Cultural and interpersonal analysis example
Engagement: Week 2, Day 8 | Strictly Confidential
After spending eight days observing your team in action—during meetings, patient interactions, breaks, and informal moments—I've identified the hidden dynamics that are shaping your practice culture. What you see on the surface (professional interactions, task completion) doesn't tell the full story of what's happening beneath.
Key Finding: Your team is operating as three separate "micro-teams" with conflicting priorities and minimal cross-functional trust. This fragmentation is costing you efficiency, creating patient experience inconsistencies, and building resentment that will eventually lead to turnover if left unaddressed.
Your official org chart shows you at the top, with three dental hygienists and two front desk staff reporting to you. But here's how your team actually operates based on my observations:
Relationship Dynamic: These two have worked together for 6+ years and operate as a unit. They've developed their own systems, shortcuts, and "rules" that they don't share with others.
What I Observed:
Impact on Team: The hygienists feel like Sarah and Monica "run the show" and make unilateral decisions that affect patient scheduling without input.
Relationship Dynamic: Both hired within the past 18 months, they bond over being "the new people." They're hungry to improve processes but feel their ideas aren't taken seriously.
What I Observed:
Impact on Team: Fresh perspective and innovation are being stifled. You're at high risk of losing two potentially great long-term team members.
Relationship Dynamic: Linda has been with the practice for 12 years. She's highly competent but has become isolated from the rest of the team.
What I Observed:
Impact on Team: You're underutilizing your most experienced hygienist, and she's disengaging. She told me: "I just come in, do my job, and go home. It's not worth trying anymore."
Here are the specific friction points I observed that are creating daily stress and inefficiency:
The Issue: Sarah and Monica control the schedule, but the hygienists are the ones dealing with the consequences of poor scheduling decisions.
Specific Example from Tuesday:
Monica double-booked two new patient exams back-to-back in Jessica's schedule (which violates practice protocol). When Jessica expressed concern, Monica said "you'll be fine" and walked away. Jessica ended up 25 minutes behind for the rest of the day, created a poor experience for patients, and vented to Amy afterward: "They don't respect my time or the patients."
Impact:
The Issue: Information doesn't flow consistently. Some people are "in the know," others find out after the fact.
Specific Example from Thursday:
You decided to change the office supply vendor. You told Sarah and Monica on Monday. Linda found out on Thursday when she went to order materials and the account didn't work. Jessica and Amy still don't know as of Friday. Linda's comment to me: "I'm always the last to know anything around here."
Impact:
The Issue: Nobody is addressing conflicts directly. Problems fester and manifest as passive-aggressive behavior.
Specific Example from Wednesday:
During the team meeting, you asked for input on the new patient intake process. Silence. After the meeting, I heard Amy say to Jessica: "I have so many ideas, but what's the point? They'll just do whatever they want anyway." Meanwhile, Sarah later told Monica: "The new people don't understand how things work here, but they think they know better."
Impact:
I use a simple framework to assess team trust levels. Here's how your team scored based on my observations:
3/10
Cross-Functional Trust
Front desk vs. hygienists
5/10
Leadership Trust
Team's trust in your decisions
4/10
Psychological Safety
Comfort speaking up
What This Means:
Your team doesn't trust each other enough to collaborate effectively, doesn't fully trust your leadership to address their concerns, and doesn't feel safe bringing up problems or ideas. This isn't about them being "bad people"—it's about systems and culture that haven't been intentionally built.
Despite the challenges, I observed several strengths that can be leveraged:
1. Everyone Cares About Patient Experience
Even when frustrated with each other, every team member I observed went above and beyond for patients. This shared value is your foundation—it's what can unite the team if you make it the centerpiece of your culture.
2. Untapped Talent in Multiple Areas
Linda has institutional knowledge that could be invaluable for training. Jessica has marketing ideas that could grow your practice. Amy has operational insights that could improve efficiency. Sarah and Monica have relationship skills with long-term patients that are remarkable. The talent exists—it's just not being channeled effectively.
3. Desire for Things to Improve
Every single team member, when I spoke with them one-on-one, expressed a desire for better team dynamics. They're tired of the tension. They want to work in a more cohesive environment. The will is there—you just need to provide the structure and leadership to make it happen.
15-minute standing meetings every Monday morning. Everyone attends. Purpose: Share information, surface concerns, celebrate wins. No one leaves until everyone is on the same page.
This addresses the communication black hole and creates consistent touchpoints.
Rotate one hygienist each month to work with front desk on scheduling decisions. This builds empathy, improves cross-functional understanding, and gives hygienists a voice in the process.
This addresses the power struggle and builds trust between departments.
Once a month, Linda leads a 30-minute training on a topic of her choice. This positions her as the expert she is, re-engages her with the team, and provides valuable learning for the newer hygienists.
This addresses Linda's isolation and leverages her expertise.
Anonymous suggestion box (physical or digital). You review and respond to every suggestion in the Monday huddle. Even if the answer is "no," you explain why. This shows you value input and creates psychological safety.
This addresses the unsaid resentment and encourages innovation.
Meet one-on-one with each team member. Ask: "What's one thing I could do to make your job easier?" and "What's one thing you wish was different about our team?" Listen without defending. Thank them for their honesty.
This rebuilds leadership trust and shows you're committed to change.
Final Thought: Your team dynamics aren't broken beyond repair—they're just misaligned. The foundation of shared patient care values exists. With intentional leadership and the right structures, this team can transform from fragmented to cohesive within 60-90 days. You have my continued support as you implement these changes.