1. Team Structure
The ratio of We’s to I’s is the best indicator of the development of a team.
–Lewis B. Ergen
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2. Objectives Understand what defines a team
Identify the characteristics of high-performing teams
Discuss benefits of teamwork and team structure
Describe components and composition of a multi-team system (e.g., Core Team, Coordinating Team, Contingency Team, Ancillary Services, and Administration)
Define the roles and effectiveness of team members

3. Team Skills are the result of effective team structure
Common purpose
Performance Goals
Mutual Accountability
Clear Roles/Responsibilities
Complementary Skills
Interdependent Tasks
Patient
&
Family
Team Skills are the result
of effective team structure

4. What Defines a Team? Two or more people
Interact dynamically, interdependently, and adaptively
Toward a common and valued goal (14% of team function)
Have specific roles or functions (12% of team function)
Have a time-limited membership
Goal setting accounts for the greatest amount of variance in team functioning, followed closely by role clarification
Salas et al. Does team training work? Principles for health care.
Acad Emerg Med :1-8.

5. Partnering with the Patient
Embrace patients as valuable and contributing partners in patient care
Listen to patients
Learn patients’ preference regarding involvement
Ask patients about their concerns
Speak to them in lay terms
Ask for their feedback
Give them access to relevant information
Encourage patients and families to proactively participate in patient care (teach back)
What is my main problem?
What do I need to do?
Why is it important for me to do this?
Teach – Back / Show-Me Method
_02_job_aid_teach_back_method.pdf

6. Essence of a team is common commitment
Groups vs. Teams
Working Group
Clearly focused leader
Individual accountability
Individual work products
Efficient meetings
Indirect measures of performance
Discusses, decides, delegates
Team
Share leadership roles
Mutual accountability
Collective work products
Problem-solving meetings
Direct measures of performance
Discusses, decides, works together
Multidisciplinary group care differs from interdisciplinary care in the structure, process and skills of the providers. Multidisciplinary care takes place in parallel with little direct interaction between providers. Consequently, multidisciplinary treatment is characterized by narrow focus on the goals of individual disciplines and lack of coordination. (Crooks & Geldmacher, 2004, p. 124). How will we decrease readmission rates without a sense of mutual accountability?
Essence of a team is common commitment
Katzenbach & Smith (2005)

7. Barriers to Team Performance
Inconsistency in team membership
Lack of time
Lack of information sharing
Hierarchy
Defensiveness
Conventional thinking
Varying communication styles
Conflict
Lack of coordination and follow-up
Distractions
Fatigue
Workload
Misinterpretation of cues
Lack of role clarity

8. Team Failure Video
Did the team establish a leader?
Did the team assemble and assign roles and responsibilities to each member?
Did the team members communicate essential information to each other?
Did all team members contribute?
Did the team members demonstrate mutual respect toward one another?
Did the team address issues and concerns?
What are some specific actions that could have been taken to improve the outcome?
Videos must be saved in the same file as your power point for the link to work. If the link does not work, reinsert the video:
Click on insert tab in power point
Click on Video
Click on Video from file
Click on Sue SheridanLg001
Click on Insert Vig 4aLg001.mpg

9. Multi-Team System (MTS) for Patient Care
This structure…
establishes clarity of roles and responsibilities that makes mutual accountability possible
Every multi-team system has similar components….

10. A Core Team is…
Made up of care providers who work interdependently to manage a set of assigned patients
Dynamic Leadership
Core Team members have the closest contact with the patient!

11. A Coordinating Team is…
Responsible for managing
the operational environment
and resources that supports
the Core Team
Designated Leadership

12. A Contingency Team is…
A time-limited team formed for emergent or specific events and composed of members from various teams

13. Ancillary & Support Services provide…
Ancillary Services provide direct, task-specific, time-limited care to patients.
Support Services provide indirect service-focused tasks which help to facilitate the optimal healthcare experience for patients and their
families.

14. The Role of Administration is to…
Establish and communicate vision
Develop policies and set expectations for staff related to teamwork
Support and encourage staff during implementation and culture change
Hold teams accountable for team performance
Define the culture of the organization

15. Fall Risk Reduction Multi Team System Board of Directors
This slide is an example of how the multi-team system supports fall risk reduction.
Board of Directors

16. MTS Supports Chain of Accountability
Patient/ Family
Core Team
Coordinating Team
Administration
Board of Directors
The board needs to learn about quality and safety from coordinating teams that have direct knowledge of
front line structure,
process, and outcome.
Coordinating teams hold core
Core teams accountable for the
reliability of processes.
Every multi-team system has similar components….
a coordinating team is made up of Designated leaders who are responsible for managing the operational environment and resources that support the Core Team.
A coord team is responsible for managing the environment and resources that Core Teams use, and most importantly, they hold the core bedside team accountable for reliably assessing fall risk and implementing universal & targeted interventions to decrease fall risk.
Without the patient/family, the MTS has no purpose. The goal of the MTS is to Provide Patient-Centered Care:
Listen to their concerns
Know their health literacy
Give access to relevant information
Ask for their feedback….intro concept of
Ask me 3 for fall risk reduction…
What is my main problem? Becomes… Why might I fall?
What do I need to do?
Why is it important for me to do this?
The pyramid is the perfect symbol for the MTS. Without administration and coordinating and ancillary teams, the core team at the bedside has no foundation to support the patient/family.

17. Exercise: Your Multi-Team System? ?
Team members change but the behaviors remain the same

18. Paradigm Shift to Team System Approach
Dual focus (clinical and team skills)
Team performance
Informed decision-making
Clear understanding of teamwork
Managed workload
Sharing information
Mutual support
Team improvement
Team efficiency
Single focus (clinical skills)
Individual performance
Under-informed decision-making
Loose concept of teamwork
Unbalanced workload
Having information
Self-advocacy
Self-improvement
Individual efficiency

19. Effective Team Members
Are better able to predict the needs of other team members
Provide quality information and feedback
Engage in higher level decision-making
Manage conflict skillfully (NOT avoid conflict)
Understand their roles and responsibilities
Reduce stress on the team as a whole through better performance
“Achieve a mutual goal through interdependent and adaptive actions”

20. Teamwork Actions Assemble a team Establish a leader
Identify the team’s goals and vision
Assign roles and responsibilities
Hold team members accountable
Actively share information among team members
Provide feedback
Link these actions to briefs, huddles, and debriefs
“Individual commitment to a group effort—that is what makes a team work, a company work, a society work, a civilization work.”
–Vince Lombardi