The Five Step Collaboration Cycle: A Tool for the Doctors Office

Abstract

In most areas of our lives, we are collaborating with other people. Whether it be driving a car, buying groceries, selling products, seeing patients in an office, defending a client in court, working in an assembly line, leading an organization, or teaching in a classroom, individuals are connected to other people, and they rely on their skills of communication, cooperation, negotiation, and listening to accomplish goals. At the core of these collaboration skills are foundational attitudes, beliefs, and feelings, including trust, respect, and empathy. The word collaborate is a derivative of the Latin word collaborare meaning to labor together. Webster's New Collegiate Dictionary defines collaboration as "to work jointly with others especially in an intellectual endeavor" and "to cooperate with an agency or instrumentality with which one is not immediately connected. " [1] On the surface, to collaborate appears relatively easy and straightforward to do. But, all too often, this verb is dismissed and replaced with more self-serving verbs including demand, threaten, persuade, and argue which often leads to disagreement, discourse, rebellion and chaos. Going Back to Basics One of our basic human needs is connection. We are wired to connect. From birth, we bond with our mothers, and throughout life we continue to bond with others. Even ten thousand years ago, humans lived in nomadic groups as hunter-gatherers and relied on each other for survival. Collaboration has been an essential ability since the beginning of time. Seventy years ago, Abraham Maslow highlighted our need for connection in his hierarchy of needs [2]. The third level of his original five-tiered pyramid is "love and belonging. " Maslow described the first needs as our physiologic needs, and our second needs as our safety and shelter needs. Right after that comes love and belonging or connection. After this level comes self-esteem and finally self-actualization. See Figure 1. Thirty years after Maslow, Edward Deci, PhD and Richard Ryan, PhD emphasized the importance of connection in their Self Determination Theory, a theory of motivation. According to Deci and Ryan, humans need to feel competence, autonomy, and relatedness in order to feed their volitional motivation [3]. Relatedness is similar to connection. In the Theory of Self Determination, connection or relatedness is recognized as a one of three psychological needs for motivation and for best possible performance, creativity, and perseverance. If any one of these three needs is unfulfilled or obstructed, then it is unlikely that the person will reach their full potential or optimal level of wellness. See Figure 2. Figure 1: A Schematic Pyramid Representing Abraham Maslow's Hierarchy of Needs Figure 2: A Schematic Representing the Theory of Self Determination by Edward Deci, PhD and Richard Ryan, PhD with three basic psychological needs for motivation. Deci's and Ryan's theory brings up the important point of autonomy or independence, the feeling that an individual wants to do it his way and he has the right to act on his own accord. It is this autonomy that makes collaboration a challenge because if individuals do not respect the autonomy of others, collaboration is not possible. Thus, we long for connection and need cooperation for survival. Yet, at critical times, when there is stress, difficulty, or potential danger, individuals tend to abandon the essential collaboration foundational attitudes, beliefs, and feelings, including trust, respect, and empathy. When this happens, the collaboration skills of communication, cooperation, negotiation, and listening disintegrate. So, the question is how do people work towards collaboration in challenging times?