1. Examples and Characteristics
Working in Teams
Health IT Teams:
Examples and Characteristics
Welcome to Working in Teams: Health IT Teams: Examples and Characteristics. This is Lecture a.
People have a need to work in teams. Probably today, as never before, the value of teamwork is so important. It is critical for people, in terms of being successful with their tasks, toward being accurate in what they surmise, and in delivering the best quality in what they do. It’s probably more important in the health care industry as in any industry. In the health care industry, there’s a paramount need to have the correct people in a team, around a table, to ensure that electronic systems meet the needs of the patient and all stakeholders in that environment. In the health industry, it’s critical to have a team-centered orientation when designing or developing an application that will be implemented in any health care environment.
Lecture a
This material (Comp17_Unit1a) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC

2. Health IT Teams: Examples and Characteristics Learning Objective—Lecture a
Describe the characteristics of an effective team and work group.
Identify and differentiate roles of IT health care professionals in teams.
Describe the value of teams and the importance of collaboration for the IT professional in teams.
The Objectives for Health IT Teams: Examples and Characteristics are to:
 Describe the characteristics of an effective team and work group.
Identify and differentiate roles of IT health care professionals in teams.
Describe the value of teams and the importance of collaboration for the IT professional in teams.
In this lecture you will learn to describe the characteristics of an effective team and work group. You’ll be doing that in a number of ways. There will be some activities that you’ll be involved in. You will also be looking at some basic and fundamental characteristics of teams that are offered from a review of the literature and by reviewing a variety of work settings.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Health IT Teams: Examples and Characteristics Lecture a

3. The Health IT Field is Diverse and Expansive
The health IT field is diverse and expansive. Health care is provided in a variety of settings like operating rooms, medical records departments, in direct patient care settings, private practices, and in dentist offices (just to name a few). Each of these areas needs health IT to improve the quality, safety, and efficiency of the services they provide. This diversity and complexity of settings contributes to the expansiveness of the field of practice for the health IT professional.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Health IT Teams: Examples and Characteristics Lecture a

4. Teamwork in HIT
Teams and teamwork are important aspects of health care delivery today. In a complex health care setting, it takes many teams to run the system, deliver safe patient care, and to ensure a smooth throughput process for patients and families.
Teams and teamwork are critically important in health and health care. In a complex health care setting, many teams are simultaneously involved in the myriad of activities that are occurring at any given time. For example —at the same time that a surgical team is performing a complex surgical procedure, there are other teams that are readying the ICU bed that the surgical patient will be transferred into, the pharmacy team is preparing medications to be administered to the patient either during the surgery or afterwards, the nurse managers are checking staffing ratios to make sure that there will be adequate staffing when the patient is admitted to the floor —and so on. There will be people from all across the spectrum of the health care environment, who are working together to ensure the delivery of safe and efficient patient care. Teams are inherent in all aspects of life —from the hospital, to the grocery market, to your favorite football club. We work together to accomplish a common goal. 
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Health IT Teams: Examples and Characteristics Lecture a

5. Reflection
Before you learn more about HIT teams, please list three teams you have served on during the past three years. What role did you play? What was the key skill/activity you had to perform? What was the team goal and was it identified?
Take a moment to reflect on the kinds teams that affect your day-to-day life. Consider teams that you have been a member of over the past several years. Later in this module, we’ll come back to your experiences, and we’ll use your prior knowledge to build upon your current understanding of teams. You may be surprised to learn how similar the actions of a football squad are to an open heart surgery team. How does this relate to health IT? Health IT is not only a member of the team —it is also a mechanism for supporting the work of a team. This is why a deep understanding of how teams function and how health IT can either hinder or help team performance is so critically important in the health IT profession.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Health IT Teams: Examples and Characteristics Lecture a

6. Team—Definition
A team is defined as “a small number of people with complementary skills who are committed to a common purpose, performance, goals, and approach for which they hold themselves mutually accountable.”
(Harvard Business Review, 1993)
We should start with basics— with the definition of teams. A team is defined by the Harvard Business Review as “a small number of people with complementary skills who are committed to a common purpose, performance, goals, and approach for which they hold themselves mutually accountable.” Again, we can think of this as a football team scoring a goal or a nurse working with a patient and his family to ease the discharge process.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Health IT Teams: Examples and Characteristics Lecture a

7. Important Features of Team Members
Communication
Coordination
Distinctive roles
Interdependent tasks
Shared norms
Important features of team members include the ability for each of the members to clearly communicate and coordinate with one another. Team members often have very distinctive roles; yet there is a common thread that binds them to other members of a team. There are often sequential and interdependent tasks that are occurring —and a well-functioning team understands these distinct roles and how they all fit together. For example, during a cardiac arrest, the team members have defined roles, and while they are all working to save a patient’s life, they may all be doing distinctly different things. It is in the coordination, the integration, or the synthesis of these activities that the team begins to function like a well-oiled machine or a choreographed dance troop. A very well-functioning team almost becomes a single “thing.” For a team to arrive at this sort of high functioning level, the team members must have shared norms. Getting to this stage requires an established set of ground rules and shared values. If the team is not all working toward the common goal or if a member of the team is following a different path, team performance is diminished.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Health IT Teams: Examples and Characteristics Lecture a

8. Examples of Health Information Team Members
If we stop talking about football teams and ballet troops and move back over into the health domain, we will actually find that teams in health care (in general) are not that different in their idea and dedication to achieving a common goal. Drilling down a bit further and focusing directly on teams that make up health IT, we still see much commonality in this regard. At the same time, there are defining characteristics that differentiate one player from another, one practitioner from another, and one user from another. This is one of the reasons why teams that are assembled to —for example —define user needs for a new system in a small rural clinic have to have some sort of affinity or commonality with the people that they are working with. Just as you would not expect a 375 pound linebacker to understand the nuances of a ballet pointe shoe, you would not expect a pharmacist to design the workflow for a busy nursing unit. In discussing a team-based approach to the implementation of (or planning for) an EHR system, it is vitally important to have wide stakeholder participation. Most certainly physician representation is needed —but what about the office manager? What about the billing clerk? Again, the concept of good representation on the team from the groups that will be affected is critical.
 In another example, how about planning for a new CPOE (computerized patient order entry) system? Who might the members be? Well, of course a good representation of who might actually order something in the system would be important. Is that just the physician? No! Think about who actually “orders.” Nutritionists order diets, nurses order consults, and nurse practitioners order all kinds of medications, and so on. Depending on the type of system, representation from respiratory therapy, nutrition, physical therapy, and occupational therapy are often needed as are administrative workers and managers. In other words, we need the expertise of different stakeholders on teams that are comprised to plan for or to implement health IT. These are the people who understand workflow and processes —and they bring great value to a team. This is not to say that a team should be overloaded —because a team that is too large becomes lower functioning. The point is, team composition for health IT should not be haphazard. It should be focused —yet inclusive.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Health IT Teams: Examples and Characteristics Lecture a

9. Viewing Teams as a Three-Stage System
Teams are often viewed as a three-stage system that includes:
Input—Resources teams utilize
Throughput —Maintenance of internal processes
Output—Production of specific products
Teams are often viewed in a three-stage system that includes the steps of input, throughput, and output. An input can be thought of as the team’s resources, such as the team members, any technologies that support the team, and any information that the team needs at the start of a specific project. Throughput, the second stage, is the process that the team engages in to reach their goals and tasks. Outputs, the final stage- are the actual deliverables that the team creates and develops to meet the mission operatives in other words, the product that they came together to achieve in the first place
 Let’s apply this framework to a health IT perspective. Airline passengers often develop DVT, or deep vein thrombosis, from prolonged periods of sitting. The same condition can occur in hospital patients during extended periods of confinement. The hospital staff was charged with creating a plan to reduce deep vein thromboses in the hospital environment. A diverse team was formed to investigate the current process of assessing and ordering preventive measures via the deployed EHR system for high risk DVT patients. The team members gathered, shared all the information they had about the DVT issue, and discussed the issue in great detail. Many different perspectives were shared and team members learned from one another. The ground rules that were established early on by the team allowed for everyone to share and be heard in a respectful fashion. In this process of “teaming” they realized that there was a way to improve on the way that orders appeared in the EHR that could potentially impact the occurrence of DVTs. Feedback from the nursing aide on observations made in regards to bed positions was a particularly valued contribution —something pointed out by the Chief of Surgery in his final report. Because of the team interaction and contribution of perspectives, a specialized automated order set was created in the EHR that prioritized the presentation of certain interventional orders for patients deemed to be at higher risk. The rates of DVTs declined and the team continues to work in a quest to reduce the numbers down closer to zero.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Health IT Teams: Examples and Characteristics Lecture a

10. Characteristics of Effective Teamwork
Organizational structure
Individual contribution
The actual processes that the team is
involved in
There is a great deal of literature and research regarding teams. One of the more commonly accepted ways of dissecting team characteristics is to clutter them into three areas: organizational structure, individual contribution, and the actual processes that the team utilizes. We’re going to look at each of those areas in more detail as in the next several slides.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Health IT Teams: Examples and Characteristics Lecture a

11. Characteristics of Effective Teamwork
Here is a grid that lays out the three structures that are characteristic of effective teams, and some of the detailed elements within each. We are going to discuss each one in turn, starting with organizational structure.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Health IT Teams: Examples and Characteristics Lecture a

12. Organizational Structure Components
Clear purpose/mission
Appropriate culture
Specified task
Distinct roles
Leadership
As can be seen on the slide —effective teams have an organizational structure that has a clear purpose, appropriate culture, and a specified task. Clear purpose is pretty straightforward and easy to understand —the team is chartered and there is a defined mission and a clear purpose of why they have been assembled in the first place. Their tasks are specifically linked to the kinds of deliverables that are required to achieve the mission.
The culture is appropriate to achieve the mission; there are distinct roles for team members, and there is defined leadership. An organizational structure that supports these aspects is one with a higher probability of creating successful teams that achieve the goal. In taking this specifically into health IT, one could easily apply this structure to the prior DVT example. There was a clear mission and purpose, which was to reduce the occurrence of DVTs. The culture supported the inclusion of multiple stakeholders, and all contributions were respected and valued. Processes were examined and observations recorded by different members of the team who were actually seeing the same process from a variety of perspectives. The leader of the group—who was one chosen for her reputation for seeing the “big picture” and being a “discipline spanner” did an excellent job of leading the team to the goal. It was in digging out all of these perspectives and dimensions that the solution was able to be collaboratively arrived at. Then, when it was built into the automated process—the stakeholders all felt like they had played a role in improving patient care. These aspects—as part of the organizational structure—are critical contributors to success.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Health IT Teams: Examples and Characteristics Lecture a

13. Health IT Teams: Examples and Characteristics Summary—Lecture a
It is important to understand the characteristics of an effective team as healthcares settings are complex.
Most health care environments require teamwork to run the systems and deliver safe patient care.
This concludes Lecture a, of Health IT Teams: Examples and Characteristics. We will continue to discuss these characteristics in lecture b.
In summary, we defined teams and we discussed the characteristics of teams. The point was made that it is important to understand the characteristics of an effective team in complex health care enterprises and to facilitate their formation. Moreover, the importance of an understanding of team dimensions and multiple stakeholder involvement was put forth as critical to planning for and implementing successful Health IT.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Health IT Teams: Examples and Characteristics Lecture a

14. Health IT Teams: Examples and Characteristics References—Lecture a
Harvard Business Review. (1993) The Discipline of Teams.
Katzenbach JR, Smith DK. (1993) The Wisdom of Teams: Creating the High-Performance Organization, Harper Business, New York.
Mickan S, Rodger S. Characteristics of effective teams: a literature review. Australian Health Review. 23(3):
Norm N. The Value of Teams in the Workplace. The University Record Oct 8; Available from:
Richard AG, Dickson MW. Teams in Organizations: Recent Research on Performance and Effectiveness. Annual Review of Psychology. 47(1):
Zeff LE, Higby MA. Teaching More Than You Know. Academic Exchange Quarterly. 6(3)
Charts, Tables, Figure
Table 1.1. Characteristics of Effective Teamwork. Adapted from Mickan S, Rodger S: Characteristics of effective teams: a literature review. Australian Health Review 2000, 23(3): Available from:
No audio.
Images
Slide 3:Keyboard and stethoscope. Courtesy of Department of Health and Human Services. Available from:
Slide 4: Clinicians. Image courtesy The Johns Hopkins Hospital
Slide 8: Nurse checking patients blood pressure. Image courtesy National Institutes of Health (NIH). Available from:
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Health IT Teams: Examples and Characteristics Lecture a