“We had a collective vision, few people and no funding. OTW was born.” – Evangelie Polyzos, OTW Chief Operating Officer

“onthewards.org (OTW) is a free open-access medical education website created by junior doctors, for junior doctors and medical students. We are always looking at ways to help our audience provide safer, better care for their patients and themselves. In this series of blogs we’re adding something new – we’d like to help our audience take better care of their ideas. OTW is a big idea.  Over the past three years the OTW team has made it a reality, and we’d like to share what we’ve learnt in the process to help you turn your ideas into reality too.” – Dr James Edwards, Emergency Medicine Physician and OTW Founder

Introduction

This is the first of a three-part blog series about onthewards.org (OTW). Its inception, growth from zero to national, how we’ve dealt with obstacles, built a nationwide website and the key lessons we’ve learned along the way. This series includes tips on how to start building your project and is dedicated to our contributors and team, both current and those to come.

Who am I?

As the Chief Operating Officer and non-clinical team member, I facilitate the team to work together, spread the word, push forward, keep everyone ‘to schedule’ and enjoy being the challenger and disruptor of the status quo of medicine. As an outsider to the medical profession I also view OTW with a different lens.

A snapshot of OTW today

• OTW now has over 2,500 users each month
• Publications and postings reaching over 3,000 readers on Facebook each week nationwide
• In May 2015 – May 2016 our audience grew by 30%
• From July 2015 to July 2016 we’ve had over 103,000 unique users visit the website and downloads via the app
• During intern orientation 2016 OTW had over 10,000 unique users (there are only 4,000 interns starting orientation each year)

Inception: What’s your BHAG (Big Hairy Audacious Goal)?

Three years ago, James Edwards, then Director of Prevocational Education and Training at Royal Prince Alfred Hospital (RPAH) decided to start a #FOAMed based podcast series for JMOs.

James had a good idea, the timing was right and not long after inception the RPAH podcast series grew in both popularity and audience reach as word of the podcasts spread to JMOs from other hospitals. As James’ Education Support Officer I recognised the potential for OTW to benefit JMOs nationwide. This was the inception of our BHAG.

First, we decided to make the podcasts accessible to all JMOs. Second (and after many months of me gently badgering James) we decided that OTW should become a not for profit organisation. We enlisted JMOs and created a team. We had a collective vision, few people and no funding. OTW was born.

Challenges and milestones

There were many early challenges: Could we build a team of volunteer JMOs and sustain a constant flow of original content for publication each week? Would the team be able to deliver to deadlines when they themselves are busy and time-poor? Could we spread the word to become a nationally recognised medical education website and app? The odds were stacked against us.

On Wednesday 10 August 2016 we reached a milestone, posting our 100^th podcast.

The journey to get here included working many late nights and constant last-minute work. Our team now consists of over 20 regular contributors and continues to grow and thrive regardless of obstacles – time, resources and funding – due to our commitment and shared purpose.

• sharing knowledge
• team collaboration and trust
• dissent and challenging the status quo
• a culture of fun and learning

Ideas and projects: leadership and engagement

An article from the US on medical leadership and engagement wrote that doctors have a need to contribute and improve their health system, to be a part of what’s right, and suggested that engaging colleagues to participate and implement initiatives is a marker for better performing hospitals (1).

As a junior doctor (JMO) you are ideally placed to identify the need for change and to engage colleagues and advocates to challenge the status quo and improve the health system in which you work. From early in your career you will have ideas on how you can contribute, create positive change and make things work better for your colleagues and hospital.

You have the opportunity to build stronger working relationships between clinicians and non-clinical colleagues to implement change. The diversity, which comes with working with different craft groups (specialties), seniority levels and non-clinical team members, provides a variety of viewpoints – a holistic and objective perspective, with opportunity to learn from one another, regardless of position.

The first lesson we learnt is that if the timing is right, stop thinking and start doing.*

As with your first day at university or navigating medical internship, implementing a new project or beginning a new relationship, this initial step is hard but exciting. It takes commitment. You already have this – it’s the kind that got you through medical school and into internship.

If you have an idea, now is the time to talk to your colleagues, share your idea, find likeminded people to work with and make it happen.

Collaboration

At OTW we’ve created a culture of collaboration, information, knowledge and idea sharing. Experience showed me that a work culture focused on sharing, versus one that creates roadblocks, is the difference between enabling good things to happen or completely disabling them.

Take-Away Message 1: Common goals are important

Sharing and learning from each other is invaluable and a two-way process because less is achieved working in a silo.

I have seen the impact withholding information can have not only to the person deprived of knowledge but also to those choosing not to share. The individual alienates or ostracises themselves within their own work environment and is seen as not being a team player. Reflecting on this experience highlighted the importance of collaborative learning and information sharing. It’s what will facilitate and bring your idea to fruition (2), help get you over the line and push you forward – keeping your team focused and unified. It’s the principle I adopted to help the team thrive through tough times when everyone was exhausted at the end of a long day on the wards.

Though shared or common purpose and goals should not equate to group-think. This is something that our editorial team was in danger of developing at times.

Take-Away Message 2: ‘Rules of Engagement’

As with many FOAMers, the OTW team and collaborators haven’t met. Collaborating online has its challenges when you don’t know the person on the other end of that email. What was meant by that comment? Have I understood that correctly? It becomes interesting as a facilitator of a team of editors discussing content and responding to contributors on their behalf, a role that I play, sitting on the periphery for most conversations discussing content.

Conversations can be brutally honest, harsh and feedback nothing less than severely critical. Healthy teams need to be mindful of the need for objectivity. To challenge concepts objectively and be considerate about when and how we interact with our team and our colleagues – at OTW I see these as our ‘Rules of Engagement’:

Rule 1: Mutual respect between everyone regardless of differences of opinion is crucial

• This doesn’t mean that dissent should be discouraged; conflict occurs and with any luck that’s when your ideas are challenged and there’s opportunity for new concepts to emerge.
• Dissent is a part of life, it will occur, especially when working in a team. As facilitator and observer of discussions, I have had the freedom to create situations or nudge people along a path or pointing out the harshness of our editors’ comments. Our goal is to reach an outcome benefiting and improving content for the audience rather than for the sake of the individual.
• Mutual respect is the basis for the stages of healthy team development: forming a team, weathering the storm(ing), norming (accepting differences), performing together.
• Being respectful regardless of level or seniority of those you work with, on your project or day to day, will determine your work satisfaction (3). There’s both professional and financial damage caused by disrespectful individuals, the jerks at work, or on your project, aka the ‘Total Cost of Jerk (TCJ)3’. Reduce the TCJ in your team! If the health system adopted a more collegial and respectful culture (eliminating jerk behaviour) perhaps it could reduce burnout that occurs as well as save -money, reduce stress leave, absenteeism turnover and toxicity at work.

Rule 2: Questioning the status-quo is ok

• Questioning your colleagues, boss or workplace is not easy but if you think your idea or what you want to propose can contribute or improve current ways of working then it’s important that you speak up. Respectfully.
• For OTW, the first and most important question was “why can’t this be bigger”? Recognising we needed a team and that OTW had relevance on a national scale led to everything that came after.

Rule 3: Challenging an idea is ok, but not the individual on a personal level

• Our objective is that no one individual dominates, rather that we work side by side. We all need reminders to be collaborative, inclusive, focus on outcomes and leave politics at the door (3).
• We all have bad days and remaining objective isn’t always easy. Medicine is a sport for the uber-high achiever, but don’t discount what you can learn from your colleagues and what your colleagues and co-workers can learn from you.
• OTW focuses on building a community of practice and connectivity between all the team. It’s that connectivity and transparency that I believe resonates, has created our work culture and built our ‘brand’ – our reputation.

Personally, it’s rewarding to see JMOs become confident, independent thinkers and facilitating a team to work together to achieve shared goals. It motivates me to keep going even after a bad day, realising how far we’ve come and what we’ve achieved with no funding but great teamwork.

*Note: regardless of how groundbreaking or game-changing your project may be, check that you are not breaching any of your legal responsibilities that could prove to be detrimental to your career. If you’re unsure seek input from a mentor or experienced industry leader. If possible ask an industry leader to be a part of your team.

It’s your turn

This series is about sharing lessons we’ve learned, to help you with your ideas.

Do you have an idea? It’s time to get started on it!

Don’t have an idea yet? Investigate whether there’s an opportunity to lead a project or get involved in an existent one like OTW.  We’re always looking for JMOs to join us – email me.

In Part 2 – Building a culture and keeping a team healthy

Visit my site at https://evangeliepolyzos.com/

References

1. Do we need medical leadership or medical engagement?
2. Medical Engagement:  A crucial underpinning to organisational performance
3. Building the civilised workplace