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J Oncol Pract. 2007 July; 3(4): 223–224.
PMCID: PMC2793813

Developing an Effective Oncology Team

When Brian Druker, MD, an oncologist who leads the leukemia program at the Oregon Health & Science University Cancer Institute (Portland, Oregon), was elected to the National Academy of Sciences (Washington, DC) this spring, he declined to take full credit for the honor.

“It was a team effort,” he explains. When pressed to talk about his accomplishments, he continues to reiterate that view, insisting his election was made possible by all the help he had from a great bunch of people, and elaborating on the qualities that made them so special. They were “bright, personable, highly motivated” colleagues and “good citizens,” too, he said.

According to a news release announcing his election to the academy, Druker was the first to show that molecular-targeted therapy works. His efforts developing the small-molecule therapy imatinib (Gleevec; Novartis Pharma AG, Basel, Switzerland) for treatment of chronic myeloid leukemia (CML), stimulated further research in both CML and in the use of small molecule tyrosine kinase inhibitors for therapy of other malignancies.

But that didn't stop Druker from being a humble pie–eating, limelight-spreading kind of guy, which is just the way some members of his team might describe him. And those characteristics, perhaps as much as any other, are why he was likely to be so successful in the first place, says business expert Jone Pearce, PhD, professor of organization and management at The Paul Merage School of Business at the University of California (UCI; Irvine, California). Though inspiring leadership may be an important factor in team-building, most success originates from “collective endeavors,” Pearce observes.

Team effort tends to get short shrift in today's iconic culture. At a time when corporate leaders are the subject of public attention, high achievement often gets attributed to the lone visionary, but it rarely happens that way. Study after study on work-related performance not only nixes that image, but supports the opposite one: It's good teamwork that leads to triumph.

“It's really the reason that hiring ‘stars’ often doesn't work,” UCI's Pearce notes. While some high achievers gain celebrity status, they usually have a cohort of talented people surrounding them that don't make it into the headlines.

Patrick Lencioni, founder and president of The Table Group (Lafayette, California), a management and consulting firm specializing in executive team development, concurs. “It is teamwork that remains the ultimate competitive advantage—both because it is so powerful and so rare,” Lencioni states in his book The Five Dysfunctions of a Team.1

He referred to an acquaintance, who worked with a company generating a billion dollars annually, who once told him, “If you could get all the people in an organization rowing in the same direction, you could dominate any industry, in any market, against any competition, at any time.”

However, whenever Lencioni shares that observation with business leaders, “they immediately nod their heads, but in a desperate sort of way. They seem to grasp the truth of it while simultaneously surrendering to the impossibility of actually making it happen.”

From a multicenter trial to an office-based oncology practice, cancer care and research relies on a team approach. However, the genesis of a great team is the subject of some debate even in the medical literature. Does a stellar team arise from an outstanding person who serves as an example, leading people to form a cohesive, high-performing group? Or does it come from a cadre of individuals rich in positive attributes and low in egocentricity, who are likely to be the kind of people to follow a leader effectively?

“I don't know that it is chicken-or-egg question,” Druker replies, when asked about that. Team effort can be difficult when there is a lack of confidence in the leadership. “If people aren't willing to follow, you can't get the job done,” he says. Encouraging feedback is one way to fortify a team, he says, adding that he urges, above all, a healthy line of inquiry at all times. “I really try to encourage questions,” he says.

That's a ticket to successful teamwork, affirm Linda Eve Diamond and Harriet Diamond in their book Teambuilding That Gets Results, Essential Plans and Activities for Creating Effective Teams.2 In fact, making a question-friendly work environment is critical, according to the two authors. Effective team leaders never lose that ability, and the ones who welcome questions build rapport through this kind of dialogue.

And, as any first-year medical student knows, query often incites discussion. However, it doesn't always work the other way around. Diamond and Diamond note that when questions are seen as time-consuming intrusions, that perception can quash feelings of autonomy among group members and shut off the flow of information in an organization. When the boss asks about work, “some people react to the untimely question as though it's a cannon, interrupting their thoughts and work rhythm,” the coauthors observe.

To help prevent such reactions, they recommend using a “stage-setter” approach, a tentative-sounding lead-in in which questions are prefaced with expressions that seem to ask permission to pose them, such as: “Do you have time to answer a few questions about XYZ? I'm having some trouble tracking down that information we discussed,” or “When you have minute, can we talk? I'm interested in your progress on this.”

“These questions are respectful of your team members' time,” Diamond and Diamond suggest, helping to ensure “that you'll receive undivided attention when you do get to ask your specific questions.”

This year, the Harvard Business Review took its own look at what makes a great leadership team. The authors, Stephen A. Miles and Michael D. Watkins, found four pillars of alignment in successful complementary teams: a common vision, common incentives, communication and trust.3

They liken effective team leadership with Homer's account of the Trojan War. “Though the Greeks were led in their quest for retribution against Troy by the powerful King Agamemnon, their victory would not have been possible without Achilles, the mighty warrior; Odysseus, the wily tactician; and Nestor, the wise elder,” they posit. “Each had a crucial, distinct role to play in the Greek high command.”

In fact, Druker uses a bit of the same terminology when describing his team. A couple of junior faculty members act as “lieutenants,” he says, sharing issues or concerns that surface. That's a fairly common occurrence as the team holds a monthly meeting—minus him—in which such problems or challenges unabashedly can be aired, he explains.

But that is where the battlefield analogy ends. Promoting a sense of collegiality is a high priority for him, he says. In fact, Druker refers to those who work with him as “my second family.” As such, they have his trust—one of those important pillars mentioned in the Harvard Business Review—and he tries to confer a healthy dose of decision-making autonomy, something that business experts say is essential to workplace happiness and goes by the technical name “locus of control.”

This “locus of control” is the belief that “you have influence over events, that life is what you make it,” explains John Barbuto Jr, PhD, associate professor in the department of agriculture, leadership, education, and communication in the college of agricultural sciences and natural resources at the University of Nebraska (Lincoln, Nebraska). This has consistently and directly been correlated with achievement, he says.

In one of the studies Barbuto and a colleague conducted, they found that “locus of control” and “organizational citizenship behaviors” are significantly linked.4 “Organizational citizenship,” Barbuto explains, encompasses personal characteristics that go unrewarded, at least in the official sense. They aren't measured by benchmarks or plotted in quarterly summaries. However, qualities that comprise it—consideration of others, supportiveness of colleagues—affect the workplace in beneficial ways.

In fact, such citizenship is one of the characteristics cited by Druker about his team. Asked how he helped to make that happen, Druker says he simply has been “lucky.”

Teamwork development is getting a technologic boost. Software that pinpoints personality types and interactive styles has been developed to help foster better understanding among team members. Such programs are used by M.L. Hannay Associates Training & Development (Portsmouth, New Hampshire), a consulting service that works with oncology groups, says Jeanne Bryan, its project coordinator. Such software “enables us to assess an organization or subject to get a clear understanding of developmental needs and provides a foundation for comprehensive facilitation and follow-up,” Bryan says.


1. Lencioni P: The Five Dysfunctions of a Team. San Francisco, CA, Jossey-Bass, 2002, vii-ix
2. Diamond LE, Diamond H: Teambuilding That Gets Results, Essential Plans and Activities for Creating Effective Teams. Naperville, IL, Sourcebooks Inc, 2007, 81-82
3. Miles SA, Watkins MD: The leadership team: complementary strengths or conflicting agendas? Harv Bus Rev 85:90-98, 2007. [PubMed]
4. Barbuto JE, Bugenhagen MJ: Preliminary relation between followers' locus of control and organizational citizenship behaviors. Psychol Rep 98:882-884, 2006. [PubMed]

Articles from Journal of Oncology Practice are provided here courtesy of American Society of Clinical Oncology