Dynamic High Performance Transplant Teams: Trust, Talent, and Collaboration

F areas in healthcare depend on multidisciplinary collaboration more than transplantation. Whether in procurement or clinical practice, transplantation achieves its best results when team members share a focus and mission for implementing goals. High performance teams are characterized as those with clearly defined roles and expectations, in which the members value their diversity.2 In a patient selection committee, for example, the diversity of the multidisciplinary team is clearly evident. Physicians, transplant coordinators, social workers, psychologists, pharmacists, dietitians, and ethicists: each facilitates the decision-making process. Although their decisions are not always unanimous, a consensus can be reached. Trust is implicit in dynamic teamwork. Obstacles to efficient teamwork may include poor communication, distrust, personal competition, differences in goals and values, lack of team leadership, and lack of systems support from the organization. Among transplant teams, the frequency of interactions and the diversity of disciplines create a great potential for conflict.2 The perspective of a clinician who focuses on the physiologic need for transplantation versus the perspective of a social worker or psychologist who focuses on the psychosocial warnings can vary greatly. Teamwork requires individuals who understand that grandstand behaviors block effectiveness. Synergy arises only when individual talents work collaboratively and respectfully. The true value of teamwork is that the outcome is greater than the individual contributions. In a society that emphasizes individuality and independence, it is not always easy to achieve the mindset and skillset of the interdependence required of our transplant teams.3 Add to this the organizational structure and system of a hospital environment that may not support the goals or intricate needs of transplantation, and you have identified some of the challenges. Clinical transplant teams functioning in a hospital environment are self-managed, self-directed autonomous groups that may not communicate effectively within the organizational structure. Most transplant team members do not serve on hospital committees, where assignments may include facilitation of intradepartmental communication. This may contribute to the lack of understanding of team needs. Interestingly, most hospitals have several transplant teams that do not communicate with one another, serving almost as separate fiefdoms within the organization. Few hospitals have established a department of transplantation or a patient care center for transplantation where the leadership from each team is represented in a steering committee or council. More often, the teams function separately under individual departments such as cardiology, surgery, or hepatology. Programs structured within a transplant center have teams that function within a greater team concept. This design seems to promote a strength of unity that is conducive to communication within the organization and that can convey transplant issues to hospital administration. The culture of a team evolves over time. Most teams develop patterns of behavior that identify their culture. Power distribution, communication patterns, discussion topics, and conflict management exemplify behavior patterns reflecting a team’s culture.4 As personnel change, the balance shifts and new individuals must determine how their role fits and if their expectations meet with those of the team. Finding the fit in an established culture may be problematic for both new and experienced team members. How a team is structured and how it functions usually depend on the institutional culture as well as the team culture. New members must analyze their place and work within the group to develop mutual trust, and this often takes time. Decision making for clinical transplant teams extends far beyond the patient selection committee. Plans for pretransplant and posttransplant care are developed through the dynamic team process. Trust—a strong component of an effective transplant team—will ultimately translate into successful outcomes, individual satisfaction, and synergy. It is this type of teamwork that promotes dynamic high performance teams with successful outcomes.