Collaboration as Best Practice

By Tia Will

This article is an opinion piece. I offer anecdotes and examples to support my case. No facts, no graphs, no charts, no numbers. Just how I see the possibilities of life and how it might be made a little better for all.

This weekend is the opening of the movie Sully about the successful water landing of a plane by Captain Sullenberger and his crew, and the subsequent investigation of this event. The following is a quote from the New York Times.

“Captain Sullenberger, who retired from US Airways in 2010, said in an email that the tension in the film accurately reflected his state of mind at the time. ‘For those who are the focus of the investigation, the intensity of it is immense,’ he said, adding that the process was ‘inherently adversarial, with professional reputations absolutely in the balance.’”

I would like to focus on one particular point of this quote. He states that the process was “inherently adversarial.” I believe that this point could be applied equally to many of our societal processes. We see the inherently adversarial nature in our school system in which children compete for the best college placements, in our job market which is manipulated to produce winners and losers (artificially holding down the number of doctors for financial gain as my most immediate example), in how grants are distributed for research and social programs, in our legislation and policy making (the Democrats vs the Republicans, liberals vs conservatives), in our justice/legal system (prosecution vs defense) as opposed to maximizing opportunity and truth seeking for all concerned.

As Americans we are taught from childhood that competition is inherently good. We are taught that to succeed, we must compete. And we tend to buy it wholesale with few questions asked. But is competition universally the best approach?  Might there not be a better way? And what might that look like ?

I believe that there is a better way and that way is collaboration. Not compromise, collaboration. I further believe that the earlier in any process that collaboration begins, the more likely the endeavor will proceed as economically and efficiently as possible and that the best outcome possible for all concerned will be achieved.

I will use, as my example, my own career in medicine. Qualifying for medical school was inherently competitive and very stressful. The means I chose to decrease my stress and improve my chances of acceptance were collaborative. I became part of a study group. We helped each other with areas of difficulty, we rooted for each other, we encouraged each other and coached each other. We celebrated each other’s successes, even when their grades were better than our own. The result?  All who remained in the group and chose to apply were accepted. This was good, but how much better would it be for all if the number of medical school and residency positions was enlarged to allow everyone with the requisite determination, learning skills, and passion for the subject to attend and become doctors ?

I chose my career with Kaiser because of its non-competitive, collaborative model. I saw almost immediately that a system in which doctors were not competing for patients, or to see who could do more procedures, or who could earn more money had profound advantages for both doctors and patients alike. In Kaiser we are salaried. We are paid the same amount whether we are operating, or examining patients, or doing office procedures, or advising by phone or email.  There is no incentive to do either more or less than what is medically indicated for each patient. There is no financial incentive to do anything other than what is best for the patient and what we are most qualified to do. If I see a patient whose surgery I am trained and qualified to do, but I know that one of my partners does this procedure better than I do, I refer the patient. This would not happen if the other doctor and I were in competition. This costs me nothing and is a true win-win.

The collaborative model has also been demonstrated to be superior at the administrative level. Each year, the chief of our department picks one or two major innovative programs for us to work on. Each of us who had a special interest would present the concept to the group. Note the presentation of concept, not a fully fleshed out program sold to the group by presenting only advantages and neglecting to mention, or minimizing the downsides. My project advanced that year precisely because I presented the idea not only in terms of its benefits, but with all the potential obstacles and challenges that I could think of. To my surprise, in response to one of my stated obstacles, one of my colleagues (who was also presenting a concept) said, “I can help you with that.” Rather than remaining silent, or suggesting that it was prohibitive, she was willing to share resources from her clinic that I did not have in order to make my proposal work. This sparked a response in others who chimed in with ways that they could help. The pilot project went forward and ultimately was accepted throughout our department, resulting in improved access while reducing costs. This would not have been possible had each of us insisted on promoting our own projects to the detriment of others.

So what does this have to do with our community ?  I see two major areas in which we could choose to adopt more collaborative processes to our mutual advantage.

One is in city planning and development. The other is in policy making.

With regard to city planning, I do not favor the now common practice of deciding on the desired project including purpose, size, who will be the partners and investors (which intentionally or unintentionally excludes anyone who is not well connected or “in the know”). I would favor a much more open process in which potential developers reach out to the community for suggestions, ideas and concerns – long before they put extensive resources into specific project designs. I would recommend that all of the advantages and potential disadvantages of any project be fully laid out in advance by the developers. I have heard the concern from some that this would only give the “opponents” more “ammunition to oppose the project.” But what if there were no “opponents” but only individuals concerned in making our community the best possible for all? What if we saw future neighbors as potential allies instead of opponents? I know from experience that this is possible. It does require a major change in mind set, but paradigm shifts are possible and often lead to improved processes.

I suggest that the same could be achieved for policy making. What if instead of acting on a proposal, whether that is the MRAP or downtown nightclubs or the Gandhi statue, we were all to take a deep breath, and start upon a pre-established process of judging the proposal on an organized vetting of the pros and cons – with plenty of opportunity for the discussion of not only goals but also underlying needs and values, in a collaborative manner in which the good will, rather than the obstructive nature of those with differing views, was the operating assumption?

I see collaboration as a superior option to our usual default of competition in many areas of life. This is not utopian thinking.  I have seen the advantages of collaboration over competition in one of the most highly competitive arenas in our country, that of medicine. If collaboration can produce superior outcomes in this setting, I know that it could be beneficial for our community. It would, however, require large amounts of open-mindedness, good will and trust. I have seen it work in my profession, I would like to see it at work in our community.