1. Team Leader It’s more than a title Swedish Family Medicine Residency Mary Onysko, PharmD, BCPS Morgan Campbell, DO Kerry Salter, MS, CN, LPN Bradford Winslow, MD, FAAFP

2. 1.Discuss team dynamics that have worked at Swedish Family Medicine (SFMR) 2.Explain effective methods for delegating tasks 3.Share successes and barriers to QI projects implementation Objectives

3. Leadership Qualities What makes for a good leader?

4. Traditional – Intelligence – Toughness – Determination – Vision Daniel Goleman – Emotional intelligence Key team leader characteristics Harvard Business Review; www.hbr.org accessed 10/2014www.hbr.org

5. Emotional intelligence

6. History of Quality Improvement at SFMR

7. 1.Clear goals with measurable outcomes 2.Clinical and administrative systems 3.Division of labor 4.Training of all team members 5.Effective communication Key team characteristics Grumbach K. JAMA 2004;291:1246-1251

8. Provide structure Which role will each team member play? Need to select the right people for the right tasks Ensure everyone is properly trained Establish deadlines Schedule follow up Use discipline* Effective methods for delegation www.mindtools.comwww.mindtools.com accessed 9/2014 Pulich MA. Heath Care Supervisor 1995;13(3)54

9. Assigning leaders – Staff was assigned as leaders first – Faculty asked not to take leadership role Coaching does not = confident leaders Meeting times – Staff participation is dependent on productivity of the clinic – Resident participation is limited by scheduling conflicts Common goals – Patient-centered vs workload-centered Lack of accountability/follow-up Inability to make real change What didn’t work at SFMR

10. “Selling the position” – Resident/staff leader partnership Goal setting – Team picks QI projects instead of being assigned topic Confidence in team member qualifications/abilities More empowered staff What has worked AT SFMR

11. Minimal research on team building, more focus on improving EXISTING teams – Research is subjective- subjects are more likely to rate their performance as a team-member as positive – Objective performance measures are not positive Management teams are different than clinical teams – Where does the QI team fit? Little training in health professional education Building an effective team (What does the literature say?) Leggat S. BMC Health Serv Res 2007;7(17)1-10

12. Building an effective team (Australian teamwork survey) Leggat S. BMC Health Serv Res 2007;7(17)1-10 What competencies have you seen in other team members which enhance teamwork?

13. Building an effective team (Australian teamwork survey) Leggat S. BMC Health Serv Res 2007;7(17)1-10

14. Building an effective team (Australian teamwork survey) Leggat S. BMC Health Serv Res 2007;7(17)1-10

15. Summarized 48 articles, mostly multidisciplinary teams in hospital – 32 articles – how to train your team – 8 articles – how to use specific tools to improve effectiveness – 8 articles – organizational interventions Most studies provide low quality evidence (pre-post survey) – Lack of statistical significance Health Policy 2010(94):183-195

16. Methods to train your team Results – All types of training Improves confidence/knowledge of team members May improve communication between team members No difference in adverse outcomes, team performance – Simulation training Good for improving efficiency in crisis situation – Interprofessional training & team building Improves morale, participation, group cohesion Decreases burnout Health Policy 2010(94):183-195

17. Specific tools Health Policy 2010(94):183-195 Easy and inexpensive Train team on how to use certain tools to improve practice – Checklists Preoperative, rehab activities profile, quality improvement – Goal sheets Multidisciplinary teams, improve communication, increase accountability – Case analysis Gather themes for improvement around a significant event

18. Organizational interventions Health Policy 2010(94):183-195 Reconstruct patient care teams (multidisciplinary) – Inpatient Decrease length of stay, decrease OR turnover time, decrease time to carry out clinical interventions, higher job satisfaction – Primary care Increases number of self-defined objectives achieved Improved teamwork and patient services (per interview data)

19. ACGME Residents are required to work in multidisciplinary teams “Residents are expected to… work effectively as a member or leader of a health care team or group.” [Interpersonal and Communication Skills competency] “Residents are expected to… work in interprofessional teams to enhance patient safety and improve patient care quality.” [Systems-Based Practice competency] “Residents should participate in and assume progressive leadership of appropriate care teams to coordinate and optimize care for a panel of continuity patients.” [Curricular Elements  Primary FMP site] “Residents must care for patients in an environment that maximizes effective communication. This must include the opportunity to work as a member of effective interprofessional teams that are appropriate to the delivery of care to the specialty.” [Teamwork, common program requirements]

20. Group discussion How did your organization identify QI team leaders? – What worked, what didn’t? What characteristics did your leaders demonstrate that were helpful? How does your organization plan to choose leaders in the future?