Calibrating the Team: Keys to Enhancing Teamwork in Military Health Care

Calibrating the Team: Keys to Enhancing Teamwork in Military Health Care
Air Force photo by Staff Sgt. Franklin R. Ramos
By Debbie DiazGranados, Ph.D.
October 2, 2017

Excellence in teamwork.

What comes to mind when you see these words? Sports teams? Elite military units? Fictional superhero collectives? 

Raise your hand if you immediately thought about your own military health care team?

If your hand is up, you are already in the right mindset. If not, do not worry – patient care is not always freely associated with excellence in teamwork, even among health care providers. This may be because examples that easily come to mind involve clearly observable outcomes: a championship, a specific mission success, or defeating a fictional comic book villain. In military health care, poor performing teams still can, and do, save lives, and high performing teams still lose highly complex patients from time to time.

Military medical providers may have an edge in the cultivation of optimal teamwork, as they are often brought together in teams to complete specific missions, both in the United States (i.e., Public Health Service response to recent hurricanes) and overseas (i.e., combat hospitals). The team concept is inherent and a major focus in many aspects of practice.

Generally speaking, good teamwork emerges as the result of effective communication, coordination, and leadership. However, beneath this marquee of obvious big bucket traits for good teamwork, foundational concepts like team identity, trust, and backup behavior serve as the pillars of teamwork – especially for military health care teams. These are team processes that help discern why communication failures occur or leadership is not effective. In order to effectively calibrate, teams should unpack these general concepts and focus on the specific drivers of effective team behavior.

Team identity

Team identity is about belonging. We all want to feel like a part of something. Like our effort is meaningful, like our voice is heard, like we share a purpose. For many of us, this shared sense of purpose and mission is why we decided to work in a military health care setting. For many no job could provide a higher sense of purpose than working with our nation’s heroes and their families. If team members feel like their contribution is valued, they will work harder for the team. The evidence is there – when team identity is strong overall team performance improves, conflict decreases and shared understanding improves.

Accomplishing strong team identity is not simple. Trust falls and team building ropes courses do not forge team identity. Team identity emerges as a result of clearly defining the team’s purpose, getting buy-in from each member, and cultivating an environment of emotional safety, which encourages speaking up. When all of this happens effectively, something powerful happens – team members put the team ahead of personal motivations. In many ways, military health care teams function on the same principles as military operational units, with just as much at stake. They sacrifice for the team, they protect the values of the team, they communicate more openly, and they perform at a much higher level, necessary factors for success.

Actionable suggestion: Establish roles, expectations, and procedures at the formation of the team – revisit and adjust as needed, particularly when team members change.


Trust is another multifaceted gem of teamwork. Let’s face it – there are different levels of trust. For teams to perform at a high level you need to trust that your team members can and will perform their tasks, that they will protect the integrity of the team, and in return that you will bestow the same trustworthy behaviors that they require.

Trust evolves as a result of time and stability. Accomplishing strong team trust in the military health care setting is not simple. With significant provider turnover due to military transfers, the team is continuously being rebuilt, new members frequently joining the team, and trusted members leaving the team.

In addition, ad hoc or temporary teams, that may not have the benefit of time to build trust such as those assembled to respond to an urgent need (e.g., natural disaster, terrorist attack, wartime deployment), rely on what is called swift trust. Swift trust is the development of trust in a short period of time in the absence of pre-existing relationships, and is particularly important for military health care teams. Trust is fragile and in need of reinforcement and calibration by actions. Teams over time rely on experiences to strengthen (or at times weaken) trust. Positive experience-based trust emboldens team members to speak up without fear of retribution. That is not to say that conflict will not still happen, but it should be addressed openly instead of avoided so that trust is not damaged. 

Actionable suggestion: When conflicts arise and trust is compromised, openly discuss them to prohibit a negative impact on trust.

Backup behavior

Health care, particularly military health care, is not well suited for lone wolves. The system can quickly break down without vast networks of support. In that vein, backup behavior is a process predicated on awareness of what your team members are doing. Teams that mutually monitor member behavior are better equipped to offer support, provide feedback, and correct errors. This should not be mistaken as hovering or micromanaging. Backup behavior is peripheral awareness, not total focal effort on others’ work at the cost of your own productivity. Backup behavior is a willingness to help when it is requested and more importantly an openness to accept support and/or feedback when it’s offered. Providing constructive support to others on your team fosters improved communication and coordination, plus, it’s impactful to know that someone has your back. The military’s emphasis on having a “battle buddy” or “wingman” to provide backup, monitoring, and support fits well with the benefits of backup behavior in a health care team.

Actionable suggestion: Reinforce examples of productive backup behavior by acknowledging it to the team.

Team identity, trust, and backup behavior are not the only pillars of teamwork, but they provide a good start for unpacking the generalities of teamwork. Each of these concepts is interrelated and how they interact is context dependent.

The point of illustrating the need for excellence in teamwork in military health care teams is not to suggest that we seek more attention or even that other disciplines are easier models of team behavior. Teamwork is challenging in every discipline – for different reasons. But rather, it is to suggest that you consider and reflect on the teamwork skills that you practice and observe on a daily basis and continuously work to optimize your own team’s functioning.

Dr. Debbie DiazGranados is a subject matter expert in industrial/organizational psychology at Deployment Health Clinical Center. She has a doctorate in industrial/organizational psychology and has studied teamwork in health care for more than 10 years.

The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.


  • Debbie, I appreciate this generic "leadership" and "team building" advice, but you didn't address "(with)in military health care" culture. We are part of a culture that says "mission before individuals." We DO leave our team members, and patients, behind, when medical errors occur, on the battle field, if you will. LTG Horoho said it very well on her TedMedX Talk a few years ago - "Confront harm and prevent medical casualties" ( We hide behind M&M closed door conferences when 'the team' feels threatened. I found Team Identity and Trust were not upheld when the status quo was threatened. You said "Health care, particularly military health care, is not well suited for lone wolves," and indicate behavior needs to be monitored. "Providing constructive support to others on your team fosters improved communication and coordination, plus, it’s impactful to know that someone has your back. The military’s emphasis on having a “battle buddy” or “wingman” to provide backup, monitoring, and support fits well with the benefits of backup behavior in a health care team." When we needed an honest and transparent look at ourselves, this all goes out the window and scapegoats are identified, or at the very least the patient/ family members are injured and we are expected to keep it to ourselves. "Job career protection" and "protect your Commander" are the rule, and this is misconstrued as "Team Work." I submit this issue is one reason our suicide rate stays so high and would like you to write a follow-on to this blog article and address this culture issue regarding establishing teams in military health care.

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