(Author’s note:  SETMA is often asked, “How did you build this organization?”  In an attempt to answer that question, we have begun writing a Developmental History of SETMA.  This differs from a simply Chronological History as it attempts to understand the dynamic of the processes which resulted in SETMA.  Some of these processes were intentional but most were serendipitous.  As we develop this history, we hope to explain to ourselves and to others how this process can be duplicated elsewhere.)

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 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 some place 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 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 some day, 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 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.”  In SETMA, no aspect of “flexibility” is more characteristic 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 mean 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....”