Fifty shades of grey

Write Your Own “50 Shades of Grey”

One of the most popular books of recent years was “50 Shades of Grey” by E.L. James. It described a perverse relationship, deeply rooted in abuse and domination. It was such a steamy book that few people would read it with the cover in view of others. Its sales exploded in the e-book market where confidentiality in reading choices could be maintained, had it not been for the gaping looks and sweaty brows caused by the content of the story. No book read mostly by women, craving the lust of a romance novel, had ever been borrowed by spouses and significant others as much as “50 Shades of Grey”. It ignited a new sexual revolution of sorts.

Our practices are also in need of something revolutionary. What is going on in many practices is also perverse and a threat to healthy relationships.  It threatens the emotional health of practices and it leaves team members exasperated with frustration. But before you get all hot and bothered, I want to affirm that it has nothing to do with sex, though it may touch on abuse and domination, of a different sort and it can be emotionally scarring. It has to do with all of the “stuff” that clouds our sense of purpose in the daily delivery of care and caring.

The root of the problem is undefined expectations of others.  Most of the expectations of doctors for their team members can be described as black, or white.  “I expect her to be on time.”   “I expect them to clean up the staff room after lunch.”  I expect her to be prepared for the team meeting.”  “I expect the reception room to be vacuumed before we leave for the evening.”  “I can’t believe why she doesn’t get it!”

The problem with these expectations is not that they exist, but that they have not been clearly defined for the team members involved. The team members may be thinking, “It doesn’t matter if I get there a few minutes late.  The doctor doesn’t stroll in until a quarter past.”  “I’ll leave it for Mary to clean up because I cleaned up after lunch last Tuesday.”  “What can I contribute to the meeting? I’m just an assistant.”  “What different does it make if I vacuum tonight or if I come in 15 minutes early in the morning?”  “I don’t know what the doctor expects of me!”

All of these are “Gray” areas.  In the absence of some clearly defined determination of what is expected, it can be up for interpretation. This is why we recommend that each practice generate its own “50 Shades of Grey” or a “Culture Guide”, of sorts, to clearly define the expectations, in writing, for every member of the team. These expectations should be written and placed in a “Culture Guide” binder to be kept in full access to all of the team.

Some of the areas that can be addressed in this guide would be punctuality, expected levels of preparation for meetings and huddles, defining housekeeping responsibilities, determining the expected tone for interactions with patients and fellow team members, orchestrating teamwork for rotated responsibilities, expressing the importance of coordination for emergency or extended scheduling challenges, or anything similar.  When these responsibilities are clearly defined and each team member receives a copy, then there is no longer confusion over the “grayness” of expectations.  When expectations are clearly defined, then performance can be accurately evaluated and when appropriate, rewarded or questioned.  When these “gray zones” are eliminated, so are the arguments, hard feelings and disappointments that go along with them and there is much greater harmony in the practice.

We encourage you to schedule a team meeting to identify some of the “Grey” areas in your practices. Engage in respectful discussion. Come to definitive decisions. Try to have fun with it and be creative. But please leave the feathers, whips, handcuffs and blindfolds home…that day.


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