Use Teams at Your Healthcare Site to Reach Your Goalsbedewy
Are you using groups to guide quality improvement projects at your site? Are you a part of a QI group? I can hardly imagine how any quality improvement project can succeed without the involvement of a good team. One or two people cannot possibly direct and design quality projects. Attempting to do so means many good ideas will be lost. For instance, if a project is to eliminate waste in billing in a primary care office and only the coding personnel and office director are involved, then possible solutions from the physician who sees the patient, the staff person who collects the form from the physician and makes appointments and the accountant are lost.
How are teams created? That depends upon the worksite and how business is managed at the site. A primary care site with a strong business leader might have all teams formed by that leader with input from personnel. A site with a large staff might have several different managers responsible for forming teams. For situations where there is a strong leader forming teams to work there must be a sense among the staff that the leader seriously listens to suggestions about forming teams to achieve goals important to the staff. That is, for teams to work successfully, the formation of teams must be rooted in input from the staff.
It is not necessary to have a leader forming QI teams at a site, though. In a recent Wall Street Journal an article described team formation at ICU Medical Inc. in California. The employees there are urged to form their own teams to solve problems that they identify. That is, any person may initiate the formation of a team to solve a problem. There are a few rules that any team must follow, though. Teams must elect a leader who is responsible for keeping the team on task and serving the needs of the team. There must be a clear goal with a timeline for achieving the goal. The CEO of the company does reserve the right to overrule the goals set for a team if he thinks it will hurt the bottom line, but he has not done so yet. An example of one successful team there was one that took 6 months to redesign the shuttling of parts by forklift; it saved the company $500,000 in one year. Further, being a team member at ICU does not excuse one from accomplishing one’s work. Such teams typically meet once a week until the goal is achieved. The company rewards accomplishments of teams with bonuses from a fund replenished each quarter.
From these two examples you can see that there are various ways to form teams-strong leader formation, staff initiated teams, or some blend of the two. Team formation varies from site to site, fitting the culture and needs of the site.
Teams need not be formed just to solve one problem, either. Some teams are long term and focus on multiple goals. For instance, a QI team at a hospital might have as a primary broad goal the elimination of waste in delivering care on a ward. This is a complex goal and will require many projects. One project, for example, might be efficiently delivering the right medication to the ward at the right time from the hospital pharmacy so that the patient gets the right medication at the right time. Another example of long term teams is a team meeting in a morning huddle at a primary care office to discuss the patients that will be seen that day, so that operations will run smoothly. Such a team will exist as long as it is successful at meeting its daily goal. I am on a team presently whose goal is to devise a model for delivering care to patients with a chronic illness using the Wagner Chronic Care Model combined with the principles of Lean quality improvement. The team is scheduled to meet over three years; the progress and work of the team is defined by milestones set by the leaders of the team.
Teams evolve over time, as the culture of quality improvement matures at a site. If your site is just beginning to use groups to solve problems and improve quality, expect some roadblocks. You might find that some members of the group seem to monopolize the time and others are very quiet, barely contributing. This is where a good team leader can make a difference. If the team has been put together well-there is diverse representation of all the staff who have a stake in solving the problem-then a good leader can help all feel comfortable contributing, making sure each member’s voice is heard and recognized as important. During the first year of team formation at ICU Medical, teams seemed aimless and did not achieve much, as there were no rules for group work and engagement. Teams became functional when a few rules were developed:
–each team must have an elected leader
–challenge the issue not the person
–goals must be well defined
These few rules helped the company move forward with its projects of meeting customer needs. This was not the end of team development, however. Eventually, a team was formed to develop a handbook for directing team formation and work. The result was a 25-page book that describes the smooth function of all teams at ICU Medical.
This example is not meant to imply that all sites will follow this same path. I believe that a simple book guiding teamwork and functioning is very useful; as personnel change at a site the gains of teamwork are maintained by such a book. The rules of team function can be different from site to site. In fact, the rules in the guide can change over time too. The guide should fit the culture of the site. To achieve this good fit, it should be developed and edited by a group of representatives of each job skills at a site.
I hope that I have demonstrated the necessity of teams to achieve quality goals and how such teams work. The surprising fact is that there are many varieties of good teams. Teams are formed in a variety of ways and function best when following rules designed at a given site. A team may be formed to solve one problem and dissolve when it completes its task or a team may have a complex task made up of well-defined milestones and thus have a long life.
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