October 2015
The Quality Improvement ProjectMODULE 5: TEAM WORK AND MAKING CHANGE
October 2015
Objectives
1. Explore teams and team function in QI and how this can make a difference in the success of your QI project
2. Explore change management concepts and how these apply to QI
October 2015
SUCCESS IN QI IS STRONGLY RELATED TO TEAM FUNCTION!
October 2015
Who is on a QI Project team? 5-8 people generally (not too big, not too small)
Project sponsor (senior person in your clinic) Content expert (often the facilitator of the team) Champions of your idea People involved in all parts of the process Data support Skeptics (better to know what the resistance will be) Someone knowledgeable about QI/Change Patients
October 2015
Facilitator and Team Member Roles
Facilitator should set out in advance with your QI team what the expectations are
Be aware for team members who are displaying “self-oriented” behaviours that can be destructive
October 2015
Team Member Task Oriented Behaviours
Facilitator Task Oriented
Behaviours
Team Member Relationship
Oriented Behaviours
Facilitator Relationship
Oriented Behaviours
Self Oriented Behaviours
Provide information
Ask for clarification
Bring discussion back to purpose
Collect and analyze data
Summarize what has been said
Ask clarification questions
Suggest alternative ideas or solutions
Record PDSA plans on worksheets
Set agenda
Honour timelines
Define the work (Charter)
Provide data
Teach & use QI tools
Set up work groups and plans for between meetings
Summarize
Facilitate team consensus
Use PDSA worksheets
Offer encouragement and positive feedback to other members
Listen – one voice at a time
Indicate agreement – voice, nod, smile
Ask open ended/ exploratory questions
Check with the team for agreement
Design warm ups that help team to know each other
Establish ground rulesWrite on flip chart so all can see
Use parking lot – and come back to it!
Ensure opportunities for all to contribute/ participate
Use active listening
Make sure members are heard by team
Give positive recognition
Acknowledge feelings of frustration or anxiety
Celebrate successes Provide treats!
Side conversations
“Talking over” others
Multi-tasking
Negative body language (eye rolling, crossed arms, move away from table, shake head)
Not participating
Bringing up the same issue repeatedly; stalling the team discussion
Arriving late
October 2015
The teams for the QI project
You (the residents) are the leaders of the team For the QI Project you must demonstrate that you have consulted
with at least two other staff members (and not just physicians) You should try to meet them face to face Consider having an agenda and objectives for the meeting This is NOT about blaming anyone for the gap you found Thank them for their time Keep them informed
October 2015
Sample Agenda for a resident meeting with clinic staff
Meeting to discuss Practice Improvement projectDecember 1, 2014, 12-1pm in conference roomInvited: Resident 1, Resident 2, Clerk 1, Nurse 1
Objective for the meeting: To gain input from team members in the FHT to help us complete our Practice Improvement project on the topic of FOBT screening
1. Introductions (who are you, why you called the meeting, everyone introduces themselves)2. Approval of agenda (ask for input/changes/questions)3. Approval of minutes (from past meeting)4. Presentation of practice audit results (Resident X will lead, 10 min)5. Root cause analysis using process mapping exercize (Resident Y to lead, 15 min)6. Discussion about next steps (Resident 1 to lead, 5 min)7. Next meeting (if required)
October 2015
Role play a meetingGroups of 4+ residents
Assign roles: Resident (Chairs meeting)NurseClerkAnother doctorOthers… (patient, allied health, executive director, lab tech)
Resident should introduce your practice gap and tell them that you are seeking to understand root causes of that gap.
Feel free to use the tools your previously learned: 5 Whys, Cause and Effect diagram/Fishbone, Process Map or other brainstorming techniques
October 2015
Debrief…
Was it a successful meeting?
Did you feel it was easy to explain your project goals and get input?
Who was missing from the meeting?
What would be the next step you would take?
October 2015
Making change
October 2015
Making Change
Expect resistance to your idea
You need to be the constant champion for the change you want to make
Some people are early adopters, some are laggards, some are in between
Physicians can be particularly resistant to change
October 2015
Making Change: Key elements for change
Beckhard Change Model C = D x V x F > X
C = changeD = desire for changeV = vision for the futureF = practical first stepsX = cost of change
October 2015
Goals of patient care more pressing than system problems Inbuilt sense of autonomy, “lone healer” so may want to solve the problem on their own Critical thinkers (look for negative) and need certainty so can shoot down ideas MDs more accepting of “technical” change but less so “adaptive” change (more on this…) so can shy away from complex solutions
Hussey, R et al. (2013) NHS Improving Healthcare White Papers. Doctors: leaders of change
Barriers to MDs making change
October 2015
Technical vs Adaptive Change – QI is a bit of both
TECHNICAL CHANGE Uses knowledge that has been
proven/tested
Implemented by “authority”
Simple
ADAPTIVE CHANGE Learn new ways of doing, experiment
Implemented by the people with the problem
Complex, takes time, can be stressful
October 2015
Reflection on making change
Think about a time that you went through a change in an organization or team that you were a part of
What made the change process go well?
What made it more difficult?
How can you apply these lessons to making change with your QI idea?