not for reproduction or redistribution...today patients are rarely cared for by a physician alone...

Not for reproduction or redistribution


Building High Performance Teams That

Work Well (Together) Linda M. Shell DNP, MA, BSN, MA


Learning Objectives

1. Define critical role of teams in the healthcare setting2. Describe process for developing effective teams3. Explore assessment for identifying educational needs

of team members4. Identify specific actions for developing a team that

works well (together)


Chapter OneThe Vital Role of Teams in the

Healthcare Setting


Success and Failure


Teams are the backbone of healthcare organizations and form the foundation for problem solving and decision making processes, offering the potential to achieve more than any one person in the organization can attain.

Importance of Teams


1. Increasing complexity of patients2. Workforce shortages

3. Consumer demands4. Increased regulatory scrutiny5. Declining reimbursement

6. Value-based purchasing: accountability for outcomes

Rapid Changes in Healthcare


“Our challenge… is not whether we will deliver care in teams, but rather how well we will deliver care in teams”

– Dr. Paul Schyve, Senior Vice President, Joint Commission

Care Team Challenges


Type Description

Core Teams Consist of members involved in the direct care of the patient and/or resident. May include therapists, nurses, nursing assistants, social workers, etc.

Coordination Teams Consist of members responsible for day to day operations such as

department heads, managers, supervisors

Contingency Teams Formed for specific problem or time limited events and may include a

variety of members from core teams

Support Teams Consist of individuals who provide services to patients/residents charged with helping facilitate a positive healthcare experience for both patients and their families

Administrative Teams Composed of executive leaders that have 24-hour accountability for

overall function and management of the organization

Virtual TeamsCan be a form of the above types of teams where members are in geographically different locations and utilize technology as their primary communication method

Types of Teams


Medical practice, whether in the clinic, hospital, post-acute, or long-term setting traditionally focused on the individual physician as solely responsible for the patientToday patients are rarely cared for by a physician alone but are provided care by an interdisciplinary team of professional caregivers

World Health Organization, 2018

Current Trends About Patient Care


• Interdisciplinary team• Foundational to quality of care and bear responsibility

for assessment, delivery, monitoring and evaluation of care for complex patients

• Implementation of Patient Driven Payment Model (PDPM)

• Shift from primary care to team model• Accountability for delivery of both clinical and therapy

services within limited financial constraints

Example


• Geographically separated from one another• Be valued for your skills irrespective of physical location

• Reduced lost time, discomfort, and cost of commuting• Work from any place you choose• Work at times that suit you

• Physical disabilities are no hindrance• Challenge to maintain engagement• Team building essential

Virtual Teams


• Effective teams have been shown to improve patient outcomes and satisfaction

• Impact employee morale and job satisfaction1

• High performance teams are core component of high-reliability organizations.2

1. Bunnell et al., 2013, Salas & Rosen, 2013; Weller et al., 20142. Baker, et al., 2006

Research on Teams


Team Training Research

1. Review of 129 studies with 23,018 participants from healthcare settings in U.S. and abroad

2. Meta-analysis examined the impact on team performance when education is provided

3. Team education targeted knowledge, skills, attitudes and problem-solving behaviors

4. Focused on coordination, cooperation, communication, leadership and other team-based skills and the achievement of a common goal or outcome


Outcomes

1. Improved employees’ learning of new skills by 31%2. Use of these skills on the job increased by 25%

3. Financial outcomes improved by 15%4. Associated with a 34% improvement in clinical

performance

5. Increased patient satisfaction by 15%6. Reduced medical errors by 19%


Up to 70% of medical errors are attributed to poor team dynamics and dysfunctional teams

Caprice & Gustafson, 2006

Medical Errors


Chapter TwoProcess for Developing a High

Performance Team


A team is a small number of people with complimentary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable

Definition


Stages of Team Development

1. Forming2. Storming

3. Norming4. Performing5. Adjourning

Tuckman & Jensen, 1977


Stages of Team Development (cont.)

1. Forming– Team members are positive and polite– May be anxious as not sure what team will do– High level of excitement around tasks ahead– Leader plays dominant role– May last for some time as people work together and get

to know each other




1. Forming2. Storming

– People start to push boundaries. This is stage where many teams fail.

– Conflict can generate between personality styles– Team members can be frustrated with team dynamics– If role of team is not well defined, people may be overwhelmed

by workload, or uncomfortable with approaches of leader– Team members may experience increased levels of stress as

those don’t have full support or strong relationships



1. Forming2. Storming3. Norming

– People start to resolve differences, appreciate other’s strengths, and respect authority of leader

– Team members may socialize more and be willing to offer constructive feedback

– Stronger commitment to team goal, and good progress towards it

– May be overlap between storming and norming as new tasks come up. Team may move back into behavior from storming stage.




1. Forming2. Storming3. Norming4. Performing

– Hard work occurs without friction– Structures and processes are in place– Leader can delegate much of work and focus on developing

team members– Feels easy to be part of a team– People leaving or joining won’t disrupt performance



1. Forming2. Storming3. Norming4. Performing5. Adjourning

– Many teams reach this stage eventually– Project teams, quality teams, etc. – Permanent teams may be disbanded related to organizational

changes– Team members who like routine or have developed close

working relationships may find this stage challenging

Stages of Team Development


A group of high performing individuals does not make a high performing team

Key point…


• Silo mentality• High turnover

• Leadership gap• Time, fatigue, workload • Hierarchy/ranking

• Lack of transparency• III defined vision• Lack of role clarity• Varying communication styles

AHRQ, 2010

Barriers to Effective Teams


Task NeedsDefining the task, making a plan, allocating work and resources, controlling quality and tempo of work, checking performance against plan and adjusting plan

Group Needs

Setting standards, maintaining discipline, building team spirit, encouraging, motivating, giving sense of purpose, appointing roles, ensuring communication within the group, training the group

Individual Needs

Attending to personal problems, praising individuals, giving status, recognizing and using individual abilities, training the individual

Adair’s Functional Model (1986)


• Leader: create common purpose• Thinker: collect information and analysis

• Achiever: get things done, make things happen!• Carer: build team spirit, work toward consensus• Doer: task focused

Adair, 1986

Team Roles


Personal Example


Chapter ThreeAssessment of Team Needs


Purpose of Assessment

• Identify skill gaps within teams

• Helps build case for training resources

• Improve productivity, efficiency and effectiveness

• Increase engagement and boost morale


• What performance gaps exist?• What training do you think the team needs?

• What training do team members think they need?• What training are they interested in?• How important are these skills and competencies in

relationship to the needs of the organizations?• What type of training do they prefer?• How can training needs best be addressed?

Analyzing Needs of Team


• What are the team’s key tasks?• What training has already taken place, and has it been

successful?• What are the most pressing performance issues?• What training will have the maximum results?• Are there upcoming changes in the organization that are

relevant to your team?• Are there discrepancies between the organization’s

expectations and results delivered by the team?• What common themes arise in employee appraisals and

development plans?

Analyze Performance Gaps


Data Collection Methods

• Survey: involve a wide group of people

• Individual interviews • Focus groups• Review of organizational

outcomes


• Who needs training?• What training do they need?

• Why is it important?• How will the training be delivered?• Do we have the expertise in-house or is an outside

resource required?

Assessment of Individual Needs


Training is Not the Only Answer


Chapter FourActions for Building Strong Teams


• Priorities: what absolutely must be covered?• Results: what do you need to accomplish at the

meeting?• Participants: who needs to attend the meeting for it to

be successful?• Sequence: in what order will you cover the topics?• Timing: how much time will you spend on each topic?

• Date and time: when will the meeting take place?• Place: where will the meeting take place?

Meeting Agenda


Goal Setting

“Setting goals is the first step in turning the invisible to the visible”

GOALS


1. Set goals that motivate the team2. Use S.M.A.R.T. goals format

3. Put goals in writing4. Make an action plan5. Review progress

6. Stick with it!

Goal Setting (cont.)


• If certain people are dominating the conversation, make a point of asking others for their ideas.

• At the end of each agenda item, quickly summarize what was said, and ask people to confirm that that's a fair summary. Make notes regarding follow-up.

• Note items that require further discussion.

• Watch body language and adjust as necessary. Maybe team members need a break, or you need to stop someone from speaking too much.

• Ensure the meeting stays on topic.

Communication Strategies


• List tasks generated at meeting. Make note of who is assigned to do what, and by when.

• At the close of the meeting, quickly summarize next steps and inform everyone you will be sending out a meeting summary.

• Identify who will be responsible for each task and hold accountable.

• At end of each meeting, debrief the meeting by asking “what was most useful to you?”

Communication Strategies (cont.)


• Deal with conflict immediately: avoid the temptation to ignore it

• Be open: if people have issues, they need to be expressed immediately and not allowed to fester

• Practice clear communication: articulate thoughts and ideas clearly

• Practice active listening: paraphrasing, clarifying, questioning

• Practice identifying assumptions: asking yourself "why" on a regular basis

• Don’t let conflict get personal: stick to facts and issues, not personalities

Conflict Management


• Focus on actionable solutions: don't belabor what can't be changed

• Encourage different points of view: insist on honest dialogue and expressing feelings

• Blameless autopsy: encourage ownership of the problem and solution

• Demonstrate respect: if the situation escalates, take a break and wait for emotions to subside

• Keep team issues within the team: talking outside allows conflict to build and fester, without being dealt with directly

Conflict Management (cont.)


• Activities - promote understanding of team dynamics and learning styles

• Icebreakers - encourage the learning of story• Case studies - reflection on patient care experiences

and identification of interventions• Mission/vision - intersections with work of team• Interprofessional education and development

Team Building


• Be mindful of how one’s values and assumptions affect interactions with others

• Recognize the impact of change and other psychosocial factors on team members

• Include customers as members of teams• Everyone on the team counts• Hear everyone’s voice

Teamwork Principles


• What types of teams are common in your organization?• What is the responsibility of these teams?

• What is the goal of the team/s?• How are they measured?• Do they meet the expectations of the organization for

improving patient care and positively impacting the bottom line?

• What actions have been taken toward development of organizational teams?

Reflection


• Are teams routinely assessed for their performance?• Does the team demonstrate a mix of strengths and

perspectives?• What are the training needs of the team?• Is there an agenda for the meetings?• Are members held accountable for work of team?• Does the team have a structure for communication and

conflict management?• Are individual team members held accountable for their

team behaviors?

Reflection (cont.)


• The healthcare environment is changing, challenging and chaotic

• Healthcare teams are charged with leading change, ensuring quality of care, improving customer satisfaction, and achieving financial outcomes

• The work of IDT in implementation of PDPM is an example• Goals serve as a compass for the actions and behaviors of

the team• Research indicates that education is essential for the

development of high performance teams but often overlooked

• Team assessment should be conducted routinely

Summary


Question and Answer Session

Building High Performance Teams That Work Well (Together)

Bibliography

MedBridge Building High Performance Teams That Work Well (Together)

Linda M. Shell DNP, MA, BSN, MA

1. Adair, J. E. (2007) Developing your leadership skills. Kogan Page Limited. Philadelphia 2. Baker, D.P., Day, R., & Salas, E. (2006). Teamwork as an essential component of high

reliability organizations. Health Services Research. 41:4. pp. 1576-1598 3. Bunnell, C.A., Gross, A.H., Weingart, S.N., Kalfin, M.J., Partridge, A., Lane, S. & Mann,

S. (2013). High performance teamwork training and systems redesign in outpatient oncology. BMJ Quality & Safety. 22(5).

4. Caprice K., Gustafson M. (2006) A prospective study of patient safety in the operating room. Surgery. Vol.139:2, pp.159-171

5. Katzenbach, J.R. & Smith, D.K. (2003). The wisdom of teams: Creating a high performance organization. New York, NY.

6. McCaig, A. (2016). Team training in health care can save lives. Retrieved from http://news.rice.edu/2016/07/14/team-training-in-health-care-can-save-lives/

7. Mindtools (2018) Resolving team conflict. Retrieved from https://www.mindtools.com/community/pages/article/newTMM_79.php

8. Salas, E. (2015) Team training essentials: A research-based guide. New York, NY: Routledge.

9. Salas E. & Rosen, M.A. (2013). Building high reliability teams: Progress and some reflections on teamwork training. BMJ Quality and Safety, 22(5).

10. Schvye, P.M. (2005) The changing nature of professional competence. Joint Commission Journal of Quality and Patient Safety. 31:185-202Tuckman, B.W. & Jensen, M.A. (1977) Stages of small-group development revisited. Group Organization Management. 2(2) pp. 419-427

11. World Health Organization (2018) Being an effective team player. World Health Curriculum. Retrieved from https://www.who.int/patientsafety/education/curriculum/who_mc_topic-4.pdf

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