Team Structure NEXT The ratio of We s to

Team Structure NEXT: The ratio of We’s to I’s is the best indicator of the development of a team. –Lewis B. Ergen

Team Structure Objectives n Identify the characteristics of high-performing teams n Discuss benefits of teamwork and team structure n Describe components and composition of a multi-team system (e. g. , Core Team, Coordinating Team, Contingency Team, Ancillary Services, and Administration) n Understand what defines a team n Define the roles and effectiveness of team members Mod 2 06. 1 Page 2 TEAMSTEPPS 05. 2 2

Team Structure Mod 2 06. 1 Page 3 TEAMSTEPPS 05. 2 3

Team Structure Partnering with the Patient Embrace patients as valuable and contributing partners in patient care n n Assess patients’ preference regarding involvement n Ask patients about their concerns n Speak to them in lay terms n Ask for their feedback n Give them access to relevant information n Mod 2 06. 1 Page 4 Learn to listen to patients Encourage patients and their families to proactively participate in patient care TEAMSTEPPS 05. 2 4

Team Structure Why Teamwork? n Reduce clinical errors n Improve patient outcomes n Improve process outcomes n Increase patient satisfaction n Increase staff satisfaction n Reduce malpractice claims Mod 2 06. 1 Page 5 TEAMSTEPPS 05. 2 5

Team Structure High-Performing Teams that perform well: n n n n n Hold shared mental models Have clear roles and responsibilities Have clear, valued, and shared vision Optimize resources Have strong team leadership Engage in a regular discipline of feedback Develop a strong sense of collective trust and confidence Create mechanisms to cooperate and coordinate Manage and optimize performance outcomes (Salas et al. 2004) Mod 2 06. 1 Page 6 TEAMSTEPPS 05. 2 6

Team Structure Barriers to Team Performance n Inconsistency in team membership n Conflict n Lack of coordination n Lack of time and follow-up n Lack of information sharing n Distractions n Hierarchy n Fatigue n Defensiveness n Workload n Conventional thinking n Misinterpretation of n Varying communication styles Mod 2 06. 1 Page 7 cues n Lack of role clarity TEAMSTEPPS 05. 2 7

Team Structure Exercise: Teams and Teamwork Write down the names (or positions) of the people in your immediate work area or unit who contribute to successful patient care. Mod 2 06. 1 Page 8 TEAMSTEPPS 05. 2 8

Team Structure Multi-Team System (MTS) for Patient Care Mod 2 06. 1 Page 9 TEAMSTEPPS 05. 2 9

Team Structure A Core Team is… A group of care providers who work interdependently to manage a set of assigned patients from point of assessment to disposition Core Team members have the closest contact with the patient! Mod 2 06. 1 Page 10 TEAMSTEPPS 05. 2 10

Team Structure A Coordinating Team is… A team comprising those work area members who are responsible for managing the operational environment that supports the Core Team Mod 2 06. 1 Page 11 TEAMSTEPPS 05. 2 11

Team Structure A Contingency Team is… A time-limited team formed for emergent or specific events and composed of members from various teams Mod 2 06. 1 Page 12 TEAMSTEPPS 05. 2 12

Team Structure Ancillary & Support Services provide… Ancillary Services provide direct, task-specific, time-limited care to patients. Support Services provide indirect service-focused tasks which help to facilitate the optimal healthcare experience for patients and their families. Mod 2 06. 1 Page 13 TEAMSTEPPS 05. 2 13

Team Structure The Role of Administration is to… n Establish and communicate vision n Develop policies and set expectations for staff related to teamwork n Support and encourage staff during implementation and culture change n Hold teams accountable for team performance n Define the culture of the organization Mod 2 06. 1 Page 14 TEAMSTEPPS 05. 2 14

Team Structure Example: A Multi-Team System in the OR Mod 2 06. 1 Page 15 TEAMSTEPPS 05. 2 15

Team Structure Exercise: Your Multi-Team System ? Mod 2 06. 1 Page 16 TEAMSTEPPS 05. 2 ? 16

Team Member Characteristics

Team Structure Importance of the Team n Why do you think the team would matter to outcomes? n “Absolute Power” over local implementation n What do you think makes a good team? n n Mod 2 06. 1 Page 18 The Who The How TEAMSTEPPS 05. 2

Team Structure Team Performance Inputs Outputs • Environment • Performance • Hospital & Unit Context • Team Composition • Task Design Mod 2 06. 1 Page 19 Processes • Attitudes • Inside Team • Behaviors • Outside Team • Team Traits TEAMSTEPPS 05. 2

Team Structure Team Composition n Size (not too small, not too large) n Multidisciplinary representation n n Mod 2 06. 1 Page 20 n ICU Nurses ICU Physicians Infection Control ICU Medical Director Nurse Educator ICU Nurse Manager Executive Partner (VP or above) Pharmacist Hospital Patient Safety Officer or Chief Quality Officer Staff from Safety, Quality or Risk Mgmt Office Respiratory Therapist 05. 2 TEAMSTEPPS

Team Structure Team Composition n A team leader n Champions (nurse and physician) n Local “opinion leaders” n People with diverse opinions Mod 2 06. 1 Page 21 TEAMSTEPPS 05. 2

Team Structure Team Composition • Someone outgoing • Someone who sees the big picture • Someone detail-oriented • Everyone dedicated Mod 2 06. 1 Page 22 TEAMSTEPPS 05. 2

Team Structure Successful teams have… • Reliable Processes – Education and engagement activities – Communication – Leadership support/buy-in – Conflict (and conflict resolution) Mod 2 06. 1 Page 23 TEAMSTEPPS 05. 2

Team Structure Successful teams have…(cont. ) • Norms – Valuing individual contributions – Cohesion (team unity) – Goal agreement – Self-assessment of knowledge /skills – Participation of team members • Role clarity Mod 2 06. 1 Page 24 TEAMSTEPPS 05. 2

Team Structure Team Failure Video Mod 2 06. 1 Page 25 TEAMSTEPPS 05. 2 25

Team Structure Teamwork Failure Video Analysis n Did the team establish a leader? n Did the team assemble and assign roles and responsibilities to each member? n Did the team members communicate essential information to each other? n Did all team members contribute? n Did the team members demonstrate mutual respect toward one another? n Did the team address issues and concerns? n What are some specific actions that could have been taken to improve the outcome? Mod 2 06. 1 Page 26 TEAMSTEPPS 05. 2 26

Team Structure What Defines a Team? Two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and have a time-limited membership Mod 2 06. 1 Page 27 TEAMSTEPPS 05. 2 27

Team Structure Paradigm Shift to Team System Approach Single focus (clinical skills) Individual performance Team performance Under-informed decision-making Informed decision-making Loose concept of teamwork Clear understanding of teamwork Unbalanced workload Managed workload Having information Sharing information Self-advocacy Mutual support Self-improvement Team improvement Individual efficiency Mod 2 06. 1 Page 28 Dual focus (clinical and team skills) Team efficiency TEAMSTEPPS 05. 2 28

Team Structure Effective Team Members n Are better able to predict the needs of other team members n Provide quality information and feedback n Engage in higher level decision-making n Manage conflict skillfully n Understand their roles and responsibilities n Reduce stress on the team as a whole through better performance “Achieve a mutual goal through interdependent and adaptive actions” Mod 2 06. 1 Page 29 TEAMSTEPPS 05. 2 29

Team Structure Teamwork Actions n Assemble a team n Establish a leader n Identify the team’s goals and vision n Assign roles and responsibilities n Hold team members accountable n Actively share information among team members n Provide feedback “Individual commitment to a group effort—that is what makes a team work, a company work, a society work, a civilization work. ” –Vince Lombardi Mod 2 06. 1 Page 30 TEAMSTEPPS 05. 2 30

Action Items Team Structure n Form your team with an appreciation of the importance of WHO is on the team n Carefully plan HOW you will act as a unified group n Do a “pre-mortem” assessment—if this project were to fail, why would it? Mod 2 06. 1 Page 31 TEAMSTEPPS 05. 2

Team Structure Reference List n Marsteller, Jill A. , Stephen Shortell, Michael Lin, Elizabeth Dell, Stephanie Wang, et al. “How Do Teams in Quality Improvement Collaboratives Interact? ” Joint Commission Journal of Quality and Patient Safety, 2007 May; 33(5): 267 -76. n Shortell, Stephen, Jill A. Marsteller, Michael Lin, Marjorie Pearson, Shinyi Wu, Peter Mendel, Shan Cretin, and Mayde Rosen. “The Role of Team Effectiveness in Improving Chronic Illness Care, ” Medical Care, November 2004. Mod 2 06. 1 Page 32 TEAMSTEPPS 05. 2