Team Structure

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

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 amulti-team system (e.g., Core Team, Coordinating Team, Contingency Team, Ancillary Services, and Administration) • Define the roles and effectiveness of team members

3. 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-limitedmembership Salas et al. Does team training work? Principles for health care. Acad Emerg Med. 2008. 15:1-8.

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? http://www.npsf.org/for-healthcare-professionals/programs/ask-me-3/ Teach – Back / Show-Me Method http://pilot.train.hrsa.gov/uhc/pdf/module _02_job_aid_teach_back_method.pdf

6. 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 Groups vs. Teams Essence of a team is common commitment Katzenbach & Smith (2005)

7. 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 Barriers to Team Performance

8. Team Failure Video • 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

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 theorganization

15. Fall Risk Reduction Multi Team System Board of Directors

16. MTS Supports Chain of Accountability 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.

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 “Individual commitment to a group effort—that is what makes a team work, a company work, a society work, a civilization work.” –Vince Lombardi