1. Leading Teams
Leadership is an essential ingredient in creating high quality work places for us as professionals and for our patients.
Leaders who focus their attention on high quality, safe care will create a workplace where safety consciousness is the norm.
‘Never tell people how to do things. Tell them what to do and they will surprise you with their ingenuity.’ GEORGE PATTON
‘The ultimate measure of a man is not where he stands during times of comfort and convenience, but where he stands at times of challenge and controversy.’ MLK
‘A computer on every desk and in every home.’ BILL GATES
‘We choose to go the moon!’ JFK
‘Price is what you pay. Value is what you get.’ WARREN BUFFET
‘Of all the paths you take in life, make sure a few of them are dirt.’ JOHN MUIR
‘To handle yourself use your head; to handle others use your heart.’ ELEANOR ROOSEVELT

2. What Makes an Effective Leader?
What characteristics, attitudes, or skills made the leaders that you have known effective and successful?
If there was room for improvement, what could they have done to be more effective?
Can leadership be learned or taught, or is it an innate skill?
What one characteristic is most important to the success of effective leaders?
Within your group, select a leader and and a scribe. You have 3-5 min to discuss these questions.
Your group’s scribe will document responses and we will reconvene to discuss.
______________________________________________________________________________________________________________
Gallup has studied thousands of executive teams----from a data set of thousands of teams, four distinct domains emerged:
1. Executing (getting things done…make something a reality)
2. Influencing (help their team reach a much broader audience. People with strength in this domain are always selling the team's ideas inside and outside the organization).  
3. Relationship Building (essential glue that holds a team together. Without these strengths on a team, in many cases, the group is simply a composite of individuals.
These leaders possess the unique ability to create groups and organizations that are much greater than the sum of their parts.
4. Strategic Thinking
These leaders keep us all focused on what could be. They are constantly absorbing and analyzing information and helping the team make better decisions.
People with strength in this domain continually stretch our thinking for the future.

3. Objectives Describe how leadership affects team processes and outcomes
Identify different types of team leaders
Describe the activities involved in successfully leading teams
Describe the tools for leading teams, including briefs, huddles, and debriefs
Apply the tools for leading teams to specific clinical scenarios

4. Leadership Holds a teamwork system together
Ensures a plan is conveyed, reviewed, and updated
Facilitated through communication, continuous monitoring of the situation, and fostering of an environment of mutual support
We just covered Gallup’s findings and not surprisingly, they synch with what we see here:
In this module we will discuss leading teams
Leadership is the linchpin that holds teams together……
Leaders also ensure that plans are conveyed, reviewed and updated as needed.
Communication, situations monitoring and fostering an environment of support
Collaborating to make a difference—
Collaboration in health care is defined as health care professionals assuming complementary roles and cooperatively working together, sharing responsibility for problem-solving and making decisions 
When leading teams an environment in which teamwork can flourish in support of both high quality care and patient safety must be created. Leading teams involves
-Identifying R&Rs; developing norms for operating and communicating
-Monitoring the situation to anticipate team member’s and patient’s needs, managing resources and adjusting plans as necessary and
-Modeling appropriate behavior, and reinforcing and rewarding appropriate behavior

5. The Theory Effectiveness Team Leadership Orientation Mutual
Performance
Monitoring
Back-up
Behavior
Adaptability
Shared Mental
Models
Trust
Effectiveness
Closed Loop
Communication
Salas, Sims, Burke. Is there a “Big Five” in teamwork? Small Group Research. 2005; 36:
Big 5
Coord.
Mechanism
Just a reminder that in our theory of teamwork as a system of strategies and tools, improving our performance begins when leaders bring people together in team events that we will learn are called briefs, huddles, and debriefs.

6. Types of Team Leaders
Designated – The person assigned to lead and organize a team, establish clear goals, and facilitate open communication and teamwork among team members
Situational – Any team member who has the skills to manage the situation at hand

7. Effective Team Leaders
Organize the team (Define, assign, share, monitor, and modify a plan)
Review the team’s performance
Establish “rules of engagement” who does what
Manage & allocate resources (what people need to get the job done)
Provide feedback on assigned responsibilities and progress toward the goal
Facilitate information sharing
Encourage team members to assist one another
Facilitate conflict resolution
Model effective teamwork
Share a story about the impact of an effective leader in your organization.

8. Defining the Plan
When developing a plan, team leaders should consider:
Time – How much time is available to complete all the necessary tasks and activities?
People – Do the available staff have the necessary knowledge and skills to perform their roles?
Equipment – Is the necessary equipment available and working?
Information – Has all of the necessary information been collected and reviewed?

9. Case Study Discussion
After attending TeamSTEPPS Master Training, a physician and Chief Nursing Officer (CNO) in a Critical Access Hospital (CAH) decide that Code Blues could be more effectively conducted. Currently, when a Code Blue is called, roles are not clear (including the Code Leader) and equipment is sometimes missing or not functioning properly. The newly trained Master Trainers observe that these practices have led to confusion and chaos that put patients at risk and result in valuable time being lost. Lack of teamwork and communication during a recent code were issues that led to lack of situation awareness. physician and lead nurse in a Medical Home decide that clinic sessions could be more effectively conducted. Currently, providers run late, patients have excessive wait time, some staff leave before end of sessions while others work late. The newly trained Master Trainers observe that these practices have led to reduced patient and employee satisfaction.

10. Assigning Tasks and Responsibilities
Determine the tasks and roles to be assigned
Determine which roles must be filled and allocate tasks appropriately
Communicate clear expectations of what team members need to do
Request feedback
How do leaders on your unit, your team assign tasks once a plan has been established? Is the plan clear? Are there necessary resources and if not, are you able to discuss allocating?
-Is the plan clearly articulated? Is there the knowledge and skills to achieve the plan?
-is feedback requested toward the goal?
**What approaches to assigning tasks and responsibilities are effective? Which approaches have not been effective?

11. Sharing the Plan: Briefs
A team briefing is an effective strategy for sharing the plan
Briefs should help:
Form the team
Designate team roles and responsibilities
Establish climate and goals
Engage team in short- and long-term planning

12. Briefing Checklist Tool
TOPIC
Who is on core team?
All members understand
and agree on goals?
Roles and responsibilities
understood?
Plan of care?
Staff availability?
Workload?
Available resources?
Checklist for pilots:
Charlie GLUMPS
C-Carb Heat
G-Gas (proper tank on or off)
L-Lights
U-undercarriage
M-mixture set
P-prop set
S-switches (light, pilot, heat)

13. Exercise: Briefing INSTRUCTIONS:
Break into small groups with others from your unit/work area/organization.
Identify when, why, where briefs might be conducted in your setting. Who should lead the brief and who should participate?
Discuss what outcomes you expect to see as a result of implementing briefs.
If you currently conduct briefs, how might you improve them?

14. Monitoring & Modifying the Plan: Huddle
Problem Solving
Hold ad hoc, “touch base” meetings to regain situation awareness
Discuss critical issues and emerging events
Anticipate outcomes and likely contingencies
Assign resources
Express concerns
A video demonstrating a huddle is available at

15. Review the Team’s Performance: Debrief
Performance Improvement!
Informal exchange & feedback after an event
Review the timeline of key events
What happened/ why it happened (e.g. mini RCA)
Revise plan to incorporate lessons learned from what went well and what went poorly
Goals
Learn from experience (prevent a repeat adverse event)
Improve outcomes
Improve team orientation and trust

16. Debrief Checklist Communication clear?
TOPIC
Communication clear?
Roles and responsibilities understood?
Situation awareness
maintained?
Workload distribution?
Did we ask for or offer
assistance?
Were errors made or
avoided?
What went well, what should change, what can improve?

17. Facilitating Conflict Resolution
Effective leaders:
Facilitate conflict resolution to avoid compromising patient safety and quality of care
Do not allow interpersonal or irrelevant issues to negatively affect the team
Help team members master conflict resolution techniques

18. Promoting & Modeling Teamwork
Effective leaders promote desired team behaviors and skills through:
Open sharing of information
Role modeling and effective cuing of team members to use teamwork behaviors and skills
Constructive and timely feedback
Provide opportunities to practice and improve
Mitigating conflict within the team
Executing
Influencing
Relationship Building
Strategic
Thinking

19. Tools & Strategies Summary
BARRIERS
Inconsistency in Team Membership
Lack of Time
Lack of Information Sharing
Hierarchy
Defensiveness
Conventional Thinking
Complacency
Varying Communication Styles
Conflict
Lack of Coordination and Followup With Coworkers
Distractions
Fatigue
Workload
Misinterpretation of Cues
Lack of Role Clarity
TOOLS and STRATEGIES
Communication
SBAR
Call-Out
Check-Back
Handoff
Leading Teams
Brief
Huddle
Debrief
OUTCOMES
Shared Mental Model
Adaptability
Team Orientation
Mutual Trust
Team Performance
Patient Safety!!

20. Case Study Discussion
Mr. Smith presents to the clinic with shortness of breath. He has been referred by his primary care provider (PCP) for a cardiac consultation, at which time a stress test is ordered. The results indicate a positive finding for potential heart disease. The results are not communicated to his PCP. They are sent to the cardiologist, however that provider is out of the country for one month. Ten days later, Mr. Smith presents to the Emergency Department (ED) with chest pain and is diagnosed with an Acute Myocardial Infarction.

21. Applying TeamSTEPPS Exercise
What barriers are these care settings experiencing that contribute to the issues presented?
Which of the tools and/or strategies for leading teams might you consider implementing to address the issue?
Who needs to be involved?
How might you implement change?