Two Habits of a Healthy Team: Managing Conflict and Practicing Gratitude


Most teams try to avoid conflict, yet can't stop focusing on the negative. Healthy teams do the opposite.

Fam Pract Manag. 2020 Jul-Aug;27(4):11-16.

Author disclosure: no relevant financial affiliations disclosed.

“Morale is at an all-time low.” “Everyone feels overworked, understaffed, and undervalued.” “We lose staff faster than we can hire them.” “The atmosphere is negative, and everyone is irritable and quick to snap.” “Dread is palpable at the beginning of every workday.”

This is how one physician leader described his practice environment to me. I had been invited to speak to his team members about well-being, and when I asked them how they were doing, they admitted to feeling “beat up,” “in a rut,” “boxed in,” and “not supported.” They shared that they felt more pressure than ever to deliver better outcomes with fewer people and fewer resources. Everyone I spoke with was negative, some were cynical, and others were clearly burned out. Many viewed their only option as leaving.

The team had multiple sources of conflict and negativity, but chief among them was a chronic barrage of mandated, top-down, unfunded initiatives, which left everyone feeling overwhelmed, demotivated, and demoralized.

Perhaps you can relate to this team's story, or perhaps you have a healthy team and want to keep it that way. This article will outline why a healthy team matters and share two habits that can promote team well-being: managing conflict and practicing gratitude.


  • The health of a team affects not only the individuals on the team but also the practice's performance.

  • Being able to address conflicts openly but respectfully is key to a team's progression, and it requires a foundation of trust.

  • Gratitude is important to team wellness, because team members who feel appreciated and recognized will extend those feelings to others, creating a positive cycle.


Health care is a science, an art, and an interdisciplinary team activity. A healthy team is a high-performing team, leading to better patient outcomes, reduced costs to the health care system, and improved well-being of health care providers.16 Traditionally, medical care was delivered exclusively by physicians. But excessive workloads and limited workforce now demand team-based care models in which health professionals work together at the top of their licenses.

Doctors who serve as team leaders require new skills to support not only the health and well-being of patients but also of their team members.7 The best team leaders are “multipliers” who amplify the strengths, skills, and voices of others, as opposed to “diminishers” who drain capability and intelligence from their teams.8 Leaders who possess this quality don't need to accomplish everything themselves or be experts in every area.


Dr. Pipas is a family physician and Professor of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, and the Department of Medical Education at the Geisel School of Medicine at Dartmouth. She is the author of A Doctor's Dozen: 12 Strategies for Personal Health and a Culture of Wellness, and has been recognized as a leader in wellness, education, research, and clinical care. Her recent awards include the 2019 Society of Teachers of Family Medicine Humanism Award and the 2019 Family Medicine Education Consortium This We Believe Award. Dr. Pipas serves as the chief wellness officer for CaseNetwork.

Author disclosure: no relevant financial affiliations disclosed.


show all references

1. Luxama C, Dreyfus D. Collaborative care for depression and anxiety. Am Fam Physician. 2014;89(7):524–525....

2. Kaferle JE, Wimsatt LA. A team-based approach to providing asthma action plans. J Am Board Fam Med. 2012;25(2):247–249.

3. Copley LA, Kinsler MA, Gheen T, Shar A, Sun D, Browne R. The impact of evidence-based clinical practice guidelines applied by a multidisciplinary team for the care of children with osteomyelitis. J Bone Joint Surg Am. 2013;95(8):686–693.

4. St Peter WL, Farley TM, Carter BL. Role of collaborative care models including pharmacists in improving blood pressure management in chronic kidney disease patients. Curr Opin Nephrol Hypertens. 2011;20(5):498–503.

5. Solheim K, McElmurry BJ, Kim MJ. Multidisciplinary teamwork in U.S. primary health care. Soc Sci Med. 2007;65(3):622–634.

6. Rosser WW, Colwill JM, Kasperski J, Wilson L. Progress of Ontario's Family Health Team model: a patient-centered medical home. Ann Fam Med. 2011;9(2):165–171.

7. Snyderman CH, Eibling DE, Johnson JT. The physician as team leader: new job skills are required. Acad Med. 2011;86(11):1348.

8. Wiseman L, Bradwejn J, Westbroek EM. A new leadership curriculum: the multiplication of intelligence. Acad Med. 2014;89(3):376–379.

9. Gardner TB, Barth RJ, Zaki BI, et al. Effect of initiating a multidisciplinary care clinic on access and time to treatment in patients with pancreatic adenocarcinoma. J Oncol Pract. 2010;6(6):288–292.

10. Lencioni P. The Five Dysfunctions of a Team. Jossey-Bass; 2002.

11. Norville D. Thank You Power: Making the Science of Gratitude Work for You. Nelson; 2007.

12. Emmons RA, McCullough ME. The Psychology of Gratitude. Oxford University Press; 2004.

13. Fredrickson B. Positivity: Groundbreaking Research to Release Your Inner Optimist and Thrive. Oneworld Publications; 2011.

14. Emmons RA, Mishra A. Why gratitude enhances well-being: what we know, what we need to know. In Sheldon K, Kashdan TB, Steger MF (eds.) Designing Positive Psychology: Taking Stock and Moving Forward. Oxford University Press; 2011.

15. Plews-Ogan M, May N, Schorling JB, et al. Feeding the good wolf: appreciative inquiry and graduate medical education. ACGME Bulletin. November 2007:5–8.

16. Emmons RA, McCullough ME. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Pers Social Psychol. 2003;84(2):377–389.

17. Whitney D, Trosten-Bloom A. The Power of Appreciative Inquiry: A Practical Guide to Positive Change. Berrett-Koehler Publishers; 2003.

18. Kini P, Wong J, McInnis S, Gabana N, Brown JW. The effects of gratitude expression on neural activity. Neuroimage. 2016;128:1–10.

19. Sexton JB, Adair KC. Forty-five good things: a prospective pilot study of the Three Good Things well-being intervention in the USA for healthcare worker emotional exhaustion, depression, work-life balance and happiness. BMJ Open. 2019;9(3):e022695.


Copyright © 2020 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz


May-Jun 2021

Access the latest issue
of FPM journal

Read the Issue

FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now