Teamwork 150 150 Endeavour Medical



You are part of a team trekking the Sinai Trail, a 550km walking trail in Egypt. The trek is going smoothly and it feels like the perfect team; you get on well, support each other through the harder, mountainous days of walking, and have naturally settled into roles when navigating and setting up camp. However, 3 weeks into the walk, the water drop-off you had arranged falls through. You know that there may be a water source during the following days’ walk but the season has been particularly dry and this is not guaranteed. It’s two days before the next guaranteed water supply. How would you address this as a team?

Teamwork is the collaborative work of a group of people to achieve a common goal; a level of interdependence within this group of people to achieve the goal creates a team. The importance of teamwork in providing good patient care is highlighted across the spectrum of medical practice, from the General Medical Council Good Medical Practice guidelines to questions within interview and appraisal processes. In the expedition world, an article about rescue efforts at Everest Base Camp and the surrounding area following the Nepal earthquake in 2015 focuses on the action of teams rather than individuals. In summary of these efforts, Zafren and colleagues (1) reflect that people must work together in order to achieve big things.

The function of a team is affected by the composition of individual factors such as age, gender, culture and expertise, and interpersonal factors including leadership, group cohesion and communication. For more on communication as well as how human factors and heuristics can affect decision making check out our other posts on non-technical skills here. This article will focus on the effect of group cohesion on teamwork.

An expedition team is often formed of a diverse group of people but all generally have the shared aim of achieving the goal of the expedition. From a medical standpoint the priorities are two-fold: achieving the goal of the expedition; also to keep everyone safe and overcome any complications that may put the team in danger.  

Collectivism is used to describe an attitude within a team where the needs of the group are prioritised over individual needs and desires in order to achieve the collective goal. Collectivism can reduce ‘social loafing’ in which individuals do not contribute proportionately, and it increases effectiveness of the team. However, whilst group cohesion and a shared desire to achieve the common goal is necessary, in the case of group solidarity you can have too much of a good thing…

Back to our case: The leader of the group, not formally appointed but had been the one to suggest the trek and had naturally taken charge, suggests that you continue walking; you can just drink less than the previous days and hopefully there’ll be a chance to refill at the spring tomorrow. Everything has worked so well as a team so far so no one considers other options or wants to disagree with them. You continue walking but it’s very hot, and when you get there the spring is dry. Having less water also means that you can cook less food and walking becomes very difficult. You meet a Bedouin tribe who are able to contact someone from the next village who brings you enough water to complete that section of the walk, but some of the group need a few days to recover and rest before continuing the trek.

Groupthink occurs when, due to high levels of cohesion within the group, individuals no longer voice concerns and/or lose the ability to think critically about group decisions made. This is particularly a problem when things go wrong. Greer and her team (2) analysed over 5000 Himalayan summit attempts between 1950 and 2013 to assess the level of collectivism within the team and its correspondence to successful summit and preventing deaths. They confirmed their findings using a laboratory-based experiment assessing team problem-solving. Collectivism and cohesion was found to be essential in ‘conjunctive’ tasks, i.e. those in which success is determined by the weakest member such as ability to summit. This was owing to equal commitment to the goal and an agreed need to support each other in order to achieve this. However, in ‘disjunctive’ tasks, whereby success is determined by the best solution provided, collectivism can become a barrier. Greer highlights that the key to overcoming disjunctive, problem solving tasks is the acknowledgment of individual skills and expertise, and the appropriate use of these when required. In the context of an expedition this may be finding the most efficient way to evacuate an injured team member or finding shelter from bad weather. Expedition teams may be formed with consideration of each participant’s skills.  Even when this is not the case, such as on a commercial expedition of individuals signing up for an ‘experience’, efforts should be made to the identify skills and experience present within the team.. Our case is an example of groupthink occurring in a highly cohesive team and demonstrates the need for teams to be flexible: while tolerance for differences is essential, at times differences in expertise should be highlighted and celebrated. . Groupthink can also be influenced or prevented by good communication, both prior to the event, and in case of something going wrong. 

Factors affecting teamwork are extensive and complex, increasingly so as each team has a unique composition of its members. The team goal is further influenced by its leader and their leadership style. The above is just one aspect to take into account when forming your team and performing as part of it. 

Take home messages

  • Teamwork is affected by individual and interpersonal factors.
  • Diversity is key within a team, alongside tolerance of these differences. 
  • Look out for groupthink, if you think things can be done better, say it! 
  • Voicing ideas in a productive and appropriate way is important.
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Further reading


  1. Zafren K, Brants A, Tabner K, Nyberg A, Pun M, Basnyat B, et al. Wilderness Mass Casualty Incident (MCI): Rescue Chain After Avalanche at Everest Base Camp (EBC) In 2015. Wilderness & Environmental Medicine. 2018 Sep;29(3):401–10.
  2. Chatman JA, Greer LL, Sherman E, Doerr B. Blurred Lines: How the Collectivism Norm Operates Through Perceived Group Diversity to Boost or Harm Group Performance in Himalayan Mountain Climbing. Organization Science. 2019 Mar;30(2):235–59.

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