1. Team Structure The ratio of We’s to I’s is the best indicator of the development of a team. –Lewis B. Ergen NEXT:

2. T EAM STEPPS 05.2 Mod 2 06.1 Page 2 Team Structure 2 Objectives 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) Understand what defines a team Define the roles and effectiveness of team members

3. T EAM STEPPS 05.2 Mod 2 06.1 Page 3 Team Structure 3

4. T EAM STEPPS 05.2 Mod 2 06.1 Page 4 Team Structure 4 Partnering with the Patient Embrace patients as valuable and contributing partners in patient care Learn to listen to patients Assess 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 their families to proactively participate in patient care

5. T EAM STEPPS 05.2 Mod 2 06.1 Page 5 Team Structure 5 Why Teamwork? Reduce clinical errors Improve patient outcomes Improve process outcomes Increase patient satisfaction Increase staff satisfaction Reduce malpractice claims

6. T EAM STEPPS 05.2 Mod 2 06.1 Page 6 Team Structure 6 High-Performing Teams Teams that perform well: Hold shared mental models Have clear roles and responsibilities Have clear, valued, and shared vision Optimize resources Have strong team leadership Engage in a regular discipline of feedback Develop a strong sense of collective trust and confidence Create mechanisms to cooperate and coordinate Manage and optimize performance outcomes (Salas et al. 2004)

7. T EAM STEPPS 05.2 Mod 2 06.1 Page 7 Team Structure 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. T EAM STEPPS 05.2 Mod 2 06.1 Page 8 Team Structure 8 Exercise: Teams and Teamwork Write down the names (or positions) of the people in your immediate work area or unit who contribute to successful patient care.

9. T EAM STEPPS 05.2 Mod 2 06.1 Page 9 Team Structure 9 Multi-Team System (MTS) for Patient Care

10. T EAM STEPPS 05.2 Mod 2 06.1 Page 10 Team Structure 10 Core Team members have the closest contact with the patient! A Core Team is… A group of care providers who work interdependently to manage a set of assigned patients from point of assessment to disposition

11. T EAM STEPPS 05.2 Mod 2 06.1 Page 11 Team Structure 11 A team comprising those work area members who are responsible for managing the operational environment that supports the Core Team A Coordinating Team is…

12. T EAM STEPPS 05.2 Mod 2 06.1 Page 12 Team Structure 12 A time-limited team formed for emergent or specific events and composed of members from various teams A Contingency Team is…

13. T EAM STEPPS 05.2 Mod 2 06.1 Page 13 Team Structure 13 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. Ancillary & Support Services provide…

14. T EAM STEPPS 05.2 Mod 2 06.1 Page 14 Team Structure 14 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 The Role of Administration is to…

15. T EAM STEPPS 05.2 Mod 2 06.1 Page 15 Team Structure 15 Example: A Multi-Team System in the OR

16. T EAM STEPPS 05.2 Mod 2 06.1 Page 16 Team Structure 16 Exercise: Your Multi-Team System ? ?

17. Team Member Characteristics

18. T EAM STEPPS 05.2 Mod 2 06.1 Page 18 Team Structure Importance of the Team Why do you think the team would matter to outcomes? “Absolute Power” over local implementation What do you think makes a good team? The Who The How

19. T EAM STEPPS 05.2 Mod 2 06.1 Page 19 Team Structure Team Performance Outputs Performance Attitudes Behaviors Inputs Environment Hospital & Unit Context Team Composition Task Design Processes Inside Team Outside Team Team Traits

20. T EAM STEPPS 05.2 Mod 2 06.1 Page 20 Team Structure Team Composition Size (not too small, not too large) Multidisciplinary representation ICU Nurses ICU Physicians Infection Control ICU Medical Director Nurse Educator ICU Nurse Manager Executive Partner (VP or above) Pharmacist Hospital Patient Safety Officer or Chief Quality Officer Staff from Safety, Quality or Risk Mgmt Office Respiratory Therapist

21. T EAM STEPPS 05.2 Mod 2 06.1 Page 21 Team Structure Team Composition A team leader Champions (nurse and physician) Local “opinion leaders” People with diverse opinions

22. T EAM STEPPS 05.2 Mod 2 06.1 Page 22 Team Structure Team Composition Someone outgoing Someone who sees the big picture Someone detail-oriented Everyone dedicated

23. T EAM STEPPS 05.2 Mod 2 06.1 Page 23 Team Structure Successful teams have… Reliable Processes – Education and engagement activities – Communication – Leadership support/buy-in – Conflict (and conflict resolution)

24. T EAM STEPPS 05.2 Mod 2 06.1 Page 24 Team Structure Successful teams have …(cont.) Norms – Valuing individual contributions – Cohesion (team unity) – Goal agreement – Self-assessment of knowledge /skills – Participation of team members Role clarity

25. T EAM STEPPS 05.2 Mod 2 06.1 Page 25 Team Structure 25 Team Failure Video

26. T EAM STEPPS 05.2 Mod 2 06.1 Page 26 Team Structure 26 Teamwork Failure Video Analysis 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?

27. T EAM STEPPS 05.2 Mod 2 06.1 Page 27 Team Structure 27 Two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and have a time-limited membership What Defines a Team?

28. T EAM STEPPS 05.2 Mod 2 06.1 Page 28 Team Structure 28 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

29. T EAM STEPPS 05.2 Mod 2 06.1 Page 29 Team Structure 29 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 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” Effective Team Members

30. T EAM STEPPS 05.2 Mod 2 06.1 Page 30 Team Structure 30 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 “Individual commitment to a group effort—that is what makes a team work, a company work, a society work, a civilization work.” –Vince Lombardi

31. T EAM STEPPS 05.2 Mod 2 06.1 Page 31 Team Structure Action Items Form your team with an appreciation of the importance of WHO is on the team Carefully plan HOW you will act as a unified group Do a “pre-mortem” assessment—if this project were to fail, why would it?

32. T EAM STEPPS 05.2 Mod 2 06.1 Page 32 Team Structure Reference List Marsteller, Jill A., Stephen Shortell, Michael Lin, Elizabeth Dell, Stephanie Wang, et al. “How Do Teams in Quality Improvement Collaboratives Interact?” Joint Commission Journal of Quality and Patient Safety, 2007 May; 33(5):267-76. Shortell, Stephen, Jill A. Marsteller, Michael Lin, Marjorie Pearson, Shinyi Wu, Peter Mendel, Shan Cretin, and Mayde Rosen. “The Role of Team Effectiveness in Improving Chronic Illness Care,” Medical Care, November 2004.