By Todd Pickard, MMSc, PA-C, DFAAPA

I have to admit that emotional intelligence (EQ) is a new term in my lexicon. Although the term was coined by Peter Salovey and John D. Mayer in 1990, describing it as “form of social intelligence,” I have been more familiar with the still popular term “soft skills.”

Over the past year at my institution we have experienced a leadership change, with a new president and a reorganization of reporting structures. It was in an introductory meeting that I first heard the term emotional intelligence and came to the realization that if it was important to our new president, I should get educated. He suggested that I consider Emotional Intelligence 2.0 by Travis Bradberry and Jean Greaves.¹ Naturally, I got the book and decided that my entire team and a few other providers would begin a journey together to discover this “new” skillset.

After taking the introductory Emotional Intelligence Appraisal and reading the first six chapters, I quickly realized that my previous reflections on team-based care and team wellness are deeply impacted by emotional intelligence.^2,3 I had defined these connections as:

• Physical proximity seems to matter to the team
• Frequent communication has a positive impact on team function
• Mutual respect contributes to positive team wellness
• Team dynamics can increase burnout or protect against it
• Shared burdens can mitigate burnout
• Backup behaviors appear to be common in functional teams

What is so striking to me is that EQ is based on personal and social competencies that will have a profound impact on team-based care and wellness. Our ability to be aware of our emotions, manage them, be aware of our team members’ emotions and their reactions to our emotions, and manage relationships are critical to team-based care and wellness. Moreover, that is incredibly hard to do. I find myself wondering out loud why we call these things soft skills.

The Expansion of Team-Based Care

It has been well documented through previous ASCO studies and articles that the oncology workforce and delivery of oncology care is changing. There is more demand for services, an aging oncology workforce, and a limited pipeline of new oncologists.^4,5 There is increased pressure to deliver care in more team-based models that include not only local teams and the inclusion of “new” members such as advanced practice providers (APPs), but greater engagement of primary care providers to reclaim some of the responsibility of survivorship care.^4,6,7 With more individuals involved in our care teams, are there more opportunities for EQ to be a positive impact on how those teams perform? And, conversely, can a lack of EQ prevent team-based care from working well and likely contribute to burnout?

ASCO has dedicated a significant effort in the concept of team-based care and how team science applies to the care of patients with cancer. From 2014 to 2016 ASCO engaged in a collaboration with the National Cancer Institute to explore how teamwork and teams impact clinical care in oncology.⁸ In November 2016 the entire issue of the Journal of Oncology Practice was dedicated to exploring team-based care. Through this project, literature was referenced that demonstrates how health care teams and teamwork can reduce mortality and improve treatment of patients.^9,10

Other organizations such as the American Medical Association (AMA) and Agency for Healthcare Research and Quality (AHRQ) have also explored the impact and importance of team-based care. The AMA, through their StepsForward program, has defined team-based care as “a strategic redistribution of work among members of a team to share responsibility for patient care and better connect with patients.” According to this program, communication is a key factor in success.¹¹ The AHRQ has taken the concept further in terms of highlighting the inherent relationship management, shared values, and cultural facets of teams.¹² Others have gone so far as to define a team as being made of members “…who see themselves and who are seen by others as an intact social entity.”¹³

Lessons From the Business World

It appears to be a logical conclusion that if 1) team-based care is recognized as a positive contribution in patient care, 2) teams by their nature are relationship and socially based constructs, and 3) EQ is focused on emotional and relationship management, then EQ could play a significant role in the success of the team. But, do data or literature show any connection between EQ and performance?

As reported by Sebastian Bailey in Forbes, a study reviewed multiple sources of research looking at the relationship between self-reported emotional intelligence and job performance that included an overall data set from 2,168 employed adults. The results found a strong correlation between emotional intelligence and supervisory ratings of job performance. The study also found seven common traits around emotional intelligence that explained the outcome.¹⁴ A Huffington Post article reports on the experience of Pepsi and L’Oreal in looking at emotional intelligence and performance. Pepsi found that executives with high EQs generated 10% more productivity, had 87% less turnover, and brought $3.75 million more value to the company. L’Oreal found that salespeople with a high EQ sold $2.5 million more than others.¹⁵

Do these published experiences with emotional intelligence and performance prove anything? Perhaps not. But, they do raise interesting questions for team-based care in oncology: Can we learn to increase our EQ so that our teams are more efficient and effective? And will this improvement in teamwork positively impact our patients? If nothing else, increasing our EQ may raise the morale in our teams.

Raising My EQ

The Emotional Intelligence Appraisal is deceptively simple, a series of questions that you rate along a Likert-type scale. I cleared my mind and readied myself for a multi-hour deluge of questions and scenarios. This is complicated stuff so the appraisal must be gigantic, I thought to myself. I completed the appraisal in about 20 minutes. That was unexpected and I returned to the appraisal assuming I had made a mistake. How could my complicated awareness, self-management, awareness of others’ emotions, and my relationship management skills be boiled down to a 20-minute appraisal? However, as I reviewed the report, I began to recognize myself in the assessment, strategies, and lessons.

I have always thought of myself as an empathetic person, able to sense what others are feeling and aware of their reactions. I have also thought of myself as being fairly self-aware. It’s typically pretty clear to myself when I have acted in a manner that I would rather be able to do over. I was surprised to see that I have opportunities in all of the domains of EQ:

• Self-Awareness
• Self-Management
• Social Awareness
• Relationship Management

The appraisal confirmed my self-assessment as a person with a decent amount of social awareness. But, my score was certainly not at the top of the scale, and this represents an area I can improve. More importantly for me, it confirmed my suspicion that I had a great deal of work to do in self-management. Bradberry and Greaves define self-management as the ability to use awareness of your emotions to stay flexible and positively direct your behavior as well as manage your emotional reactions to all situations and people.¹ Sounds easy enough, right? It’s just all situations and all people, how hard could that be?

What was intriguing to me is that this simple test had confirmed some of my own self-assessments and then pinpointed some of the specific details of what influences my self-management skills the most—trouble handling frustration, letting stress overwhelm you, and brushing people off when something is bothering you. Whether these are completely accurate from a psychologic standpoint or what a licensed therapist would deduce are not clear to me. However, they do resonate with me, and maybe that’s the whole point.

My team, along with a few other providers, have decided that we will do a monthly book club and reflection on our EQ strategies and lessons. Our goal is to learn more about ourselves, each other, how we feel, and how we harness those emotions for positive behaviors. So far it seems apropos to quote Sebastian Bailey: EQ “is not soft, fluffy or about wanting to be liked. Individuals who have high emotional intelligence want to succeed, can control their emotions, are gregarious and have positive self-appraisals.”¹⁴ I am hopeful that we will find this to be a valuable journey—it is challenging work, but it most certainly will be interesting.

Mr. Pickard is the director of PA Practice at The University of Texas MD Anderson Cancer Center. He is the chair of ASCO's Workforce Advisory Group and a member of the Clinical Practice Committee, Practice Administrators Work Group, Tobacco Use and Treatment Work Group, and Genitourinary Cancer Advisory Panel.

References

1. Bradberry T, Greaves J. Emotional Intelligence 2.0. San Diego: TalentSmart; 2009
2. Pickard T. ASCO Connection. 12 May 2017.
3. Pickard T. ASCO Connection. 21 Dec 2017.
4. Erikson C, Salsberg E, Forte G, et al. J Oncol Pract. 2007;3:79-86.
5. Yang W, Williams JH, Hogan PF, et al. J Oncol Pract. 2014;10:39-45.
6. Towle EL, Barr TR, Hanley A, et al. J Oncol Pract. 2011;7:278-82.
7. Coniglio D, Pickard T, Wei S. J Oncol Pract. 2011;7:283-4.
8. Kosty MP, Hanley A, Chollette V, et al. J Oncol Pract. 2016;12;955-8.
9. West MA, Guthrie JP, Dawson JF, et al. J Organ Behav. 2006;27:983-1002.
10. Bosch M, Faber MJ, Cruijsberg J, et al. Med Care Res Rev. 2009;66 (suppl 6):5S-35S.
11. Sinsky C, Rajcevich E. StepsForward. American Medical Association. Oct 2015.
12. Schottenfeld L, Petersen D, Peikes D, et al. AHRQ Pub. No. 16-0002-EF. Rockville, MD: Agency for Healthcare Research and Quality. Mar 2016.
13. Cohen SG, Bailey DE. J Manage. 1997;23:239-90.
14. Bailey S. Forbes. 5 Mar 2015. 
15. Loehr A. Huffington Post. 18 May 2015, updated 6 Dec 2017.