Officia Mth of PUBLIC HEALTH Official Monthly Publication of the American Public Health Association, Inc. Volume 44 November, 1954 Number II Teamwork in the Service of Health HUGH R. LEAVELL, M.D., Dr.P.H., F.A.P.H.A. We all realize that an organized ap- Here is a classic summary of what proach is needed to deal effectively with we mean by public health "team- work," and a very pertinent appli- the complex problems and the diverse cation to our own Association. population groups we meet in our daily work. We are concerned with the total community rather than placing our em- All of us have experience in team- phasis on the individual, as the private work and we know how important it is practitioner does. in getting a job done. As an introduc- We tend to stress the preventive tion to our discussion, may we consider rather than the curative aspects of total first some of the things we in public health service. At the same time we health have in common which provide recognize that it is impossible to draw the oneness of objective so essential to a sharp line dividing prevention from good teamwork. cure. Curing one phase of a disease All of us are involved in some type of may so interrupt its natural history that organized community activity. This is complications and aftereffects are pre- the essential element that differentiates vented. public health from other forms of pre- Though we come from many basic ventive medicine, according to Profes- professions, we tend to think of our- sor Winslow's world-famous definition, selves as members of the public health which I recently found to be just about profession-a sort of "E pluribus as well known in Latin America and unum"! As professional people, and be- in Asia as in North America. May I cause of our training and experience, remind you of Professor Winslow's far- we feel that we have the right and the sighted Presidential Address entitled responsibility to speak with some degree "Public Health at the Crossroads" made of authority about health matters. before this association here in Buffalo Though some of us work in voluntary in 1926. He showed then the character- istic leadership which has inspired Dr. Leavell is professor of public health practice, Harvard School of Public Health, generations of his students. The exam- Boston, Mass. ple of teamwork which he and Mrs. Presidential address to the American Public Winslow have set is one we all might Health Association at the First General Ses- sion of the Eighty-second Annual Meeting in hope to follow. Buffalo, N. Y., October 12, 1954. 1393 1394 NOVEMBER 1954 AMERICAN JOURNAL OF PUBLIC HEALTH agencies and some for government, we exist among chickens (and among our- do not divide ourselves into two groups selves) today. on this basis, even though our problems Chester Barnard,' an outstanding may differ somewhat. business leader himself, has done much We recognize the importance of the to clarify our ideas on the subject of "public" part of public health, and leadership. He has a most useful list of know from our own experience that our leadership qualities, including vitality "health" technics can be used with max- and endurance, decisiveness, persuasive- imum effect only if the public under- ness, responsibility, and intellectual stands our objectives and is sympathetic capacity, which he considers subsidiary with them. in importance to the other qualities. His One could mention many additional definition of responsibility reminds me similarities which draw us together and of the aseptic conscience one develops provide the basis for teamwork. when working in an operating room or with microorganisms. Responsibility, Psychological Basis of Teamwork he says, is "an emotional condition that gives an individual a sense of acute The word "team" in its Middle dissatisfaction because of failure to do English origin referred to "offspring, what he feels he is morally bound to do, progeny, and family," as well as to "a or because of doing what he thinks he is line of animals harnessed together." morally bound not to do, in particular Significant for our discussion are addi- concrete situations." My New England tional meanings of the word "team": "a friends would relate this pretty closely number of persons associated together with Conscience, I believe. in any work," and "a group of persons Barnard recognizes four major sec- pulling together," also "a group of work- tors of leadership behavior which I men each completing one of a set of should like to discuss briefly: operations." These meanings are in 1. The determination of objectives addition to those relating to the athletic 2. The manipulation of the technical means team. The word "team" clearly carries for attaining the objectives the strong implication of a job to be 3. Control of the organization done cooperatively. 4. Stimulation of coordinated action Literature on the psychology of team- Determination of team objectives is work as such is not abundant. There is, vitally important. Pearson 2 notes that however, a rapidly growing volume of "The team must believe that the kind of data on the dynamics of the human game for which it is organized is worth group, especially the small group, and playing." Team members cooperate on the subject of leadership. Much of with the leader when they believe it to this is pertinent to understanding the be in their own best interest to do so. team. This is not the time to review the Whether their interest is altruistic or literature, though it is important to sum- selfish, the result from the standpoint marize points relevant to our discussion, of cooperation is the same. There will especially those related to leadership. be effective teamwork only when the None of us will question the im- leader can make his objectives and those portance of leadership in teamwork. of the followers essentially the same. Leaders have existed since the begin- Therefore, the "leader will listen" as nings of human history. There were Homans 3 has said, to learn what the fol- doubtless animal leaders before that, lowers think, and to profit by their ideas. with their "pecking orders" just as they Out of all the suggestions and ideas PRESIDENTIAL ADDRESS VOL. 44 1395 that may arise, choices must be made. with which we are working, or the To make such choices the good leader legally constituted health officer. When must have, "an understanding that leads badges such as these are normal parts of to distinguishing between the important our culture we tend to accept them up and the unimportant in the particular to a point. However, in the final concrete situation, between what can be analysis, as Homans has said, "The done and what cannot be done, between authority of an order always rests on what will probably succeed and what the willingness of the persons to whom will probably not, between what will it is addressed to obey it." Ordway weaken cooperation and what will in- Tead 4 says, "Every good leader is at crease it." 1 The leader is something heart summoning loyalty for a purpose more than a chairman of the group which commends itself deeply and truly comprising the team; he cannot always to the led and to the best they know and take a vote and let the majority rule. feel." When all the followers have had their Barnard's 1 second sector of leader- say and made the issues clear, the leader ship behavior is that in which the leader must decide. This attribute of decisive- manipulates the technical means of ac- ness is one essential quality of leader- complishing the team's objectives. Tech- ship which seems to be universally nical processes loom large in our healtlh agreed upon. Barnard calls it, "The work. We tend, perhaps, to equate tech- element of critical importance in all nical competence with leadership more leadership." Some ways of being de- than is done in some other types of cisive favor cooperation and others have teamwork. The leader naturally must the reverse effect. Then, too, there are have an adequate understanding of the situations when decisiveness on the technical processes his team performs, leader's part is absolutely essential and but he need not be the most proficient others in which it is not crucial. If the technician on the team. leader has convinced his team that his Because the physician has technical basic objectives and theirs are similar, competence and is legally empowered to his decision will "stick." prescribe therapy for the sick; because This raises the basic question of he has taken a course of training which authority. Authority is not an oily sub- is probably longer, more arduous, and stance with which some high priest may more expensive than that taken by other anoint the heads of leaders. Authority members of the public health team; and is rather an attribute with which the because of the high status which the followers cloak their leader. The size of physician holds in society-all these and the cloak the followers are willing to other reasons have made it customary give him depends on the oneness of ob- for the physician to be designated as jectives and the confidence the followers leader of the health team. have in their leader's ability to be useful Leadership based on technical compe- to the team in accomplishing those ob- tence alone does not go unquestioned. jectives. We are accustomed to thinking Public administration experts stress the of the trappings of leadership, the value of filling many top posts with badges of "authority" which designate "generalists" in administration, rather those whose instructions we are sup- than with technical people.