Until May 1994, when the program was reduced in scope, it would appear that only one pediatric cardiac surgery patient was referred out of province. When compared with the way that Collins helped to ease Duncan into his role as a pediatric cardiac surgeon, this has to be seen as a very rapid start. Three inter-related issues from this period are deserving of discussion. These are the lack of attention that was paid to team building, the cool response that was given to those nurses who sought orientation sessions to prepare themselves for working with Odim and the approach that was taken to case selection. Team building Operations are not performed simply by a collection of individual professionals, but by teams, which require a high degree of trust and strong communication.
Teamwork improves over time, through the experience of working together.
For this reason, any time there is a hiatus or a new member is introduced to the team, particularly as key a member as the surgeon, the team must undergo a process of rebuilding. As was noted in Chapter Five, the pre-surgical preparation set up at the VCHC by Duncan and Collins involved a series of meetings where team members prepared as a team for the forthcoming surgery. In addition, there were post-operative meetings that served as a forum for discussion of outcomes. Collins and Duncan had worked hard to develop a feeling of trust and open communication, as they recognized that without these, such meetings could easily turn into acrimonious encounters or simply become routine events where difficult questions were avoided and not addressed. It is worthwhile comparing the startup of February 1994 with the sort of team building that had taken place under Collins.