soul_of_the_organization-william_o_brien.pdf