6 Teambuilding

8/19/2019 6 Teambuilding

1/20


2/20

Chapter 10 Team Building in Quality Improveme

DRAFT, please do not circula

Promoting Quality

Why Teams?Why Teams?

Complex and multiComplex and multi--faceted problems infaceted problems inhealth carehealth care

Integration of divergent points of viewIntegration of divergent points of view

Collaboration & cooperationCollaboration & cooperation

Knowled e rocessKnowled e rocess

AGI Consulting, LLC 03 AGI Consulting, LLC 03--1010

Open atmosphereOpen atmosphere

Greater number of ideasGreater number of ideas

Greater acceptance of solutionsGreater acceptance of solutions

Higher implementation rateHigher implementation rate

Mutual supportMutual support

4

What is Team Building?What is Team Building?

“The process of deliberately


creating an effective team”

--- Francis & Young

Need to achieve rapidNeed to achieve rapidprogress/successprogress/success

Why Team Building?Why Team Building?


commitmentcommitment

Need to overcome problems inNeed to overcome problems inrelationships, commitment and lackrelationships, commitment and lackof clarityof clarity

6


3/20



Promoting Quality

Factors InfluencingFactors Influencing

team Effectivenessteam Effectiveness

The Task Team skills


Individual

concerns

7

Choosing a TeamChoosing a Team

Who makes the selection?Who makes the selection?

The team’s role!The team’s role!


Creating the teamCreating the team

Team ResourcesTeam Resources

8

Choosing a TeamChoosing a Team2/22/2

Team MeetingsTeam Meetings

Team Members rolesTeam Members roles


First MeetingFirst Meeting

9


4/20



Promoting Quality

Stages of TeamStages of Team

DevelopmentDevelopment

Formin

g Closing


Storming

Norming

Performin

g

10

Stage 1: FormingStage 1: Forming

ExcitementExcitement

Anticipation Anticipation


OptimismOptimism

Anxiety Anxiety

FormalFormal

Attempts to define task Attempts to define task

ComplaintsComplaints

11


Polite, fairly formalPolite, fairly formal

Task orientatedTask orientated

Figuring out what is acceptableFiguring out what is acceptable

group behaviourgroup behaviour


How to deal with groupHow to deal with groupproblemsproblems

Discuss issue not relevant toDiscuss issue not relevant totasktask

Complain about organisation &Complain about organisation &behavioursbehaviours

12


5/20



Promoting Quality


Clarify mission/projectClarify mission/project


Introduction & specifying activitiesIntroduction & specifying activities

Establish ground rules for teamEstablish ground rules for team

behaviour behaviour

Provide trainingProvide training

13

Stage 2: StormingStage 2: Storming

ResistanceResistance


Varying attitudesVarying attitudes

about the teamabout the team

team membersteam members

chance of successchance of success

14


Argue Argue

DefensivenessDefensiveness


CompetitionCompetition

WithdrawalWithdrawal

Questioning purposeQuestioning purpose

Unrealistic goal settingUnrealistic goal setting

Concern about excessiveConcern about excessive

workwork15


6/20



Promoting Quality


Conflict managementConflict management

techniquetechnique


Clarification of concepts,Clarification of concepts,

tools, roles etc.tools, roles etc.

16

Stage 3: NormingStage 3: Norming


e ee e

“Playful” interactions“Playful” interactions

Commitment to working out differencesCommitment to working out differences

Clarify criteria for achieving successClarify criteria for achieving success

Take intelligent & effective actionTake intelligent & effective action

17


CreativityCreativity


EffectivenessEffectiveness

18


7/20



Promoting Quality


Develop understanding amongDevelop understanding among


membersmembers

Problem solvingProblem solving

Structured methods of operatingStructured methods of operating

19

Stage 4: PerformingStage 4: Performing


TrustTrust

20


High energyHigh energy

Attention to task Attention to task


OpennessOpenness

ConfrontationConfrontation

TrustTrust

EnjoymentEnjoyment

21


8/20



Promoting Quality



tools to enhancetools to enhance

performanceperformance

22

Stage 5: ClosingStage 5: Closing


If successful : joy, pride, elation & lossIf successful : joy, pride, elation & loss

If unsuccessful: frustration, anger If unsuccessful: frustration, anger

23


If successful: a reciation avoidance ofIf successful: a reciation avoidance of


final closefinal close--out activitiesout activities

If unsuccessful: denial, blame,If unsuccessful: denial, blame,

dissociationdissociation

24


9/20



Promoting Quality


Discuss next stepsDiscuss next steps


EvaluateEvaluate

PresentationsPresentations

25

Team PlayersTeam Players

Roles of Leader Roles of Leader


Roles of Scribe and Timekeeper Roles of Scribe and Timekeeper

Roles of MembersRoles of Members

26

Roles of Team MembersRoles of Team Members

Task OrientedTask Oriented

“What?“What?--Focused”Focused”

Shaper Shaper

Process OrientedProcess Oriented

“How?“How?--Focused”Focused”

Coordinator Coordinator


Innovator Innovator

Analyzer Analyzer

Implementor Implementor

Networker Networker

Harmonizer Harmonizer

Gatekeeper Gatekeeper

27


10/20



Promoting Quality

The Team’s SociogramThe Team’s Sociogram

ModelModel

Leader Member 1


Member 2

Facilitator

Scribe Member 3

28

Types of TeamsTypes of Teams

Improvement TeamsImprovement Teams

CommitteesCommittees


Focused TeamsFocused Teams

OthersOthers

29

Characteristics ofCharacteristics ofEffective TeamsEffective Teams

1.1. ConflictConflict

2.2. DisciplineDiscipline

6. Objectives

7. Out ut


3.3. EnergyEnergy

4.4. LearningLearning

5.5. MethodologyMethodology

8. Structure

9. Mutual Support

10. Team-memberfulfilment

30


11/20



Promoting Quality

Constituents of aConstituents of a

functional teamfunctional team

UniUni--disciplinarydisciplinary

MultiMulti--disciplinarydisciplinary

--

AGI Consulting, LLC 03 AGI Consulting, LLC 03--1010 31

PrePre--Collaborative TeamCollaborative Team

WorkWorkIndividual Coaching and Team DevelopmentIndividual Coaching and Team Development

Basic PI educationBasic PI education

Small sampleSmall sample

PDSA cyclePDSA cycle


Flow chart the existing processFlow chart the existing process

Consider potential changes for improvementConsider potential changes for improvement

Expose team to established best practicesExpose team to established best practices

Compare current practice to a highCompare current practice to a high

performing practiceperforming practice32

PrePre--Collaborative Team WorkCollaborative Team WorkIndividual Coaching and Team DevelopmentIndividual Coaching and Team Development

Help teams set broad goalsHelp teams set broad goals

Reduce medication errors associated withReduce medication errors associated withhigh risk medications, or high risk medications, or

Improve medication reconciliationImprove medication reconciliation


en, narrow t e ocusen, narrow t e ocus

Reduce medication errors in insulinReduce medication errors in insulinadministration by 50% by………administration by 50% by………

Then to define the strategy to useThen to define the strategy to use

This is where there should be room forThis is where there should be room forcustomization through innovationcustomization through innovation

33


12/20



Promoting Quality

Collaborative TeamCollaborative Team

MeetingsMeetings Prepares teams for networking among teamsPrepares teams for networking among teams

Diversity enriches problemDiversity enriches problem--solving potentialsolving potential Teaching OpportunityTeaching Opportunity

Introduction to systems theoryIntroduction to systems theory


Review the basics of ComplexityReview the basics of Complexity

Identifying stake holdersIdentifying stake holders

Defining goals and objectivesDefining goals and objectives

PI ProcessPI Process

Performing and understanding tests of changePerforming and understanding tests of change

Diffusion of innovationDiffusion of innovation

Envision their current and future processesEnvision their current and future processes

34

Spreading Good IdeasSpreading Good IdeasA SummaryA Summary

Think “ pull”Think “ pull” — —there are two major options forthere are two major options forthe spread of good ideas: push and pull.the spread of good ideas: push and pull. In aIn a pushpush strategy, you find the idea and use astrategy, you find the idea and use a

variety of means to push the idea out to potentialvariety of means to push the idea out to potential


..

In aIn a pullpull strategy, you find the people who have astrategy, you find the people who have agenuine current interest in the prevention andgenuine current interest in the prevention andtreatment…, work with them to understand theirtreatment…, work with them to understand theirimprovement priorities and find improvement ideasimprovement priorities and find improvement ideasand other tools that address them..and other tools that address them..

35


Reduce UncertaintyReduce Uncertainty — —Rogers has found thatRogers has found thatuncertainty underlies much of the resistanceuncertainty underlies much of the resistancethat one encounters from potential users of anthat one encounters from potential users of an

idea. Sources include:idea. Sources include:


ncer a n y rea e o e ea sencer a n y rea e o e ea se

Resources that will be need to test and implement itResources that will be need to test and implement it

Implications for jobsImplications for jobs

Impact on current valuesImpact on current values

Relationships, etcRelationships, etc..

36


13/20



Promoting Quality


Understand the Decision ProcessUnderstand the Decision Process — —individuals andindividuals andgroups generally go through a 5groups generally go through a 5--step process before theystep process before they

fully embrace a change. The steps are:fully embrace a change. The steps are: Awar eness . Awar eness . When the person or group become aware of theWhen the person or group become aware of the

idea and something about how it works operationally.idea and something about how it works operationally.

PersuasionPersuasion.When the erson or rou fo rm favorable or .When the erson or rou fo rm favorable or


. l. lunfavorable attitudes toward the idea.unfavorable attitudes toward the idea.

Decision.Decision. Where the person or group decide to adopt, adapt, orWhere the person or group decide to adopt, adapt, orreject the idea.reject the idea.

ImplementationImplementation. Where the person or group put their version of. Where the person or group put their version ofthe idea into use.the idea into use.

ConfirmationConfirmation. Where the person or group seek information that. Where the person or group seek information thatwill (or will not) reinforce the decision they made. If thewill (or will not) reinforce the decision they made. If theinformation does not confirm the decision, that decision may beinformation does not confirm the decision, that decision may be

reversed at this point.reversed at this point.37


Spread is a Social ProcessSpread is a Social Process — —steps 2 through 5 dependsteps 2 through 5 dependheavily on the social process that occurs in everyheavily on the social process that occurs in everyorganizationorganization— —the interactions in the formal and, morethe interactions in the formal and, moreimportantly, informal groups of friends and trustedimportantly, informal groups of friends and trustedcolleagues. Facilitating honest, open, attentive and noncolleagues. Facilitating honest, open, attentive and non--


coercive conversations within these informal networks iscoercive conversations within these informal networks ispossibly the most important spread strategy anypossibly the most important spread strategy anyorganization can pursue.organization can pursue.

In many cases, this may mean spending time creating orIn many cases, this may mean spending time creating orstrengthening ties among peersstrengthening ties among peers— —forming “communities offorming “communities ofpractice” or “learning networks” among the people from thepractice” or “learning networks” among the people from the

facilities with which you work.facilities with which you work.38


Fit the Idea to the EnvironmentFit the Idea to the Environment — —an idea mayan idea maywork well in one organization and not in another,work well in one organization and not in another,at least not in the same form. All improvement isat least not in the same form. All improvement islocal, dependent as it is on the many variableslocal, dependent as it is on the many variables

that make each or anization uni ue.that make each or anization uni ue.


Try it first on a small scaleTry it first on a small scale — —when a team findswhen a team findsa promising idea, it’s best to test that idea on aa promising idea, it’s best to test that idea on asmall scale, see how it works, tinker with it andsmall scale, see how it works, tinker with it andtest it again. Several of these rapidtest it again. Several of these rapid--cycle testscycle testsmay be needed before there is confidence in andmay be needed before there is confidence in andgood support for the idea. It’s then time togood support for the idea. It’s then time toimplement if for real!implement if for real!

39


14/20



Promoting Quality


Sustain the GainSustain the Gain — —good changes often gogood changes often go

off the track when attention moves to otheroff the track when attention moves to othermatters. Great gains are often notmatters. Great gains are often not

sustained. Make the policy, procedures,sustained. Make the policy, procedures,


skill building, cultural and other changesskill building, cultural and other changes

that will be needed to assure that a usefulthat will be needed to assure that a useful

change stays put.change stays put.

40

So what could derail teambuilding inSo what could derail teambuilding in

organizations??organizations??


Conflicts…Conflicts…



15/20



Promoting Quality

ConflictConflict

The value of conflictThe value of conflict


conflictconflict

Conflict interventionConflict intervention

43

ConflictConflict

The value of conflictThe value of conflict

EnergyEnergy

CreativityCreativity


DepthDepth

Effective solutionEffective solution

Too much agreement is a risk toToo much agreement is a risk to

effective team functioning.effective team functioning.

44

Conflict…Conflict…

IGNOREDIGNORED Productivity dropsProductivity drops

UnpleasantUnpleasant

MANAGEDMANAGED Changes occur Changes occur

Feelings airedFeelings aired

ClarificationClarification


StressStress

Less informationLess information

More time lostMore time lost

UnderstandingUnderstanding

More involvementMore involvement

IncreasesIncreasesmotivation andmotivation andcreativitycreativity

IncreasesIncreasesalternativesalternatives

45


16/20



Promoting Quality

ConflictConflict

Conflict results from disagreement aboutConflict results from disagreement about

the following:the following:

FactsFacts


MethodsMethods

GoalsGoals

ValuesValues

46

Understanding &Understanding &

Beliefs About ConflictBeliefs About Conflict

Conflict is natural and can be valuableConflict is natural and can be valuable

Conflict can be a source of energyConflict can be a source of energy

Conflict is a result of real differencesConflict is a result of real differences


erences n perspec ves are o enerences n perspec ves are o ennecessary for breakthrough thinkingnecessary for breakthrough thinking

One’s view and habits in handling conflict areOne’s view and habits in handling conflict areimportant determinants of the outcomes of aimportant determinants of the outcomes of aconflictconflict

Mastering skills in managing conflict takesMastering skills in managing conflict takes

lots of practicelots of practice47

Response to ConflictResponse to Conflict

Ask yourself 2 ques tions Ask yourself 2 ques tions::

How important to you is t he opinion, goal, orHow important to you is t he opinion, goal, orperspective under discussion?perspective under discussion?

How important to you is it to maintain goodHow important to you is it to maintain good


re a ons p w e peop e w w om you arere a ons p w e peop e w w om you arein conflict?in conflict?

Then use one of the following responses:• Avoid (prevention)• Smooth (minimise & sacrifice)• Force (win-lose)• Compromise (lose-lose)• Solve the problem (win-win) 48


17/20



Promoting Quality

Dealing with ConflictsDealing with Conflicts

Anticipate & prevent whenever possible Anticipate & prevent whenever possible

Think of each problem as a group problemThink of each problem as a group problem

Neither over Neither over--react not under react not under--react.react.


ea ers range o responses nc u es:ea ers range o responses ncu es:

do nothing (do nothing (nonnon--interventionintervention))

off off--line conversation (line conversation (minimal interventionminimal intervention))

impersonal group time (impersonal group time (low interventionlow intervention))

off off--line confrontation (line confrontation (medium interventionmedium intervention))

inin--group confrontation (group confrontation (high interventionhigh intervention))

expulsion from the group (expulsion from the group (rarely userarely use))

49

Tactics for ConflictTactics for ConflictInterventionIntervention

Select neutral territorySelect neutral territory

Make sure the setting is informalMake sure the setting is informal


a e sure a appropr a e peop e are presena e sure a appropr a e peop e are presen

Set an agenda and groundSet an agenda and ground--rules; stick torules; stick tothemthem

Manage the time carefullyManage the time carefully

Use active listening and constructiveUse active listening and constructivefeedback skills throughout the interventionfeedback skills throughout the intervention

Suppress or contain triggersSuppress or contain triggers50

Biased ?Biased ?

Not Me!Not Me!

Bias is universal.Bias is universal. Everyone sees things from a slightlyEveryone sees things from a slightly

different perspectivedifferent perspective..


We only see what we look for We only see what we look for Present company excepted, of course.Present company excepted, of course.

Bias can result in:Bias can result in: Impaired CommunicationImpaired Communication

Disagreement and conflict.Disagreement and conflict.

51


18/20



Promoting Quality

Bias Generated ConflictBias Generated Conflict

Physician’s view ofPhysician’s view of

CEOsCEOs Profits before patientsProfits before patients

Cost before ualitCost before ualit

What CEOs wantWhat CEOs want

Quality of careQuality of care

Local communityLocal communityissuesissues


Market dominance andMarket dominance andcontrolcontrol

Regional or nationalRegional or nationalambitionsambitions

Physician partnershipPhysician partnership

Patient advocacy andPatient advocacy andtrusttrust

Health system costsHealth system costsand marginsand margins

Source: The Physician Perspective: Key Drivers of Physician Loyalty,

Copyright 1999, The Health Care Advisory Board, The Advisory Board

Company.52

Bias Generated ConflictBias Generated Conflict

CEO’s view ofCEO’s view of

Physicians:Physicians:

Professional incomeProfessional income

What doctors want:What doctors want:




Share of ancillary profitsShare of ancillary profits

Equity and ownershipEquity and ownership

Clinical autonomyClinical autonomy

Patient advocacyPatient advocacyand trustand trust


Source: The Physician Perspective: Key Drivers of Physician Loyalty,

Copyright 1999, The Health Care Advisory Board, The Advisory BoardCompany.

53

Crucial Conversations &Crucial Conversations &

Conflict ResolutionConflict Resolution

Effective communicationEffective communication

Eliminates biasEliminates bias

You help me to understand my bias and yourYou help me to understand my bias and your

true motivations, andtrue motivations, and


I help you to understand your bias, and myI help you to understand your bias, and my

true motivationstrue motivations

Enriches the total viewEnriches the total view

Two (or more) perspectives can give a moreTwo (or more) perspectives can give a more

complete picturecomplete picture

54


19/20



Promoting Quality

Eliminated BiasEliminated Bias

Opportunity for collaborationOpportunity for collaboration

What CEOs w antWhat CEOs w ant



What doctors wantWhat doctors want




PhysicianPhysicianpartnershippartnership


Health systemHealth systemcosts & marginscosts & margins

ClinicalClinicalautonomyautonomy



55

GroupthinkGroupthink

What is it?What is it?

How do you recognize it?How do you recognize it?


Why is itWhy is it notnot usually desirable?usually desirable?

Are there exceptions? Are there exceptions?

56

Groupthink (cont.)Groupthink (cont.)

What are the conditions forWhat are the conditions for

groupthink?groupthink?

“ ”“ ”


IsolationIsolation

DomineeringDomineering

ClosedClosed--mindedminded

57


20/20



Groupthink (cont.)Groupthink (cont.)

How to prevent groupthink?How to prevent groupthink? Use scientific methodUse scientific method


External eyeExternal eye

Criteria to evaluate optionsCriteria to evaluate options

Risk assessmentRisk assessment

Alternatives Alternatives

58

SummarySummary

Understanding team and team building is essential inUnderstanding team and team building is essential inquality improvement since all quality improvementquality improvement since all quality improvementactivities require team work.activities require team work.

Appreciation of effective team work would enhance Appreciation of effective team work would enhance


,,but also getting the task done in a harmonious andbut also getting the task done in a harmonious andenjoyable environment.enjoyable environment.

Conflict in a team can be healthyConflict in a team can be healthy. Appreciating the. Appreciating thevalue of conflict and how to recognise it wouldvalue of conflict and how to recognise it wouldenhance the team ability to strategically managed it.enhance the team ability to strategically managed it.

59

One determined person can make a

significant difference, but a small

group of determined people can

change the course of history.


Any ???Any ???

60

--- Sonia Johnson

Documents

6 Teambuilding