Southeast Texas Medical Associates, LLP James L. Holly, M.D. Southeast Texas Medical Associates, LLP

Senior Medical Student Externship - An Introduction to the Origins and Beginnings of Southeast Texas Medical Associates, LLP
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In April, 1995, four physicians in Beaumont, Texas began discussing the formation of a group practice.  One of the four had a fifth physician who worked for him.  These physicians had individually been in the private practice of either family medicine or internal medicine from ten to twenty years.  On Tuesday, August 1, 1995, SETMA opened the doors on this new adventure. 

The primary motive was to respond to the challenges of managed care which we all saw as a challenge to our future.  As the pressures of managed care increased, we pushed back.  We resented the need to hire people for dealing with referrals and pre-authorizations.  We saw managed care as an intrusion upon the way we had practiced medicine all of our careers. 

While we were judicious in our utilization of studies, procedures, tests, etc., we still saw the business-side of our practice as a function of doing more tests, more procedures, more studies, etc.  We measured and reported provider productivity and from the first day, we produced a daily cash flow report which told us what we owed, when we owed it, what our bank balances were, how much money we needed to collect every day in order to sustain the practice, what each provider produced and collected, etc.  This focus on measuring, auditing, tracking and reporting would become critical to our future.  But gradually, we began to see that what we were measuring, tracking and following were not the important issues for our future or for the future of medicine.

Team Building

Before SETMA understood that Twenty-First Century medicine could not be practiced with pencil and paper (19th Century Medical Record Methodology) or with Dictation and Transcription (20th Century Medical Record Methodology), both of which drove us to Electronic Medical Records in 1998, SETMA understood that the demands of 21st Century medicine would require a team approach to healthcare delivery.  All of the team building concepts in this chapter about SETMA’s beginnings were enunciated in 1995 and 1996.  They have been repeated and refined but they have been part of the organizational spirit of STEMA from the beginning.

Formed by four partners and from five practices, the new organization was made up of employees who had loyalties to different employers, each of whom had different styles of practice and all of which had worked independently for years.  Creating a team out of this group would be challenging.  Some medical records were done by handwriting and others were done by dictation and transcription.  Some records were organized alphabetically and others numerically.  All practices had laboratory equipment, none of which interacted with each other.  One practice had sacks of laboratory test results which had never been filed and another had accordion files with thousands of pages of lab results which had never been placed in the patients’ charts.  It would take over ten thousand dollars of paper products just to convert the five practices to a common paper filing system.1

One provider mentioned electronic medical records, but none of us knew what that looked like.  We needed a team but we had no tools with which to build a team.  Nevertheless, team building was the most important part of the early days of SETMA. In reality, our efforts at team building were directed toward making our “business” run better, but we shortly would discover that without that team spirit and effort, we could not produce the results we desired in the delivery of excellent healthcare. We discovered that 21st Century medicine could not be performed excellently without all members of our practice working together to care for patients.  Roles and duties were going to have to change.  Each member of that team would need to gain new respect and appreciation for the contribution of every other member of the team.

Team Building and Discouragements

As if our differences were not enough of a barrier to the success of the new enterprise, only four months after the founding of SETMA, on December 4, 1995, one of our partners was injured in an automobile-pedestrian accident which resulted in multiple fractures to both lower extremities. This was the first major challenge to SETMA’s success; and, it was the first of what would be many challenges to our commitment to a team-based practice.  For the eight weeks our colleague was out, I would be in my office one day and in his office the next.  No patient’s needs were unmet and all of our partner’s needs were fulfilled.  It was a strain, physically, financially and emotionally but we survived it, as did he, and it made us stronger.

Fourteen months after we started SETMA, one of the founding partners filed an injunction against the practice on a Wednesday afternoon.  The papers were served after five in the afternoon, making it impossible for us to deal with until the next morning.  However, by 10 AM the next morning, the injunction was removed and a negotiated settlement was reach. The partner was gone and SETMA was stable.  His departure was disappointing and particularly the way in which it was done, but it did not stop our efforts to build a team.  From the outside, it looked like the practice was unstable, but from the inside, it was prospering with excitement, energy and commitment.

Eight months later, a provider left STEMA involuntarily.  Soon, we became aware that that provider had filed a Qui tam law suit against SETMA alleging extensive fraud and criminal conduct by the founding partners of SETMA.2   While there was no substance to the accusation, a fact which was determined by the Federal Justice Department, the investigation dragged on for five years.  If there were any thought on our part of “giving up” on team building, this would have done it, but it did not. 

And, as with any new enterprise, there were financial pressures. One of the reasons for having principles and commitments is that they guide you through difficulties. Without them, compromise and mistakes will occur.  SETMA was founded on principles of business-decision making and they kept us from serious mistakes.  There were three principles:  ethics, equity, eternity. 

  • All decisions had to be legal.  We referred to that as ethics.
  • All decisions had to be fair.  We referred to that as equitable.  Decisions had to be good for both parties rather than being a zero-sum game with winners and losers. 
  • All decisions had to be moral or right.  We referred to that as being eternally significant.3  

Early on, SETMA’s principles were put to the test. In January, 1996, we arrived at the point that we wanted to provide health insurance for our employees.  After applications and interviews were done, the insurance agent told me that there was one employee whose health history was such that if we insured her our annual premium would be $10,000 higher than it would be if she declined the insurance or if we dismissed her.  Intuitively, the right decision was obvious, but with defined principles to follow, this was also an easy decision to make. I asked the agent, “Is there any legal way that I could ask her to decline the insurance?”  He said that anything we said would be a violation of the law.  I then said, “She is a faithful employee and even after knowing that once all five practices were together she will probably not have a job, she stayed with me.  Do you think it would be fair, to dismiss her over the cost of insurance?”  He agreed that he thought it would not be.  Finally, I said, “Do you think that in the grand scheme of things that this lady came to my practice without insurance which she desperately needed and the in the providence of God that her needs were going to be met by our insurance?”  He agreed that that was possible.

I told him, “Then we will insure her.”   This was at a time when $10,000 was a serious expenditure for SETMA.  He marveled. When I called her to tell her she would have insurance, she wept.  In June, when our new office was available, we kept her on, working at a job beneath her training, but paying her professional salary.  Almost one year later, we discovered that the person who was performing the professional services for which this lady was trained was incompetent.  Without any disruption to care, the lady with the insurance problems was able to move into the job for which she was trained.  We had blessed her and now she was blessing us.  SETMA’s history is filled with stories like this.

The principles upon which we founded SETMA  and our responses to these pressures contributed to our building a team.  We began to know that we could not only survive pressures but we could surmount them and succeed in the face of them.   And, we could do that internally with ourselves and externally with others with whom we would work.  We began to learn that team building not only involved how we related to one anther but also to how we related to others outside of SETMA, 

Team Building through Communication

It took until June 17, 1996, for all of SETMA to be moved into a single location from the five offices which the merging practices had occupied.  Upon moving into one location, our efforts at team building accelerated and we began publishing The SETMA Sentinel which was “irregularly and irreverently” published.  The Sentinel was  an in-house publication for the building of team spirit and for the making of one office out of five different medical practices.  It evolved over several years to be a means of communicating the core values, the philosophy, the growth, the vision and the mission of SETMA.

The Sentinel was also used to develop SETMA into a “learning organization” and into a team which creates opportunities for growth and development of individuals.  Perhaps the intent of The Sentinel was best expressed by a statement from Peter Senge’s The Fifth Discipline:4

Max de Pree, retired CEO of Herman Miller, speaks of a ‘covenant’ between organization and individual, in contrast to the traditional ‘contract’ (‘an honest day’s pay in exchange for an honest day’s work’).  ‘Contracts,’ says De Pree, ‘are a small part of a relationship.  A complete relationship needs a covenant. A covenantal relationship rests on a shared commitment to ideas, to issues, to values, to goals, and to management processes. Covenantal relationships reflect unity and grace and poise.  They are expressions of the sacred nature of relationships.’  (p. 145)

SETMA’s goal was and is for everyone in SETMA to rediscover the sacred in business relationships based on mutual respect, common goals and a commitment to common values.  The Sentinel’s goal was to employ humor, inspiration, information and education as a means to this end.  Not only did The Sentinel record and preserve SETMA’s history; it helped make SETMA’s history.

More important, however, than the written communication, was the living dialogue that formed SETMA.  At its formation, the community believed that two of the partners could not work together.  They seemed to be too different in their approaches to live and to do medicine.  Informally, and without an intentional plan, these two partners began to spend hours and hours talking after clinic hours.  In October, 1997, the two attended the Medical Group Management Association meeting in Washington, D.C.  In a pre-conference Strategic-Planning seminar, they realized they had the same goals and while their methods and manner were different, they had the same goals, passions and resolve.  This was a great contribution to the building of the SETMA team.

Team Building  - Risk Taking

Success can only take place in the face of the potential of failure, i.e., risk taking.  In September, 1995, we addressed team building and risk taking with President Teddy Roosevelt’s 1887 observation about risk:

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better.  The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, and comes short again and again, because there is no effort without error and shortcoming; but who does actually try to do the deeds; who knows the great enthusiasms, the great devotions, who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who know neither victory nor defeat.”5

SETMA’s formation did risk failure, but we were determined that if we failed, it would  not be because we did not “try.”  If we failed, it would not be because we did not set the standard very high and try to scale the wall to reach the standard!  If we failed, it would not be because we sat on the sidelines and envied what others were achieving.  In the sixties, there was a wonderful song entitled, “To Dream the Impossible Dream.”  We were willing to dream what at the time seemed impossible.  And, we realized that it was possible not to be able to achieve SETMA’s goals, which was:

  • To create a clinic where our patients’ Healthcare is the Only Care
  • To fulfill SETMA’s private motto of “Doing Good While We Do Well”
  • To answer every call every day from every patient
  • To compassionately care for those for whom no one else cared
  • To honorably and honestly deal with every issue which came before SETMA
  • To review every laboratory and x-ray report the day that it is reported
  • To deal courteously and kindly with discourteous and unkind people
  • To instill dignity and respect into every person who contacts SETMA whether in person or on the phone
  • To improve the health of our patients by expanding the services which are available to them
  • To set the standard for quality health care in the Golden Triangle

SETMA took the risk and succeeded.  In the process of building a team, we succeeded.  It is not surprising that team building is both a process and an outcome of risk taking.

Team Building as a Family

The SETMA family did not result from our having the same mother and father, but nevertheless, we became a family.  We were of different backgrounds, nationalities, faiths, ethnicities, genders, and ages, but we became a family.  We enjoyed watching each member of the SETMA family grow and mature..  Today, we continue to still delight in seeing what each colleague can become individually and what we all can become collectively.  As the SETMA team emerged, it was a delight.  And, as a family-team, we all became protective of each other.  When one hurt, we all hurt; when one rejoiced, we all rejoiced.  As pointed out above, there were disappointments.  There were those who did not want to be part of SETMA’s team or family.  Some left quietly; others used their relationship with SETMA to build other businesses before leaving.  Over time, we discovered that everyone that left only strengthened SETMA by leaving. 

We learned that as a family:

  • We were more interested in solutions than in blame.  When we discovered a problem, or when we experienced a problem, our first thought was, “How can I solve this problem,” rather than, “Whose fault is this?”  A family wants everyone to succeed.  Early in SETMA a memo stated, “You will never be as successful as when you help someone else fulfill their potential while you are succeeding yourself.”  Blame is cheap and therefore worthless; solutions are expensive, and therefore extremely valuable!
  • We wanted to support others when they were having a “bad hair day,” or when they have had a special, personal need.  We wanted to support them with enthusiasm!  We wanted to support them with an eye to making their load lighter, even if it meant a brief increase in our load!  In the long run, this approach to a team spirit will make us all winners..
  • We wanted others, especially the guests of our family - who are our patients - to think well of our family and to speak well of our family.  It’s so much more encouraging to our guests when they hear us say, “Can you believe how busy our front office is, and yet they still get the job done.  I’m sorry for your delay, but they are a great team!”  Rather than, “That dumb front office lost your chart!”  When we speak well of other members of our family, we really speak well of ourselves.  When we speak badly of them, our guests associate that negative attitude with us as well.
  • We wanted our guests to have the best possible experience with our family.  Therefore, the first contact with us had to be positive.  The receptionists had to be friendly, attentive and helpful.  No one could be ignored in our waiting room.  The file clerks needed to reflect an attitude of wanting to help the entire team function well.  They needed to speak kindly to one another, and they needed to do their best to facilitate our guests having a good experience while in SETMA’s office.  We wanted our guest to look into our front office, and say, “This is the kind of place I want to come to.”

Team Building Requires Leaders

The team leaders of SETMA - some people call them physicians or health-care providers - but we called them what they are, team leaders - needed to be leaders especially when things are going badly.  Rather than succumb to frustration and irritation, team leaders needed to encourage those around them to avoid:

  • Anger - there is not a more destructive emotion in a family, in that it reflects a low regard for the person-hood of the one toward whom anger is expressed.
  • Impatience - this is a condescending and demeaning attitude, which suggests that the one toward whom impatience is being expressed is less important than the one who is impatient.  The truth is that everyone in our family is important and no one is unimportant.  If a person is not important, then they don’t need to be here.  If they are here, they need to be treated with the dignity and appreciation which their importance requires.
  • Rudeness - a rude and thoughtless person reflects their own poor character, not anything about the one toward whom they are rude.  Rudeness is unthinkable from anyone, but especially from a leader.  On the anniversary of his hundredth birthday, friends and acquaintances of Albert Einstein were asked to remember him.  The most common memory was the he was KIND.  Rudeness and kindness are mutually exclusive.
  • Selfishness - nothing is more unattractive in a family than self-centeredness, which is reflected in ignoring the needs of others in order to “get what you want.”  Leadership means that you put aside your needs for the benefit of others.  Physicians, as team leaders, look to the meeting of the needs of those who support them, even before team leaders' needs are met.  This often means neglecting the leader’s business, interests, pastimes and friends until the needs of other team members are met, such as getting to lunch on time at noon or getting home on time in the evening.  A leader also puts the interests of his or her guests above his own, which means delaying other activities and treating his or her guests with preferential attention.

A leader is one who keeps his or her cool when everyone else is losing theirs.  A leader is not one who occupies a “position,” but one who overcomes pressure, rises above it and shows others how to do the same.  A leader is one whom others can “lean on” when they are down, discouraged or disappointed.  Every team member, no matter what their position, has the potential of being a leader.  And, leadership is what a company looks for when rewarding service.

A team cannot exist without leaders, but leaders are not commanders; they are colleagues, examples and they are those who see something which needs to be done and they do it.

By example, they lead members of their team to become leaders themselves. 

Team Building and Momentum

“Momentum” and “inertia” explain why it takes less energy to maintain a course and speed once they have been achieved, than it does to gain that speed and course.  In 1995-1997, SETMA had both “momentum” - it would take tremendous energy and effort to stop what we were doing - and “inertia” - SETMA, LLP had a tendency to maintain the course and speed which had been established.  Every day, each one of us realized how much easier it was to maintain what we had started than it was to “get it started” to begin with, i.e., that which seemed to take such a huge effort, had become a daily routine.

  • The effort required to answer every call every day from every patient seems to be less and less burdensome every day that we do it.
  • The effort to get all lab, correspondence, hospital records, consultations and other materials into the files got to be less and less every day.  (This was while SETMA was still on paper records, but our commitments to excellence made the adoption of electronic patient records both inevitable and essential.)
  • The effort to see patients within reasonable proximity to their appointment time became less and less burdensome every day that we did it.

Teamwork requires momentum in order to sustain its work; team leaders are a kind of “fly wheel,” which provided the momentum to sustain the work of the team.

Team Building - things to avoid

Success doesn’t take much more energy to achieve than failure; your goals just have to be different.  Our goals, defined in 1995-1998, were:

  1. To do well, while we were doing good.  “Doing well” is our reward for “doing good,” “doing good” was what we did for our patients.
  2. To establish a work environment where every employee finds personal fulfillment and satisfaction, which is why we rejected:
    1. Disharmony - because of our goals and commitments, we did not tolerate bickering and backbiting.  We established the following principle about attitudes:  “If you don’t have something good to say about others in SETMA, LLP, then you will need to find someplace else to work.”
    2. Disloyalty - because of our concern for the welfare of each and every member of SETMA’s team and because of our commitment to the practice of excellent medicine, we did not tolerate disloyalty.  The second principle we established was, “If you do not respect and embrace the mission of SETMA and the associates of that organization, then you need to find another place to work.”
    3. Dishonesty - each partner of SETMA has committed himself to a level of personal integrity and rectitude which established a standard for all employees.  This third principle of attitude was, “No employee of SETMA will ever be asked to distort facts, or tell a lie for this corporation."  Therefore, each employee was expected to maintain an absolute commitment to honesty.
    4. Discourtesy - all patients, clients, callers and visitors to SETMA will be treated with dignity, respect and courtesy.  The fourth principle was “No employee of SETMA will ever be allowed to be abused by anyone coming to this office, and conversely no employee of SETMA will ever be allowed to abuse a patient, guest, or visitor.”

SETMA’s mission was to creatively, collegially and cooperatively build a model of excellence in the delivery of primary-health care services to Southeast Texas, such that every employee can be proud to be a part of this unique experiment.

Team Building - Adding New Members to the Team

SETMA learned a great deal about team building when on June 17, 1996, Certified Family Nurse Practitioner, Mrs.  Sandra Amen Fowler began working with SETMA.  Mrs. Fowler represented a new dimension of health-care provider.  We were delighted that she chose to join the SETMA team.  Because the concept of a Nurse Practitioner was novel to us, the following explanation was sent to our staff.

  1. Unless Mrs. Fowler instructs you otherwise, her position as an independent health-care provider would make it appropriate for you to address her by her title, rather than by her first name.
  2. All of us will be learning about Mrs. Fowler’s professional capabilities and about this new relationship.  The partners of SETMA welcome Mrs. Fowler as a colleague, and would like you to extend her your full cooperation and the courtesies which her achieving the professional status of CFNP warrants.
  3. Mrs. Fowler is a team member of SETMA, LLP, and like the physicians of SETMA, sees her role as both team leader and facilitator of your success and fulfillment in this organization.  Introduce yourself to her, and let her know what a friendly and supportive team SETMA is.

The physicians were eager to have other Nurse Practitioners join SETMA as soon as possible.  All of SETMA was encouraged to enjoy a collegial relationship of teaching and learning in relationship to Mrs. Fowler, the Nurse Practitioners who are training with SETMA, and the Nurse Practitioners whom we are recruiting to joining SETMA.

Mrs. Fowler provided the opportunity for SETMA to expand our concept of a team.  Nothing illustrated this more than an event which occurred on the second day, Mrs. Fowler worked with SETMA.  As SETMA’s CEO stepped into an examination room, Mrs. Fowler had just finished drawing blood.  Startled, she dropped the tube of blood and it broke.  Immediately, she stooped down and SETMA’s CEO said, “What are you doing?”  She said that she was going to clean up the blood.  He told her to stand up and said, “I am going to clean up the blood (which he did).” He added, “I want you to learn that you are not here to do what I don’t want to do.  You are not here as a scrub nurse.  You are here as a healthcare provider who has a license to practice medicine within certain parameters.  You are my colleague.  I will never ask you to do anything which I am not willing to do. And, I will never ask you to do anything which is not legal, ethical and moral.  Therefore, I will always expect you to do what I ask.”

This established a relationship of mutual respect between all members of SETMA’s team which has existed ever since.  In less than six months, Mrs. Fowler reached and exceeded the goals which she and her colleagues set for her participation in SETMA.  During a difficult time in SETMA’s development, she functioned outstandingly.  In an in-house publication, the following note was sent to all of SETMA, “When you see Mrs. Fowler, congratulate her on a job well done!!  Let her know how proud we are of her, and how proud we are that she is a part of the SETMA family!!”

Team Building Attitudes

All in a supervisory role were asked to follow the following simple guidelines.  We believed that doing such would contribute to our team building efforts by making everyone’s job more pleasant and fulfilling.  The request reflected the respect we wish for each team member to have toward others and the expectation that anyone and everyone could become a leader in SETMA:

  1. Invite creative input about their areas of responsibility from those you manage.
  2. Involve everyone in your department in problem solving.
  3. Be kind to those with whom you work, and be sensitive to their feelings. 

These attitudes reflect SETMA’s belief that leadership has more to do with serving others than you having others serve you.  WE believed that how we related to one another would communicate to our patients - the guests of SETMA’s family - to know how pleased we are that they chose SETMA by letting them see how effectively this family works together and above all how much we value and appreciate one another. 

Team Building - Individuals Functioning as a Unit

We emphasized that we should never minimize how important it is for each of us to be a positive, constructive part of SETMA’s team.  We acknowledged that such a team does not happen without a great deal of effort on everyone’s part.  The attitudes identified above would turn into action through which building such a team would occur.  The actions are:

  1. Doing more than is expected of you, and expecting nothing for it.
  2. Doing someone else’s work when they are overwhelmed and expecting no thanks for it.  And, also, not expecting others to do your work.  Interesting dynamic isn’t it?  When everyone is operating on these two principles, you will be amazed how much work can get done, and how “good you will feel” about having done it.  Working by these principles results in the attitude:  “I’m going to do this now, because if I don’t someone else will do it or will have to do it!” rather than the attitude, “If I just procrastinate or neglect this, someone else will do it.”  You’ll be amazed at how your job satisfaction will increase when you work in an environment where everyone is trying to do the job so that someone else doesn’t have to do it.
  3. Seeing pressures and problems as opportunities for non-verbally expressing your appreciation for others.
  4. Not complaining when you feel pressured, or when you are asked to do something, which you would rather not do.  Anyone can complain and cause dissension, that’s easy.  But, it takes a creative and constructive person to turn their irritations into opportunities to promote teamwork and team spirit.
  5. Remember, the best insurance which you have against layoffs is to make yourself such an integral part of the SETMA team that you would be the last person anyone would ever think about “letting go.”

A team is built by the response team members have to stress, problems and crisis.  They may be little, like being asked to do something you don’t like to do, or they may be larger, like feeling overwhelmed by the amount of work in a day, or they may be huge like having a child critically ill, but however large, when responded to positively, they can build character and team spirit.

The process of team building never ceases.  On Nov 22, 2012, at 4:51 AM, SETMA’s CEO sent the following note to all of SETMA’s team:  “Yesterday, Dr. Caesar Deiparine and I decided that as our Thanksgiving Gift to our associates we would see all of the patients at Baptist on Thanksgiving Day.  We have done that - all of Baptist has been seen.”
“I hope that you learn from this that ‘random acts of kindness,’ are the most valuable gifts to others.  The only debt you incur in receiving this gift is that you are now obligated to do the same, not necessarily for us but for others.  On this Thanksgiving Day, we hope that this gives you an additional reason to thank God for your life and for your living.”

When one of SETMA’s physicians responded with a “thank you,” the following response was sent, “Thank you; the only appropriate repayment for a random act of kindness is gratitude and that someday, you extended to others your own random act of kindness.”  The principle was explained that a “random act of kindness” cannot be repaid to the one who acted kindly but it must be repaid to another, creating in the team a culture of “random acts of kindness” which are repaid to others.

Team Building and Flexibility

From one perspective, the most important character trait which will help make us successful is “flexibility.”  The characteristics of flexibility are:

  • Sensing and adapting to the wishes of other members of the team
  • Conserving my time and energy to complete my priorities as a member of the team
  • Remaining free to accept the best course of action
  • Changing plans if unexpected conditions require it.

Understanding the application of, “sensing and adapting to the wishes of the one I serve,” depends upon understanding who it is that “I serve.”  In reality, there are four groups SETMA serves:

  • We all are here to SERVE our clients, our customers, whom we call “patients.”
  • All employees are here to serve the employers at SETMA.
  • The employers must understand, if they are going to be as successful as they can be, that they are the servants of their employees and that their employees are the servants of their fellow employees.
  • In fact, everyone is here to serve everyone else.

At SETMA, through the principles of and commitment to professionalism, and now through the philosophy of the patient-centered Medical Home, SETMA colleagues want to go beyond professionalism to where we care personally and individually for and about each person who seeks care at SETMA.

When the attitude of a servant is adopted by everyone -- especially the owners -- rather than an entitlement attitude of privilege and prerogative -- the creative dynamic of the organization becomes constructive, compassionate and concentrated on success.  The next element of understanding this aspect of “flexibility” is determining what “wishes” means in the phrase “adapting to the wishes of the one I serve.”  In the work place, most employees' desires revolve around:

  • Being treated with dignity and respect.
  • Making a contribution, which then instills within one’s self the sense of worth and achievement.
  • Believing and knowing that what they are doing is important and necessary to the organization.
  • Being recognized for the quality of their contribution, and particularly having special recognition for doing more than is required.
  • Being able to achieve their personal financial goals within the context of the choices they have made for their lives.
  • Having a work place which gives something back rather just taking everything away.
  • And, having a work place which is physically and emotionally bearable as to the work load.  This generally is reflected in the feeling that there is an endpoint at which time or place “the job is done,” and that a sense of resolution and completion can be sensed.

The second aspect of “flexibility” is “conserving my time and energy to complete my priorities.”  At SETMA, our “priorities” are:

  • The health and well-being of our patients.
  • The success of our organization.
  • The maintaining of professionalism, placing the patient’s interests first, which reflects our character and commitment.

This is just another way of saying that our priority is “doing good, while we do well.”  How can we “conserve our time and energy to complete our priorities”?

  • By focusing on the task, and by not forgetting what we are here for.
  • By not allowing others to “steal our time.”  Time thieves are not malicious, and sometimes they are very pleasant.  For employees that means limiting personal calls and concerns to the necessary minimum during work time.  For employers, that means assigning certain times for personal business, and not allowing personal business to interfere with company priorities on company time.
  • By knowing how to “get off the telephone,” and/or how to end conversations politely in order to “get back on target” and/or to “get back on schedule.”
  • By giving friends and family the opportunity to participate in the success of our organization, as they contribute their sensitivity to our time demands while we are in the office.  And, by gently reminding them of those demands if they become insensitive to it.
  • By constantly focusing on the task at hand so that we can in a friendly and effective way “get the job done,” as we let others know that we really care about them.

The third aspect of “flexibility” is “remaining free to accept the best course of action.”  In another field of enterprise, an insightful book was written about a dying organization.  The cause of death was identified by the title of the book, which reflected the lack of “flexibility” in the organization.  The title of the book was, "We Have Never Done It That Way Before!"  Resisting change, because “we have never done it that way before” is the antithesis of “flexibility,” and may kill an organization more effectively than any other mindset. 
We seldom associate resistance to change as the lack of freedom, but the one who is truly free is the one who is willing and able to welcome change when that change:

  • Is a “better” way of doing things.
  • Contributes to the well-being of the organization.
  • Enables me to “serve” others by changing to make their task easier.

The fourth aspect of “flexibility” is “changing plans if unexpected conditions require it.”  At SETMA, “flexibility” is not an aspect of our day.  Adjustments are not daily or hourly, but almost minute to minute.  And, this aspect of “flexibility” addresses the ability to make smooth and rapid transitions from one task to another.  Nothing will make an employee more valuable to SETMA or a healthcare provider more productive than the ability to make such transitions.  Time thieves often exist in the creases created by transitions between tasks.  They are squeezed out and are unable to do their dirty deeds when transitions are smoothly made.

Team Building - Instilling Worth and Value in Others

One employer addressed his goal and how he viewed the people with whom he worked.  He states:  “A man I know owns a meatpacking plant in the Midwest. His company’s motto is ‘People don’t make sausages; sausages make people.’  That is, the purpose of the company is not to manufacture a product.  The purpose is to give the people who work there the sense of competent, valued men and women.  This means products are by-products.  Work lets us feel needed...Work lets us feel creative...I would even insist that when work is done in the right frame of mind, work can be holy. 

“There is a linguistic connection between the words ‘work’ and ‘worship.’  Work can be a way of serving God.  Whatever we do for a living, we can learn to see it not only for the money we earn, but in terms of the blessings and benefits it brings to other people...a man who works for a moving company brings a religious approach to his work...moving is stressful for most people.  They are unsure about what awaits them in their new community.  When he makes the experience of packing and shipping their belongings a pleasant, stress-free one by his attitude, when he speaks to them of the new opportunities which are theirs, he believes he is serving God by making those people less fearful...a lingerie saleswoman...sanctifies her otherwise ordinary job by being especially sensitive and compassionate to the mastectomy patients who come to her store....”

Lessons SETMA’s Developmental History has taught us about Teamwork

  1. Team building is not easy.
  2. Team building is imperative.
  3. Team building requires relentlessness.
  4. Team building requires genuine caring for and valuing the contribution of each member of the team.
  5. Team building requires leaders, but those leaders really are the servants of all members of the team.
  6. Becoming a member of a team is one of the most satisfying experiences of life.

In the next chapter, we will address the concepts from Peter Senge’s "The Fifth Discipline" which created the foundation for SETMA’s growth and development.  Speaking of teamwork, Senge said:

“Most of us at one time or another have been part of a great ‘team,’ a group of people who functioned together in an extraordinary way - who trusted one another, who complemented each others’ strengths and compensated for each other’s limitations, who had common goals that were larger than individual goals, and who produced extraordinary results.  I have met many people who have experienced this sort of profound teamwork - in sports, or in the performing arts or in business.  Many say that they have spent much of their life looking for that experience again.  What they experienced was a learning organization.  The team that became great didn’t start off great - it learned how to produce extraordinary results.” 

1 From August to October 1995, Dr and Mrs. Holly spent almost every weekend at the office, cross referencing stacks of laboratory results from an alphabetical filing system to a numerical one and filing the lab results in the correct chart, making sure that anything that impacted patient well being was given attention.

2 In common law, a writ of qui tam is a writ whereby a private individual who assists a prosecution can receive all or part of any penalty imposed. Its name is an abbreviation of the Latin phrase qui tam pro domino rege quam pro se ipso in hac parte sequitur, meaning "[he] who sues in this matter for the king as [well as] for himself."  This type of lawsuit is often called a “whistle blower” suit.

3 Being a multi-faith practice, this was not a sectarian issue, but it addressed issues of value and virtue, which were common to all faiths. 

4 Chapter Two will detail the significant impact this work had on the growth and development in SETMA, even to helping define how we would deploy an electronic medical record.

5 Theodore Roosevelt, “Citizens in a Republic,” the Sorbonne, Paris, France, April 23, 1910, quoted in The Man in the Arena, ed. John Allen Gable [Oyster Books, N.Y, Theodore Roosevelt Association, 1987], p. 54.