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Introduction to healthcare quality management pdf

28/10/2021 Client: muhammad11 Deadline: 2 Day

1 7 5

L e a r n i n g O b j e c t i v e s

C H A P T E R 7

I M P R O V E M E N T P R O J E C T T E A M S

After reading this chapter, you will be able to

➤ explain the role of improvement project participants,

➤ discuss the purpose of a team charter,

➤ recognize beneficial and disruptive team behaviors,

➤ apply leadership skills to manage team meetings effectively,

➤ describe the stages of team development, and

➤ identify strategies for preventing improvement project failures.

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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➤ Charter

➤ Facilitator

➤ Ground rules

➤ Independents

➤ Inputs

➤ Leadership

➤ Outputs

➤ Problem statement

➤ Process owners

➤ Sponsor

I f improvement models are the recipe and if improvement tools are the ingredients, where does the improvement team fit into this analogy? When I bake a cake, I work alone; I do not need a group of people to help me. I could not work alone, however, if I had to

prepare a banquet for 50 guests. I would need a team of people to help cook the meal. The more complex the process—whether cooking or improving health services quality—the greater is the need for teamwork. When improvement opportunities are identified, a group of people known as an improvement team is assembled. By following an improvement model and using improvement tools, the team works together to accomplish improvement goals. This team’s success hinges on effective project management.

A formal team need not be assembled for every improvement opportunity. The case study at the beginning of chapter 3 describes an initiative to reduce patient wait times at the Redwood Health Center. The clinic manager did most of the work for this project. He gathered data on how long patients waited to be seen by a clinician, shared those data with other people in the clinic, and informally discussed ways of reducing wait times. An improvement team was not formed for the project. Likewise, for the improvement initia- tive involving patient identification wristbands at Community Hospital in chapter 4, a project team was not formed to resolve the problems people were having with the bands. After collecting information about band defects, the manager fixed the problem on her own. The case study discussing Sunrise Home Health Agency at the beginning of chapter 5 is yet another example of an informal initiative. The director and clinical staff members used regular staff meetings to revise the meeting process.

Some performance problems cannot (and should not) be solved individually or informally and require the attention of a dedicated improvement project team that includes several people familiar with the systems and processes that need to be changed. A project team should be created when the improvement goal is more likely to be achieved through the

K e y w o r d S

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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C h a p t e r 7 : I m p r o v e m e n t P r o j e c t T e a m s 1 7 7

coordinated efforts of people with varying knowledge, skills, and perspectives. The greatest improvement potential lies in problems that involve different professions and departments. The team’s role is to analyze and eliminate undesirable, unpredictable, or unworkable per- formance situations. Once the improvement project is complete, the team is disbanded.

People at all levels in the organization may be part of an improvement project team. Because projects generally take employees away from their primary work responsibilities, time spent on an improvement initiative had better produce measurable performance gains. This chapter describes ways to increase the likelihood that formal improvement projects will be successful.

pr o j e C t pa rt i C i pa n t S When the best approach to an improvement opportunity is a formal project, a team of people is chosen to fill the following roles:

◆ Sponsor

◆ Team leader

◆ Facilitator

◆ Recorder

◆ Timekeeper

◆ Team members

These roles are summarized in exhibit 7.1. Although the roles may vary, at a mini- mum each project has a sponsor, a team leader, and team members. Involvement of the other roles depends on the organization’s resources and the scope of the project.

S p o n S o r

The project sponsor is the individual or group that decides to initiate an improvement project. If the improvement project involves more than one department, a leadership rep- resentative or a quality oversight committee should sponsor the project. (The role of quality oversight committees is covered in chapter 12.) If the project affects activities in only one department or unit, the manager of that area usually serves as the sponsor.

The sponsor clearly defines the performance problem that needs to be solved by writing a problem statement—a description of the situation. The problem statement, sometimes called the aim statement, influences many aspects of the project, including the makeup of the team and the improvement expectations. In addition, a clearly communicated

Sponsor

An individual or a

group that supports,

guides, and mentors an

improvement project

team; serves as a link

to the organization’s

leadership; removes

barriers; and acquires

the resources a team

needs to achieve

successful outcomes.

Leadership

An organization’s

senior leaders or

decision makers.

Problem statement

A description of the

performance problem

that needs to be

solved. Sometimes

called the aim

statement.

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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problem statement establishes project boundaries so that problem-solving activities do not escalate into larger issues or wander into unrelated topics.

The project goal should include measurable improvement expectations. For instance, the manager at Community Hospital hoped to achieve an 80 percent reduction in staff complaints about patient identification bands by making some process changes. The proj- ect sponsor sets these expectations and defines the time frame for achieving them. An explicit project goal with clearly stated, measurable expectations and time frames focuses the improvement efforts.

Once the goal is clear, the sponsor identifies people who need to be included in the project. If the sponsor already has someone in mind to serve as the team leader, that person may help the sponsor select these key people. The following questions can guide their selection:

◆ Where is the problem occurring?

◆ What tasks are involved?

◆ Who carries out these tasks?

Project Participant Role

Sponsor Charters the improvement team, provides initial improvement goals, monitors team progress, and supports the team

Team leader Coordinates project assignments and communication with external parties, removes barriers, and keeps the project on track

Facilitator Helps manage discussions about the process during team meetings, usually by asking questions (e.g., How do we want to make this decision? What points can we agree on?)

Recorder Captures ideas, decisions, action items, and assignments on a flip chart or whiteboard for later transcription into a written summary of the project

Timekeeper Keeps track of time during project meetings

Team member Participates in discussions, decision-making, and other team tasks such as gathering data, analyzing information, assisting with documentation, and sharing results

exhibit 7.1 Roles of

Improvement Project Participants

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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C h a p t e r 7 : I m p r o v e m e n t P r o j e c t T e a m s 1 7 9

◆ Who determines how the tasks should be done?

◆ Who provides the inputs to these tasks?

◆ Who uses the outputs of these tasks?

The people chosen for the team should possess detailed knowledge gained through experience with some part of the performance problem. They also must be willing and able to attend team meetings and make time for project work that may need to be done between meetings. Once the project is under way, the team may ask additional members to participate if critical expertise is needed or a key group is not represented. The team should be capped at five to ten members. To keep the team from expanding beyond the preferred size, some individuals may serve as consultants and attend meetings only when their expertise is needed.

In an ideal project initiation, the sponsor creates a written charter incorporating all the aforementioned elements: the project goal, a description of the system or process to be improved, the time frame for project completion, deliverables, measures, project scope, and team members. Exhibit 7.2 is a charter for a project aimed at improving the employee hiring process in a county-operated emergency medical service (ambulance) company.

When expectations are unclear or too broad, an improvement project can flounder. At one hospital, for example, staff members voiced concerns about the safety of the process of ordering, dispensing, and administering chemotherapy medications. An interdisciplinary team was chartered, which included representatives from the hospital’s inpatient, outpatient, adult, and pediatric areas (physicians, nurses, pharmacists, and laboratory staff). Over a four- month period, the team developed a top-down flowchart of the process, which ultimately was diagrammed as 21 steps, each with multiple substeps. On review, the team realized the enormity of the project and discovered that each area had its own way of executing tasks. The charter the team developed at the outset of the project was too broad and was stalling the project. The team decided it would address only the adult outpatient population and limited the project to the medication administration phase, where most of the problems were occurring. Once the project scope and focus were better defined, the improvement initiative proceeded more quickly.

Charters keep teams focused and on track during projects. Team members may want to revisit the charter periodically to remind themselves of the project’s boundaries and the objectives of the improvement effort. If the team receives new information during the project or if situations change, it may need to renegotiate its objectives or boundaries.

The sponsor supports the team throughout the project, monitoring progress and clearing obstacles that may arise. The sponsor acts as a sounding board for improvement ideas but does not become overly involved in the details of the team’s work. At the end of the project, the sponsor reviews the team’s improvement actions and ensures the solutions are effectively implemented.

Inputs

Products, services, or

information flowing

into a process.

Outputs

Products, services, or

information flowing out

of a process.

Charter

A written declaration of

an improvement team’s

purpose. (An example

of an improvement

project charter is found

in exhibit 7.2.)

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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Problem Statement • During the last fiscal year, 342 applications were received for paramedic

or emergency medical technician (EMT) vacancies. In this same period, 49 applicants—14%—were hired and eventually began employment with Grant County Emergency Medical Services (EMS).

• The current hiring process for EMTs and paramedics averages 87 days with a range of 7 to 212 days from time of application.

• As of February, EMS operations are understaffed by 17% (47 vacancies for EMTs and paramedics).

• Understaffing causes an increase in EMS operational overtime, idle time during field training, and system and administrative workload.

Goal A 5% or less vacancy rate for EMTs and paramedics

Project Scope Individuals who apply for a paramedic or EMT position with Grant County EMS

Out-of-Project Scope • Existing paramedic or EMT employees who are promoted or return to full-time

status • Vacancies for other positions

Measures • Current vacancies • Current overtime standby utilization • Hiring process intervals (in days) and

cost

• Applicants (count) • Applicant status (percentage of overall

applicants) • Range of application date to start date

Deliverables Within 6 months: • Increase the hire rate of qualified applicants from 14% to 30%. • Reduce annualized cost of EMS overtime and standby time to less than $280,000. • Reduce cost per new hire (recruiting, advertising, and assessing) to no more than

$300.

Sponsor Robert Jones, Director, Public Safety

Team Leader Larry McNeill, Deputy Chief, EMS Training

Team Members • Jackie Gregory, Administrative Services • Todd O’Brien, Human Resources • Michael Fine, EMT • Gary Young, Paramedic

Team Facilitator Sally Steward, Manager, Information Services

exhibit 7.2 Charter for

Improvement Project

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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t e a m l e a d e r

The team leader organizes the project, chairs team discussions, keeps the project focused on the improvement goal, establishes the meeting schedule, and serves as a liaison between the team and the sponsor. Often, team leaders are process owners—supervisors, manag- ers, or physicians in the work area most affected by the improvement project. The leader is considered a member of the team.

The team leader should be familiar with the improvement model to be used during the project and various improvement tools. She should also be skilled at managing group interactions and running a project. Some organiza- tions assign a quality resource advisor to interde- partmental improvement projects. This person is familiar with performance improvement principles and serves as an internal consultant. The quality resource advisor helps the team understand the purpose of the project, the desired results, and team roles and responsibilities. When there is no quality advisor assigned to the project, the team leader takes on these responsibilities.

f a C i l i tat o r

The facilitator supports the team leader. The facilitator assists with team-building activities, keeps meeting discussions and the entire project on track, and ensures deadlines are met. The facili- tator should be an objective team resource and detached from the process being improved. As a neutral party, the facilitator is particularly effective at engaging everyone on the team and helping the group reach consensus on controversial issues.

The facilitator works with the leader to plan meetings, structure tasks and assign- ments, and incorporate quality improvement tools into the project. The facilitator knows what data to gather, how to gather the data, and how to present the results in a meaningful graphic or tabular form.

In cases where the project is not overly complex, one person may assume the dual role of team leader and facilitator. Research suggests, however, that multifaceted healthcare improvement projects involving several departments and professions benefit from having a facilitator who is not also responsible for leading the project (Agency for Healthcare Research and Quality 2013).

Process owners

Individuals ultimately

responsible for a

process, including

its performance and

outcomes.

Facilitator

An individual

knowledgeable about

group processes and

team interaction as

well as performance

improvement principles

and techniques.

DID YOU KNOW??

A team leader’s abilities and characteristics influence the out-

come of an improvement initiative. Studies have demonstrated

the importance of the following characteristics of a team leader

(Turner and Müller 2005):

• Problem-solving ability

• Perspective

• Results orientation

• Communication skills

• Energy and initiative

• Negotiation skills

• Self-confidence

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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r e C o r d e r

The recorder, or notetaker, documents activities throughout the project. This position is usually assigned to one or more team members. During meetings, recorders are responsible for writing the team’s ideas, decisions, and recommendations on a flip chart or whiteboard. Recorders also create meeting minutes and distribute them to team members before the next meeting. The team uses the minutes to recall previous ideas, decisions, the rationales behind the decisions, actions to be taken, the people responsible for executing those actions, and the schedule according to which those actions will be carried out.

t i m e K e e p e r

The timekeeper keeps the team on track during meetings. If the time allotted for a discus- sion point is exceeded, the timekeeper alerts the group. The team then decides whether to accelerate the discussion, defer the item to another meeting, or end the discussion. In some cases, the leader functions as the timekeeper, or this role may be assigned to the facilitator or another team member.

t e a m m e m b e r S

Team members share responsibility for achieving the improvement goal. Members participate in discussions, decision-making, and other team tasks such as data collection. Each team mem- ber should represent a program, department, or work unit significantly affected by the process to be improved or the problem to be solved. Ideally, team members should have a basic understanding of quality improvement principles, but familiar- ity with this topic is not a prerequisite for team membership.

Inclusion of one or two independents— members with little or no knowledge of the

process—can also be useful. Because independents have no vested interest in the prob- lem, they may provide a fresh and creative perspective. Some healthcare improvement projects also benefit from customer input. For example, if a hospital team is working to improve security in the maternity ward, a woman who recently delivered a baby in the facility can be included as a team member. The recent patient may be made a permanent member of the team or serve part time by attending meetings only when her input is needed.

Independents

Improvement team

members who have

little or no knowledge

of the process under

consideration and have

no vested interest in

the outcome of the

project.

LEARNING POINT Project Participants*

An improvement project involves several roles. At a minimum,

each project includes a sponsor, a team leader, and team

members.

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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te a m me e t i n g S At the first meeting, the team leader uses the project charter to introduce and explain the project goal and scope. He should discuss the charter openly to prevent misunderstandings. Any confusion or disagreement should be resolved at the first meeting.

The team leader also provides an overview of the project timeline at the first meet- ing. Exhibit 7.3 is a Gantt chart showing the approximate start and finish times for the steps of an improvement project.

The first meeting also is a good time to set ground rules for team conduct— directives stating how team members are expected to communicate in meetings, make decisions, resolve conflicts, and so forth. Critical concept 7.1 lists examples of improvement team ground rules. Teams usually adopt only a few key ground rules; however, project improve- ment best practices do not limit the number (Barner and Barner 2012).

Ground rules

Established

guidelines for how an

improvement team

wants to operate;

norms for behavior.

(Examples of ground

rules are found in

critical concept 7.1.)

exhibit 7.3 Gantt Chart for an Improvement Project

March April May June July August September October

Develop project charter

Appoint improvement team

Kick off project— first team meeting

Analyze current practices

Gather performance data

Identify improvement opportunities— second meeting

Solicit solution ideas from colleagues

Finalize solutions— third meeting

Implement solutions on a trial basis

Evaluate the effect of solutions— fourth meeting

Roll out successful solutions

Redesign ineffective solutions— fifth meeting

Evaluation Criteria

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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CRITICAL CONCEPT 7.1 Improvement Team Ground Rules!

• Participate by sharing your own opinions and experiences.

• Contribute but do not dominate.

• Actively listen to and consider the opinions of others.

• Stay focused on the improvement goal.

• Avoid side conversations.

• Respect other people’s time (e.g., arrive on time, do not leave early, return from

breaks promptly).

• Complete assignments to which you have committed.

• Speak one at a time.

• Leave rank at the door; all team members are equal.

• Address conflict by dealing with the issue, not the person.

• Turn off cell phones and other mobile devices.

• Be a participant, not a lurker.

• Have fun, but not at the expense of someone else’s feelings.

• Be physically and mentally present during meetings.

• Listen, listen, listen, and respond.

• Allow for some mistakes; acknowledge them, let go, and move on.

• Accept conflict and its resolution as necessary catalysts for learning.

• Be open-minded to new thoughts and different behaviors.

• Honor confidentiality.

• Accept diversity as a gift.

• Begin and end all meetings on time.

• Share in the responsibilities of the recorder.

• Criticize ideas, not individuals.

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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Some organizations have a core set of ground rules for all improvement projects. From this set, teams are usually allowed to select the rules they wish to observe. If the organization has no such set of rules, the leader solicits ideas from the team members by asking them to describe acceptable team behaviors. When the list is finalized and everyone understands the ground rules, members individually acknowledge that they agree to abide by the group behaviors. Posting the rules on a large sheet of paper in the meeting room is an effective way to remind group members of the rules they agreed to follow.

i m p r o v e m e n t p r o j e C t l e n g t h

The time needed to complete an improvement project varies. Some projects are elephant- sized, and some are bite-sized. Exhibit 7.4 is a timeline for completing a project involving hospital signage. At this hospital, patients occasionally have difficulty finding the outpa- tient testing departments. Although signs are posted to lead the way, patients may not be able to read the signs or the signs may be unclear. The director of the patient registration department brought this concern to the attention of the chief operating officer, who then sponsored a project to resolve the problem.

Not all projects are completed quickly. A project team at the University of Wisconsin Hospital and Clinics was formed for the purpose of improving the use of intravenous pumps to deliver patient medications (Tosha et al. 2006). The 22-member team included represen- tatives from anesthesiology, biomedical engineering central supply, industrial engineering, internal medicine, nursing, and pharmacy. The team met for 46 hours over four-and-a-half months to describe the process, identify improvement opportunities, and design solutions, and then it took additional time to implement the solutions (Tosha et al. 2006).

Whether the project is long or short, the team should meet regularly; otherwise, enthusiasm for achieving the improvement goal diminishes. The project sponsor must stay informed of the progress of the initiative and intervene when progress is moving too slowly.

t h e l e a d e r ’ S r e S p o n S i b i l i t i e S

The team leader manages project meetings. This responsibility involves activities that ensure meetings are well run, including

◆ preparing the meeting agenda and distributing it at least one day in advance,

◆ keeping the meeting focused on the agenda,

◆ encouraging participation by all team members,

◆ fostering an environment in which team members feel safe expressing their ideas, and

◆ distributing the last meeting’s minutes before the next meeting.

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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Timeline Activities

Week 1 The team meets for two hours to discuss project objectives and set ground rules. The members brainstorm reasons patients might get lost when trying to find outpatient testing departments. To determine whether these assumptions are correct, the members will gather some data over the next seven days. Some members will evaluate the current signs, and other members will interview patients and staff in the testing areas to gain their perspective.

Week 2 The team meets for two hours to review the collected data. In three locations, the signs are not at eye level, making it more difficult for people to see them. People who are having an electrocardiogram (EKG) may not recognize that they need to go to the EKG unit. Five of the interviewed patients have limited English proficiency and cannot read the signs. Several staff members confirm that lack of English proficiency is a major cause of the problem. The team comes up with three solutions:

1. Place all signs at eye level. 2. Describe outpatient departments and testing areas in terms that

laypeople can understand. 3. Color code departments/testing areas (lines of the corresponding color

will be painted along the wall to lead patients to the different areas).

The team drafts an implementation plan for each of these solutions.

Weeks 3–7 • Team members identify signs using terminology that laypeople may not understand. New signs with patient-friendly terminology are manufactured.

• Maintenance staff move existing signs to eye level and hang all new signs at eye level.

• Colors are assigned to each testing area. Maintenance staff paint lines of the corresponding color along the walls leading from the registration area to the various departments.

The team leader monitors the activities to ensure the solutions are implemented as expected.

Week 8 The team meets for one hour to discuss the solutions’ effectiveness. Members agree to gather information to evaluate the success of the solutions. Some members will evaluate the new signs, and some members will interview staff in the testing areas to gain their perspective.

Week 9 The team meets for one hour to review data collection results. All signs are now at eye level. The director of the patient registration department reports that patients are pleased with the color coding and that no patients are having difficulty finding the outpatient departments. Staff in the testing departments report similar findings. The project is deemed a success.

exhibit 7.4 Timeline for an

Improvement Project

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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The leader’s responsibilities are not glamorous, but leaders keep meetings running smoothly and prevent them from becoming sloppy and unproductive. Without a leader’s guidance and preparation, team members may come to meetings unprepared and fail to follow up on decisions made at prior meetings. Absent a clear agenda, meetings are likely to veer off track. When meetings deteriorate, issues are left unresolved and team mem- bers become frustrated. In their frustration, they may stop showing up for meetings. The responsibility of keeping meetings focused does not rest on the team leader alone, however. All team members must cooperate to ensure successful meeting outcomes.

To minimize disruptions, meetings should flow in an orderly manner and include the follow- ing elements:

◆ A brief overview of the agenda, including the primary objective of the meeting

◆ A short update (no longer than five minutes) on work completed since the last meeting, including a synopsis of any major obstacles encountered

◆ A group assessment of overall progress, including a review of the improvement project timeline

◆ A brief discussion or time for reflection on the team’s functioning as a group

◆ Assignment of action items to be accomplished by the next meeting

If team members talk or have questions about an issue that is not on the agenda, the leader can write the topic on a big piece of paper marked “Issues Bin” or “Parking Lot.” The team can discuss these issues later or defer them to the next meeting. To keep the meeting moving, the leader may need to make arbitrary decisions about parking lot issues. If time allows, the leader can ask the group whether it wants to park the issue or discuss it.

te a m dy n a m i C S Tension always arises between people who come together to accomplish a common goal. For instance, when my relatives plan our annual family reunion, they always disagree on the date, location, or other details. At least one contrarian in the group wants everything her way. My uncle interrupts to voice his opinions. My older sister doesn’t say a word until

LEARNING POINT Effective Meetings*

Strong leadership is essential to a well-functioning improve-

ment project. One of a team leader’s first activities is to help the

group establish ground rules and ensure the team abides by

them. While team meetings are an essential part of the improve-

ment project, meetings that lack focus, drag on, or are unpro-

ductive can be a source of frustration. Not only the leader but all

team members are responsible for keeping meetings on track.

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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2 0 1 8 . H

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. A

ll ri g h ts

r e se

rv e d .

I n t r o d u c t i o n t o H e a l t h c a r e Q u a l i t y M a n a g e m e n t1 8 8

everyone is in agreement. When she finally speaks, she complains about the decision. In the midst of this turmoil, I wonder why we bother to have reunions. In the end, though, they turn out to be lots of fun and worth the effort.

An improvement team is like a family. Each member of the team brings his values, beliefs, and personal agendas to the project. Some people show up at the first meeting thinking they already know what the problem is and how it should be fixed. Some team members are unwilling to express their opinions when a manager or leader is in the room.

Some members want to be sure the improvement solutions will not require too much extra work. These people typically advocate easy-to-implement solutions even though other improvement actions might produce better results. The team leader, assisted by the facilitator, is responsible for man- aging this diverse group of people.

One of the team leader’s greatest chal- lenges is moving the improvement team through the stages of team development. In the 1960s, psychologist B. W. Tuckman (1965) identified four stages that all teams go through to become productive:

1. Forming. The team meets and works together for the first time.

2. Storming. Team members “jockey” for position and struggle for control.

3. Norming. Team members adjust to one another and feel comfortable working together.

4. Performing. The team begins to function as a highly effective, problem-solving group.

Typical team characteristics and the role of the leader at each stage of development are summarized in exhibit 7.5. As mentioned earlier, if a facilitator has been assigned to the team, he will help the leader with team-building and project management responsibilities.

The rapidity of a team’s progression through the four stages depends on the com- position of the team, the capabilities of the team leader and members, and the tasks to be performed. But no team passes through the storming stage quickly. This stage is uncom- fortable, but this discomfort and any conflict experienced are all prerequisites to successful project outcomes. When the leader is not able to help the team work through the storming phase, members are less likely to voice different perspectives. The success of the improve- ment project is jeopardized if team members cannot work as a cohesive group.

LEARNING POINT Team Development*

Improvement teams mature experientially and in stages; des-

ignating a group of individuals to function as a team is only the

first step in team development. Developing a group of people

into a team takes time, commitment, and energy. To achieve

desired outcomes, teams must establish and focus on common

goals ahead of personal needs.

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

C o p yr

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2 0 1 8 . H

e a lth

A d m

in is

tr a tio

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re ss

. A

ll ri g h ts

r e se

rv e d .

C h a p t e r 7 : I m p r o v e m e n t P r o j e c t T e a m s 1 8 9

Stage Team Characteristics Role of Team Leader

Forming

Members are

concerned with

inclusion and

acceptance.

• Interactions are polite and

superficial; open conflict is rare.

• Groupthink (conformity of

opinion) tends to dominate.

• Members rely on the leader for

direction.

• Project goals are not clear.

The leader’s role is primarily

directive. She introduces the team

members to the project and shares

project goals and the timeline for

completion. The leader helps team

members become acquainted

and allows time for them to get

comfortable with one another while

still moving the project along.

Ground rules are established.

Storming

Members want

to be heard and

begin to assert

control.

• Participation increases; members

want to exercise some influence

on the improvement project.

• Groupthink decreases; open

conflict increases.

• Members look more critically at

the improvement process and

question how and why decisions

are made.

• Members may challenge the team

leader directly or indirectly.

The leader clarifies the team’s

role in achieving project goals

and addresses conflicts as they

surface. Ground rules are reviewed

and enforced. The purpose of the

improvement project is revisited.

The leader engages the project

sponsor in resolving conflicts that

cannot be effectively handled within

the team structure.

Norming

Members have

a good under-

standing of the

improvement

process and

want to accom-

plish the project

goals.

• Members are friendlier and more

supportive of one another.

• Ground rules that may have been

overlooked in the beginning are

now taken more seriously.

• Subgroups may be formed to

move the project along more

quickly.

• Conflict is handled openly and

constructively.

The leader encourages members to

spend less time on idea generation

and more time on decision-making.

She keeps the team on track toward

improvement goals and provides

time for discussion and feedback.

Performing

Members are

highly effec-

tive problem

solvers.

• All contributions are recognized

and appreciated.

• Members develop a sense of

cohesiveness and team identity.

• Project goals are achieved.

Members may look for additional

improvement opportunities.

The leader takes a less directive and

more supportive role as members

actively take responsibility for

achieving the improvement goals.

exhibit 7.5 Team Characteristics and the Role of the Team Leader Through the Four Stages of Development

Spath, Patrice. Introduction to Healthcare Quality Management, Third Edition : Third Edition, Health Administration Press, 2018. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/westernkentucky/detail.action?docID=5517319. Created from westernkentucky on 2021-02-15 13:06:57.

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