[MUSIC] Welcome to module three, teamwork and collaboration. Quality improvement, as we remember, is doing your work, and then improving your work. It's really looking at the gap, between what we know that we should be doing, and then what we are actually doing. For this module we are going to be reviewing Chapter Three, Working in Inter professional Teams for the Improvement of Patient Care. The three objectives of this chapter are what are the criteria for effective teamwork, we're also going to be looking at the characteristics of working together. Third, we'll be describing factors that influence team functioning, and then lastly a little bit about choosing the members of your team. The definition of teamwork is a group of people working together to achieve a common purpose, for which they hold themselves mutually accountable. Teams are two or more people with this common goal. And really clear roles. Who's going to do what? The next component of teams are interpersonal relationships. These are the expectations that we have for one another on our team. The ability to give feedback to each other when things are going well or not going well. And then really having a true respect for the expertise of the other members on your team. Why do we work on teams? Well we know that quality and safety problems are inter-professional in origin. 70% of medical errors are due to poor teamwork, and communication. We also know that high-functioning teams have a greater success at quality improvement. Why do we work on teams? To think out of the box. To really look at what other people think in other professions around us, and also to insure that we have success. For, if we do not work in teams and if our teams are not functioning at high levels, we really won't achieve success. Now, where do we learn to work on teams? If you think back in your life you may recall times when you were expected to work on a team, but was there any tutorial on how to enhance your team work? Do you think about your sports in past, or working on projects in school? We really don't have a good playbook for how to work as a team. First before we get into how do we work as a team or what are the factors to improve team work, it's important to look at what types of teams we work on in healthcare. In general, we have work teams in healthcare, such as emergency room teams where professionals work together to care for patients coming through the ER. We also have patient care teams such as the medical home and primary care, where we have physicians, nurses and other essential health care professionals working to care for patients in the outpatient setting. Another example of teamwork is in the operating room, where we really can see the importance of team function. A second type of team in health care are project teams. And this is where there's a specific problem that really is complex. And that depends on multiple people in different types of units in a hospital system. The changes that are required really are across units, and also the changes that are required need cross-functional skills, so we have to form teams in order to get that perspective of different people. In order to insure that our improvements are going to be successful. And then the third type of teams are improvement teams. In this type of a team we really need to have a system leader. So, someone who has a higher view of the system is important to be on this team. The other key to an improvement team is to have team members with technical expertise. This is essential, as we all know that information technology is a key to improvement. And the next is to have a day to day leader on this improvement team, so that you have the frontline person who knows the processes and can be a champion for the change, involved in that team. And then the fourth team member that is essential in an improvement team is really to have an executive sponsor, someone from administration who really can give you the buy in and the financial support that are needed for your improvement initiative. So, what are the characteristics of working together? As I mentioned earlier there are a few essential components of a team, and that is to have a clear goal or a common goal that everyone agrees upon. The next is to have clear roles that everyone understands what's their purpose on that team. Clear expectations are the third component. And that means that everyone knows what's expected of them on that team. The fourth is to have the ability and feel safe to give feedback, whether it's good or bad on that team. And lastly is respect. And with respect it includes that we look at others who are on our team, and value their expertise, and know that they are contributing to our team in unique ways. What are some team behaviors or skills that we can learn in this course that will enhance these criteria in teams? And there's two that we're going to discuss today. The first is to establish some ground rules when you meet with your team. And then the second is to use the skill of balancing advocacy and inquiry. And we're going to talk about these two team behavior skills that you can incorporate as you move along on your quality improvement project. Team ground rules are expectations of what you have of your other team members. Team ground rules need to be created by all team members. Some examples of ground rules are that attendance is expected. So, if you have a team where people are not coming to meetings, or are coming late, this would be a ground rule that you want to institute. Another example of a ground rule for a team would be that all team members actively participate. This gets out the team member who sits silently and doesn't voice their opinions in the team. And if the ground rule is agreed upon by all the members of the team, then the team members can try to get active participation from everyone. A third example is following through with assignments. So many times in teams, it's so frustrating when people are given an assignment and don't come back with their assignment completed. So if the whole team agrees in their ground rules. Then they can call the person on not doing the assignment. Another ground rule is sharing information and seeking input outside of the meeting. Another one is being respectful of all members and their opinions, and this gets back at that respect in that we have to believe that our team members have an expertise and an unique perspective that needs to be heard. And lastly keeping side conversations to a minimum. So, there's nothing more frustrating than that. That during a team meeting that people are talking together on the side. And if you create a ground rule that this is not going to be acceptable, it's going to help your team functioning. For all these ground rules, it's similar to in the sport of soccer. Where if a ground rule is not adhered to then you can pull the yellow card and say stop, someone has not followed our ground rules here, and we need to re-look at what's the behavior that we all agree upon should be happening and then comparing it with the behavior that has happened. This is an important team function; it's not always easy. But if you all agree on this process, that you'll have ground rules, and that you'll be able to pull this yellow card, then I think it makes it a little bit fun at times. In our team meetings, we actually put a yellow card in the center of our meeting space, and then we all feel that we can take the card and pull it when someone is not meeting our ground rules. The second skill I wanted to focus on today was balancing advocacy and inquiry. And this is a really important communication skill. And I think what it gets at is then having the ability to hear the views of others, and kind of sharing your views. Sharing your views is advocating. Here's where you really use the skill of stating your opinion or your perspective directly. Another skill set that's important in advocating is to present your conclusions as options. So, not to say that here's what we should do, but, put it in the position of here's some ideas that we could consider as an option for what we need to do next. And then also a part of advocating is sharing your reasoning for why you're thinking what you're thinking, and maybe providing some examples of how your opinion or how your perspective has been carried out in the past. On the other end of the scale, for balancing this advocacy inquiry is really to try to hear the views of others. In hearing the views of others after someone has presented their position, test your understanding of what they have just said. When you test your understanding, you're asking the person, here's what I heard you say, is that what you meant? Or, do I have the right? Another component of the skill of inquiry is exploring others' reasoning. For this you could simply say, tell me a little bit about why you think that. Or what did you observe, that helped you to come to that conclusion? The next component of inquiry is to solicit a range of views. You could actually ask the person who's sort of soft spoken or not really saying much in the meeting. Tell me a little bit about how you feel about this situation. And then the last part of inquiry is really to encourage challenging questions, such as, hm, I don't really agree with that. Tell me a little bit about how you would maybe support your position, so that we can better come to a conclusion. Balancing advocacy and inquiry is a very important team skill that you can actually learn and use in order to improve your team functioning. One of the characteristics of working together, and one of these is working in inter professional teams. We definitely know that in our teams in healthcare, we're working with physicians, nurses, pharmacists, and healthcare administrators, and we know that they are different in their perspectives of what they value from every profession. The reason that they value different things is that their education was different, and that each healthcare professional is learning about how to care for the patient in a unique way. Their expertise is unique. Here's a little visual to explain that. As healthcare professionals, we are all on different parts of this elephant. If you can think about each one of these men as a different profession. The physician may be on the tusk, nurse might be on the tail, maybe social work on the back. And if you were to ask each one of the professions on the different parts of the elephant. What is an elephant. Each profession would tell you a different experience. So, a physician would tell you that an elephant is smooth and sharp. And a nurse might say that the elephant is stringy and hairy. Where as the social worker may say that the elephant. Is rough or textured. Not until all the professionals get together and share their unique aspects of what an elephant is, do we really understand the elephant. And this is similar in health care. That we all have different perspectives of our patient. And not until we come together and share our perceptions and our perspectives of the patient, including the patient's perspective, do we really understand the patient's needs. And only then can we deliver effective healthcare. Factors that influence team functioning include this authority gradient. Authority is really the power in an organizational structure. This can be manifested in many different situations, but I'm going to give you an example of the patient and provider experience. Where in many situations the provider takes the expert opinion, and doesn't value the expertise from the patient. For example. My mother was in the hospital recently, and I noticed that her arm had been enlarged from the day before. And when I spoke to the healthcare provider taking care of my mom, I voiced my concern and the healthcare provider said, no the size of the arm was the same as yesterday. I then only found out that the healthcare provider wasn't even at the hospital the day before. This is an example of the healthcare provider not valuing the experience, and the expertise of the patient and the family. There was a power gradient there, where the healthcare professional felt that they knew better than the patient. In teams that function at high levels, this authority gradient or power gradient really is leveled. And the situation occurs that everyone hears and respects the views of others, even when the patient is on the team or the family member is on the team. Another factor that influences team functioning is the communication style, and there's been a lot of research in this area. The Agency for Healthcare Quality Improvement has done quite a bit, and also the Department of Defense on how can we better structure our communication to make it more effective. One example of structured communication is SBAR, where the health care providers or professionals learn about this structure of giving the situation of what's happening, giving some background information, then giving their assessment of what they think is happening, and then the recommendation or what they think should be done next. If both sides of a diad in a communication are clear about this structure, then the person delivering the message and the person hearing the message are clear about what is the point of the communication. This communication strategy was developed by Team STEPPS from the Agency for Healthcare Research and Quality. And you can actually get this whole program of better teamwork off the internet on the AHRQ website. It provides strategies and tools to enhance performance and really leads to better patient safety. The components of team STEPPS include leadership. So, that they believe that every member on the team really needs to function in the role of being a leader. They also focus on communication strategies, as the one I mentioned prior with SBAR. The third component that the team STEPPS advocates for is mutual support, in that every team member is there to support the other members. And lastly situation monitoring, where everyone is aware of what's happening in the situation in order for them to pitch in, and help the situation. High performing patient-centered teams are the key to providing health care that is safe, effective, and efficient. The Institute of Medicine suggests preparing for high functioning teams, and this must being in early health professions education with a focus on early interdisciplinary training. So students can learn about advocacy and inquiry, and so then they can take that skill and use it in their clinical practice. This was a review of chapter 3, Working in Interprofessional Teams for the Improvement of Patient Care. And in this module you learned about the criteria for effective teamwork, the characteristics of working together, and then the factors that influence team functioning. That completes module three on teamwork. Now you'll be moving to the application for module three, in which you will be learning the skills for developing an organizational readiness assessment, and also learning how to manage a team meeting. These too will be essential skills for your next steps on your quality improvement journey [MUSIC]
