April 2014

Phil Hassen

International Society for Quality in Health Care

Creating High Performance Health Care OrganizationsThrough Building Effective Teams

Philip Hassen MPH, FCCHSE

Past President, International Society for Quality in Health Care President, Canadian Network for International Surgery (2010-2012) CEO, Canadian Patient Safety Institute (2005-2010) Deputy Minister of Health, Ontario (2002-2004) President and CEO, Vancouver Coastal Health Authority (2000-2002) President and CEO, Providence Health Care (1997-2000) President and CEO, St. Joseph’s Health Care Centre (1988-1997) Other Senior Hospital Positions in Calgary and Toronto

Session Purpose

Increase your knowledge about team building and stages of team development

Build your understanding about the constructs of teams and the challenges in making them effective

Recognize that effective teams are essential for

improving quality and service providing better care to patients and families

What is Team Building? Is a philosophy of job design in which

staff members are viewed as interdependent members of a team rather than as individuals who perform jobs/work

Is built upon a culture which weighs more heavily on achieving team goals rather than individual ones

“The whole is greater than the sum of its parts.” (Aristotle)

1+1 = 3

Team Building What are the Goals?

Develop both the individual and team Increase team members understanding of:

How the team currently works How to improve the way the team can work together in the future How to achieve better results

Improve the team’s ability to collaborate, communicate, problem solve and plan together

Increase quality, safety and efficiency in order to achieve intended team/organizational objectives

Building Effective TeamsWhat are some of the challenges?

Relationships of trust

Culture of "blame”

Ineffective leadership

Members agree on everything too quickly

Building Effective TeamsWhat are some of the challenges?

Building teams within and across disciplines

Increasing complexity of

care delivery

Lack of common goals

Competing agendas

Power struggles/conflicts

What is Team Work?

Achieving a common purpose through collaboration with others

Using the talents of all members Individuals working

together for a common purpose create a force

All individuals contribute knowledge and expertise

What are the Characteristics of Effective Teams?

Work together with specific objectives in mind

Members place the best interests of the team above individual interests

Each team member has an important role and contributes uniquely to the work

Use agreed-upon principles and processes such as decision-making and communication processes

What are the Benefits of Effective Teamwork?

Aids in decision making

Improves communication

Ensures that the work is accomplished efficiently and effectively

Commits to the results

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Teamwork is the best countermeasure for fatigue

Common Team Building Exercises : Objectives

Build healthy relationships and encourage team members to get to know each other both personally and professionally

Increase Problem-solving Skills

Strengthen Communications

Build Trust

What are some examples of Team Building Exercises?

Through organized time away from daily work, teams can focus on the following exercises: Building Relationships - Use a sequence of questions and

share in pairs or small groups. For example: share hopes & fears; share something personal such as a “little known fact” or “two facts (truths) about themselves and a lie”. Members introduce themselves to the rest of the group with three "facts" and others guess which one is a lie.

Problem Solving Simulations – For example, Human Synergistics, a Canadian company provides a variety of simulations intended to demonstrate the importance of working together. In the “Desert Survival Simulation” there is a plane crash and team members must work together to survive the elements and make high quality decisions.

What are some examples of Team Building Exercises?

Through organized time away from daily work, teams can focus on the following exercises: Self Assessments – For example, use a well regarded

assessment tool such as Myers Briggs Type Indicator (MBTI) to strengthen relationships and communication. With the information from the self-assessment team members gain more understanding about themselves and appreciate differences between people. All four MBTI types are equal; there is no best “Type” --- Introversion/Extroversion; Sensing/Intuition; Thinking/Feeling; Judging/Perceiving.

Group Dynamics Observations – To build trust, team members discuss how they interact with each other. For example, ask members to observe and record speaking patterns and track who speaks to whom and observe the flow of information and general communication patterns.

Team Building Exercises Risks

Team members may become cynical of the leader and/or organization if there are no meaningful changes or improvements after a team building exercise

Events may be viewed as a waste of time and lead to decreased motivation and productivity if there is no lasting impact

Fundamentals to Team Success Team leadership

Team members

Team relationships

Organizational Culture

Team LeadershipStart with the Fundamentals

Use Best Leadership Practices described by authors & researchers Kouzes & Posner

1. Model the Way

2. Inspire Shared Vision

3. Challenge the Process

4. Enable Others to Act

5. Encourage the Heart

Team Leadership

Assemble competent team members Match the talents of the members

with the work that needs to be done

Establish clear and inspiring team goals Know what the team needs to

accomplish Believe in the team

Team Leadership Encourage standards of excellence

Develop work approaches, procedures and processes to ensure work is accomplished efficiently and effectively

Invest in learning and development and be prepared to devout time and resources

Build trust and member responsibility and accountability Coach individuals & the team Give feedback on team & individual performance

Team LeadershipGive Constructive Feedback

Tips Be descriptive and specific

Avoid generalizations Focus on behavior and state the

facts Avoid exaggerations

Give regular feedback and “catch” team members doing things right Be respectful & not

threatening Use active listening

Check for understanding & be prepared to discuss options

Examples

Positive Feedback : “I noticed that you finished the project two days ahead of schedule and so we have some flexibility and can catch our breath. I wonder if you would be willing to share your approach to project management with others?”

Critical Feedback: “I noticed that you were 30 minutes late for clinic and we are delayed in seeing some people who were scheduled. We will not be able to get to the meeting at the end of the day.” What do you suggest we do now?

Team Leadership

Leaders recognize that approaches need to be flexible and appropriate to the team’s stage of development

As we next review the stages of team development, consider the implications to the delivery of the quality and safety of care and service

Stages of Team DevelopmentOverview

Stages of Team Development (Tuckman, 1970) Describes characteristics and practical approaches for

each stage of development

Forming

Storming

Norming

Performing

Stages of Team DevelopmentForming

Forming

Storming

Norming

Performing

Characteristics Hesitant participation Roles and responsibilities are unclear Exchange of functional information High dependence on leader for direction

Team Formation

What are the goals?

What is my role?

How can I make a unique contribution?

Stages of Team DevelopmentForming

Forming

Storming

Norming

Performing

Practical Approaches Clarify roles & goals Get acquainted and orient members to the task & people Establish group agreements Identify information and resources

Stages of Team DevelopmentStorming

Forming

Storming

Norming

Performing

Characteristics Resistance to the task as members realize it is more

difficult than imagined Formation of conflicting factions Polarization of issues and lack of unity Leader may be challenged by team members

Stages of Team DevelopmentStorming

Forming

Storming

Norming

Performing

Practical Approaches Use active listening Be flexible & open-minded Clarify the issues, share views & feelings respectfully Apply understanding of different approaches to conflict

Stages of Team DevelopmentNorming

Forming Storming Norming Performing

Characteristics Development of cohesive team Engage in brief fun & playfulness Co-operation & commitment is high Acceptance of others & respect for individual

differences

Stages of Team DevelopmentNorming

Forming Storming Norming Performing

Practical Approaches Give & receive constructive feedback Seek & give opinions & perspectives Focus on problems/issues (not the person) Leader coaches and enables action

Stages of Group/Team Development Performing

Forming Storming Norming Performing

Characteristics Shared vision & values Strong interdependence of task & relationships Able to resolve disagreements positively Act on opportunities for change & improvement Team has a high degree of autonomy

Stages of Group/Team Development Performing

Forming Storming Norming Performing

Practical Skills Use participative decision making Apply problem solving approaches Stay open to new ideas Delegate, support & encourage

Forming • Clarify roles & goals• Establish team agreements/expectations

Storming• Address differences & face challenges • Use active listening

Norming • Give & receive constructive feedback • Focus on problems & issues

Performing • Use participative decision-making approaches • Support and encourage the team

Summary Stages of Team Development

“Coming together is a beginning.

Keeping together is progress.

Working together…

achieving results

… is success.”

Henry Ford

Cross Functional & Interdisciplinary Teams

“Interdisciplinary collaboration is

considered key to the visionary

21st century health care paradigm

where teams function effectively

to optimize safety and deliver

high quality care.” (Institute of Medicine, 2001)

Summary : Capabilities of Effective Teams

Clarity of Outcomes Commitment Competence Collaboration Communication Coordination Change Oriented

Cross Functional & Interdisciplinary Teams Necessary for Large Scale Change

Usually used for large & complex tasks Teams are usually more diverse More connected via technology Typically composed of more highly educated people

Harder to manage Often more diversity of views; thus more prone to

disagreement and deadlock Used selectively, for leading edge and innovative

creative-type changes Role of leader is more dynamic and thus requires a very

skilled leader

Some Examples My Experience with Team Building

Developing senior staff through modified responsibilities to achieve common mission, vision, values and principles of operation AND becoming effective team members/leaders

Improving patient/family care processes by teams collaborating to reduce steps and hand-offs to enhance surgical care resulting in improved quality and efficiency

Addressing major care problems in a complex community/multi-hospital organization by understanding roles and enabling team members to gain new perspectives to improve across the continuum for patient/client care

Cross Functional Teams

The overwhelming majority of untoward events involve communication failure

Somebody knows there’s a problem but can’t get everyone “in the same movie”

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Community (Physicians &

Homecare)

Hospital

Communication Patient Safety Practices

In 2008 Accreditation Canada established Patient Safety areas and Required Organizational Practices (R.O.P.’s) as a mandatory element of all accreditation surveys R.O.P.: Employ effective mechanisms for transfer of

information at interface points, including shift changes, discharge, and patient/client movement between health care services and sectors, and implement improvements.

Evidence: Mechanisms for transfer of information are consistently used (For example: checklists, transfer forms, huddles).

Do Effective Teams Make a Difference?

Better communication

Improved co-ordination and collaboration

Increased capability to achieve goals and make change

Quality and Safety Improve

“We are on a journey−a journey that will take enormous efforts to change. It is clear that improvement in patient safety and quality will take time, but the time for change is now. Our patients, residents, families and communities depend on providers to work as teams to achieve improved care and services.”

- Hassen & Dingwall 2008

Final Thoughts: The Road Ahead

Selected Resources Teamwork and Team Building. Corporate Training Materials.

corporatetrainingmaterials.com Effective Teamwork in Healthcare: Research & Reality. D. Clements,

M. Dault & A. Priest. Heathcare Papers. Vol. 7. Special Issue The Wisdom of Teams: Creating the High-Performance Organization.

J.R .Katzenbach & D.K .Smith. (1993) The Team Handbook. 3rd Edition. P. Schultz, B. Joiner & B. Streibel.

(2003) The Leadership Challenge. 4th Edition. J. Kouzes & B. Posner (2007) When Teams Work Best. F. LaFasto & C. Larson. (2001) Rx for Hospitals. Philip Hassen. (1993)

Creating High Performance Health Care Organizations

Through Building Effective Teams

~Your Question & Comments Please ~

Thank you!