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Healthcare today is a team activity. The rapid accumulation of specialized knowledge in healthcare has created a substantial need for partnerships between medical and mental health practitioners.

Physicians, nurses, psychologists, pharmacists, and other health professionals must work together for patient-centered care to become a reality. These partnerships are best reflected in a team of health professionals who communicate, listen intently to one another, manage conflict, and work collaboratively toward a shared goal.

Developing such a team is simple in concept, but difficult in reality. I learned everything I need to know about teams from choir singing.

My Choir Career

My choir career includes school, church, community, and professional choirs. I sang in all-male choirs, mixed choirs, quartets, and show choirs. I toured in places like Pennsylvania, California, Utah, Idaho, England, Ireland, and South Africa.

In college, I sang throughout my undergraduate and graduate degree programs. Choir singing has brought tremendous joy into my life.

During my sophomore year in an all-male choir, we sang “Hello Mary Lou”. Like most barbershop music, this song ended with a tag (a dramatic variation attached to the last section of the music) with the first tenors singing a hanger or sustained note against which the other singers carried the rhythm to the end.

As we moved into the tag during a live performance, one of the first tenors decided to sing the sustained note one octave higher than all the other first tenors. This was not in the music notation or from our rehearsal.

I will never forget the look of the director, a wonderful and highly trained musician from Wales, as she held her hands out for the sustained note and quickly scanned the choir looking for this rogue first tenor. There were over 150 men in that choir, a fact that undoubtedly helped the tenor survive the piercing gaze of our director.

I learned the most about choral teamwork during my time with a chamber choir of around 40 singers. We practiced six hours a week, memorized all our music, performed several times a year, and toured regularly. Our repertoire ranged from J.S. Bach to Irving Berlin to the Beatles.

One year we were invited to compete in the Cork International Choral Festival in Ireland. We rarely competed. Our primary goal was to uplift and inspire people, exposing audiences to a variety of beautiful and creative music from around the world. However, we agreed to participate and prepared a rigorous and diverse selection of songs.

At the festival, I heard choirs from Norway, Ireland, England, Germany, and the United States. That trip was a singular experience for me. We placed second in the competition, a reward for our hard work and ability to function as a united team.

Choir Singing is a Team Activity

The sound of a choir singing live music can be a wonderful and intense experience. But there is a difference between a group of talented soloists singing together and a choir. The latter involves individuals with excellent tone, balance, and blend. Choir singers set aside their own egos and work together toward a unified whole that is greater than the sum of its singing parts. The end goal of creating a unified and beautiful sound supersedes individual goals.

Here are a few lessons for healthcare teams I learned from choir singing.

Cohesion and Adaptability

The choir singer is committed to the greater mission of the choir. She resists the natural tendency to sing loud enough for her own pleasure and, instead, blends with the voices beside her. The success of the choir is shared among all the singers. Their cohesion, like drops of water beading on a surface, binds them together into a reliable, musical force.

Singers must also adapt, following the lead of the conductor who sets the pace and pathos of the song.  Adaptability requires ears for listening and eyes for observing. A choir certainly prepares all music through rehearsals, but sometimes the conductor will change the pace or pathos to match the needs of the audience. The singer must anticipate and be ready for change.

Attunement and Harmony

Choir singers respond to one another based on cues from the music and the conductor. The sopranos listen for the tenor counterpoint before moving from mezzo forte to forte. The basses wait for the conductor to signal the altos before they begin their decrescendo. Their responses are in time and in harmony with the music and one another.

Attunement reflects responsive relationships and is essential for a blended and harmonious sound. The attunement of the singers encourages the audience to resonate with the choir. This shared resonance is what helps people to connect through music. As the singers connect with one another, the audience connects with the choir.

At an even deeper level, attunement helps singers and audience members to connect with themselves and become more aware of the feelings, thoughts, and other experiences under their own skin. Attuned singers are aware of their inner self and responsive to the cues of those around them.

Attunement requires all the characteristics of a solid relationship: trust, mutual respect, responsiveness, and work. Consistent practice helps choir singers to develop a familiarity with the sounds and patterns of each other. They become used to one another. That familiarity helps them to feel confident in relying upon each other. Some choirs will even plan retreats and social events to accelerate this vital connection.

Environment and Technology

Choirs rely on the acoustical capabilities of the surrounding environment. Their ability to receive and send signals depends on how well the venue facilitates communication. Good acoustic design can absorb excess noise, reduce disturbances, and improve the concentration of the choir. Some choirs form tight circles, standing in sections (soprano, alto, tenor, bass) and facing the conductor, to maximize their ability to clearly listen and follow one another. During studio recordings, choir singers may even use headphones to hear better. When traveling, choirs have limited control over the venue environment and technology. In response, the choir can draw closer together and increase their focus on the conductor. Choirs will choose the best acoustical environment and technology available to them, but also adapt when their choices are limited.

Application to Integrated Care Teams

At the risk of losing nuance, I will attempt to apply these choral lessons to how a highly integrated healthcare team works.

Healthcare professionals are committed to the patient. They joined the healthcare system to improve the wellbeing and quality of life of patients. When that same professional joins an interdisciplinary team of professionals, they must also commit to the team by sharing the same mental model of healthcare, accepting influence from team members, and striving for cohesion and adaptability.

Members of a care team understand one another’s responsibilities and abilities. They respond quickly to cues from one another, closing the loop of communication, and sharing treatment plans. They make the most of the health information technology available to them and adapt when the environment is not ideal.

Highly integrated care teams know that a team develops over time. They practice listening to one another and showing support when a team member underperforms. The patient can tell that the team work together and shares decision-making.

The highly integrated care team also includes the patient and family as integral team members. They seek to understand the needs of the patient and family and resonate those needs across the team and the patient chart.

Conclusion

Choir singing is a better analogy for healthcare teams than team sports. In team sports, one team is competing to win against another team. There is a winner and there is a loser. In choir singing, the goal is different. It is to create something bigger than the choir, something that is meaningful and evocative. In healthcare, teams work together to restore wellness and health in our patients. That’s a meaningful goal. Maybe choir singing can become an elective for all healthcare graduate programs.