Leadership in #MedEd: ‘Team of Teams’ Book Review

By Rob Cooney

Team of Teams By: Stanley McChrystal, Tantum Collins, David Silverman, and Chris Fussell 

Shortly after the events of 9/11, the United States began military action against Iraq. Initially, the US experienced success, and on May 1, 2003, President George W. Bush gave his “Mission Accomplished” speech. Unfortunately for General Stanley McChrystal, the conflict was just beginning. While the initial phase of action allowed the United States to exercise it’s well honed military knowledge, the insurgency that followed the fall of Iraq brought a new type of conflict that fundamentally challenged how armed forces work with many parallels for medicine and medical education.

What McChrystal had to learn firsthand was how to succeed in the face of VUCA: volatility, uncertainty, complexity, and ambiguity. He gives the example of big data:

“the same technological advances that brought us these mountains of information and the digital resources for analyzing them have at the same time created volatile communication webs and media platforms, taking aspects of society that once resembled comets and turning them into cold fronts. We have moved from data-poor but fairly predictable settings to data-rich, uncertain ones (location 1368).

 The force that US military faced in Iraq post 2003 was not a hierarchical organization, rather it was a network in flux, enabled by modern communication technologies that allow networks to thrive. In order to succeed, the US Joint Special Operations Command (JSOC) needed to become itself a network.

Unfortunately, a large organization is often limited by its leadership structures and the JSOC was no exception. JSOC initially used a “command of teams” approach that was flexible but not scalable. The evolution in leadership structure required becoming a “team of teams.” To do this, McChrystal set out to create, “an organization within which the relationships between constituent teams resembled those between individuals on a single team…separate silos would now have to become fused to one another via trust and purpose (location 2416).

Two principles emerged that McChrystal attributes to success:

  1. Shared Consciousness: extremely transparent information sharing

Transparency is a common feature of many organizations, but in the military this is very uncommon. McChrystal focused on systems engineering in order to improve this. He moved everyone possible into a shared space. Using an empty aircraft hanger, he essentially created the first “open office” in the US Military. He also instituted the practice of a daily briefing. This was recorded and live-streamed across the globe to all organizations (FBI, CIA, NSA, other military commands) who needed (or wanted) to know what the JSOC was accomplishing. McChrystal also fostered interconnectedness between teams and destroyed work silos.

  1. Empowered Execution: Decentralized decision-making

In traditional organizations, leaders focus on a command and control style. Technology makes this even easier, but the cost is a loss of speed of decisionmaking. With the insights from the network that transparency promotes, leaders who allow the team (or individual) closest to the problem the autonomy to act, gain a competitive advantage. Within this model the role of the leader changes as well. Leaders must “enable rather than direct.” The micromanager leader is counterproductive to success.

McChrystal’s experience within a military model is akin to current developments in medical education and medicine. At times, our quest for efficiency comes at the cost of speed. (As an emergency physician I see this often). Silos between departments or divisions force us to work on the same problems without learning lessons that other already know. Perhaps by adopting and adapting some of the solutions discovered by McChrystal, we too can enjoy a measure success as #meded leaders.