The most challenging aspect we have in medical department lies in the role clarification. Team members have to understand what is expected from them and how their interdependent participation will contribute to success. To build a commitment to the teams' goal, the team members must be engaged in developing strategies and tactics. Guiding the team focus and the direction are mandatory for the team leaders.

Using the Interaction Style Indicator (INSI), we analysed the human behaviour of the team members in their interaction and communication during staff meetings and during interdepartmental meetings. Based on the quadrant model, we placed team members independently in one of the eight interaction styles. The cognitive style indicator is characterised by four basic styles: fact-finding, planning, creating and co-operating.
We defined the different cognitive styles of the team members using the provided COSI questionnaire (statements). The feedback given to the team members of our cognitive style interpretation was approved and reflected by all the individual members.

Several drivers have also an important impact on team member engagement: proudness of the team, empowerment leadership behaviour, culture of the organisation focused on well-being and goal orientation of the team.

Patrick Lencioni (The Table Group) reveals in his book the five dysfunctions of a team. These dysfunctions go to the very heart of why teams often struggle. He describes a powerful model with steps that can overcome these hurdles and build a cohesive effective team. True cohesive teams therefore trust each other, engage in unfiltered conflict around ideas, commit to decisions and plans of action, hold one another accountable, focus on the achievement of collective results. Based on a closed team members meeting on this Lencioni model, we performed a team assessment and we graded the different functions of our team.

Given the independent position of the physicians in a hospital and their relation to the overall management and their colleagues, questionnaires about physicians' performances and attitudes are avoided and not encouraged. Although this attitudes are personal, we experience that in general most of the physicians are committed to performance. Others have other standards of performances and like to be left alone in this discussion of performance and quality. On this topic, most of the medical departments struggle to align their colleagues in the same high standards and performance, because of their horizontal relationship and independency.

Standardisation and accreditation (governmental or non-governmental) can oblige this peer-to-peer evaluation to identify the underperformers. This will not only help the identification, but more important, will encourage leading and managing physicians to tackle the attitudes of their colleagues and to have an insight of the current problems of performance.

To help overcome an avoidance of accountability a few classic management tools are effective and should be implemented in an organisation: publication of goals and standards, single and regular progress reviews and team rewards.

The role of the leader (medical director, department head) is more than crucial. Leadership skills for leading physicians are a necessity. Team leaders must author a vision and identify the metrics of success, communicate clear expectations and hold team members accountable for their performance. This is enforced by humanity and sensitivity. True and successful leading a team is creating commitment, having followers by inspiration and establishing alignment.
The teams that are blessed with energy, creativity and shared commitment far surpass other teams. Different aspects of communication affect team performance.