Three Dimensions of Medical Practice Cohesion

Updated on October 1, 2017

By Nick Hernandez

Cohesion is the intense bonding of employees, strengthened over time, that results in absolute trust.  It is characterized by the subordination of self and an intuitive understanding of the collective actions of your medical practice and of the importance of teamwork, resulting in increased productivity.  Cohesion is achieved by fostering positive peer pressure and reinforcing your practice’s core values.  Cohesion provides practice staff with supportive relationships that buffer stress and increases their ability to accomplish the mission or task.  Strong staff cohesion results in increased productivity and the achievement of greater successes.

There are three dimensions of cohesion: individual morale, confidence in the medical practice’s capability, and confidence in practice leaders.  In combination, these dimensions dramatically affect the effectiveness of your practice.

1. Individual morale

Unhappy employees can be detrimental to your practice.  Not only are they less productive and absent more, if they end up walking out the door, you’ll be paying the price for months or years to come.  Turnover costs are estimated to be from 30 percent of annual salary for an entry-level employee up to 400 percent of annual salary for a high-level employee.  As a leader, you must know your staff and look out for their welfare.  Leaders who understand that morale, only morale, will bring success are more likely to keep morale high among employees.  Morale is the level of enthusiasm, confidence, loyalty, and satisfaction within a practice, and it has been widely recognized as having direct ties to productivity.  Every person contributes to the collective morale of their practice.  A high state of morale, in turn, enhances practice cohesion and productivity.

2. Confidence in the practice’s capability

Medical staff members’ confidence in their practice’s effectiveness is gained through training.  The longer employees work and train together in a practice, the more effective they become and the more confident they are in their practice’s capabilities.  They know what their practice can do because they have worked together before.  Keeping staff members together through practice cohesion is a workforce multiplier.  Success in healthcare can be directly attributed to a practice’s overall confidence in its level of performance.  Of course, the opposite holds true; lack of cohesion, lack of confidence, and poor performance preordain a practice’s failure.  Practices that have experienced workforce reductions through downsizing, restructuring, or a merger place extremely high expectations on the remaining workforce.  Restoring self-confidence to face the impending challenges is critical to meet organizational demands.  Another key to confidence is transparency in communication.  Keep employees informed right away; as soon as there is a whiff of something coming down the pipeline, employees need to know about it.  Also, keep communications going both ways by collecting feedback at meetings and having department heads collect suggestions and ideas from their people.

3. Confidence in unit leaders

The issue of confidence in the workplace can make or break a practice’s culture.  No confidence means a hostile, toxic work environment where productivity is severely limited.  No confidence also means an environment where people are not living up to the standards of physician owners.  Confidence in practice leaders’ abilities is earned as staff members spend time in the company of their supervisors and learn to trust them.  Practice leaders must earn the respect of their staff, and doing so takes time.  As staff members develop confidence, based on their prior achievements, in their practice’s ability to accomplish tasks, they also develop confidence in their leaders as they work and train together.  In order to earn confidence, the leadership needs to fulfill their obligations and commitments.  Promises and good intentions are not enough; confidence requires competent performance that fulfills expectations.

Practices with open cultures, where information is easy to obtain and communication flows regularly between leadership and employees, allow strong teams to grow and thrive.  Practices that lack two-way communication between managers and employees will also lack cohesion.  As cohesion increases, team communication continues to grow and thrive.  But, team cohesion is not possible without trust, and trust is a trait that must be present among team members, between team members and their manager, and between the team and practice leadership.  Ardant du Picq, a French Army officer and military theorist of the mid-nineteenth century, perhaps summed up the need for cohesion best. “Pride exists only among people who know each other well, who have esprit de corps, and company spirit. There is a necessity for an organization that renders unity possible by creating the real individuality of the company.”

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