Am I on an Effective Quality Improvement Team?

By Susan Pohl, MD

Many of us fondly remember the smart, independent physicians portrayed in American television dramas. Dr. Marcus Welby (Marcus Welby, MD), Dr. Hawkeye Pierce (M.A.S.H.) and Dr. Gregory House (House) all seem to be independent spirits who frequently puzzle their partners with their personality and bristle at teamwork. They seem to work best solving clinical puzzles alone, and they thrive in spite of their environments.  They may appreciate the help of their team members, but these characters don’t consistently display the true interdependence of highly functioning medical teams.

Teams of healthcare workers provide clinical care in diverse settings.  Emergency departments, labor and delivery suites, intensive care units, surgical teams, inpatient wards and outpatient clinics are hives of activity for medical teams. These teams can only provide good care when they function well.   Formal team training is now a key piece of professional training for medical students and residents.  There are various training models for clinical team training, and we all seem to know when a clinical team is functioning well.  It is more than medical knowledge that makes a good team.

Are there other types of medical teams?  Residents trained at the University of Utah Family Medicine residency program are a vital part of the multi-disciplinary quality improvement (QI) teams in our clinics.  Our residents join the work of QI teams during their first few weeks of internship to make sure we are providing high value care for our patients. Residents are given a graduated level of responsibility and autonomy on QI teams throughout their residency.  Our third-year residents lead QI teams during their last year of residency. This experience gives our residents the opportunity to apply both QI and leadership skills in a clinic setting prior to their graduation.

One of the most powerful elements of our QI training is promoting team development.  Just like clinical teams, QI teams require care and nurturing. What are the key elements of success for any team?  One framework or tool we use to study QI teams is the Team Development Measure (TDM).  The TDM is a survey tool developed by Peace Health that can be used to measure the functionality of teams.   This tool divides team development into various stages. It is a meaningful, but complex framework for understanding teams.

Although the TDM divides the development of teams into ten stages of growth, I’d like to summarize and simplify these concepts for general use.  Here are some basic concepts in team development that any team can use.  All teams need safety, accountability and creativity to be effective.

Effective teams are safe teams.  Safe teams value each member and their contribution.  Members of safe teams speak honestly and respectfully to each other.  Leaders of safe teams encourage each member to contribute.  Leaders of safe teams ask for opinions and input from the group.  Leaders of safe teams foster the growth of each individual.  Members of safe teams also allow each individual to ask questions and clarify uncertainties.  Safe teams respect the human limitations of its members.

Effective teams are accountable.  Members of effective teams understand their purpose, roles, tools, and goals.  Members of effective teams understand the “who, what, when, where, how and for how long” of their work.   Leaders and members of effective teams must be able to clearly state the scope, goals and process of their work.  Tasks generated by effective teams are clearly defined and delegated.  The members of an effective team hold themselves and each other accountable to agreed- upon tasks and timelines.

Effective teams are creative. Once a culture of safety and accountability is created on a team, the members of an effective team work creatively to solve obstacles in achieving their goals.  Creativity is an important part of QI, and it is a skill best applied when a safe and accountable environment has already been established.   It is the creativity, ingenuity, and contribution of each team member that will ensure success. Members with experience and training are vital to teams as they solve certain clinical or administrative puzzles, but it may be the intern or the young lab technician that can see a problem more creatively. Experience and creativity should both be valued.  As a team works together to solve a problem, they will create better solutions than any one person can describe individually.

How do I know if I am on an effective team?  Ask yourself the following questions. 

  • Do I feel safe on this team?
  • Can I ask for help on this team?
  • Can I ask for clarification?
  • Do I understand my role on this team?
  • Do I understand the scope of this team’s work?
  • Do I understand the goal(s) of the team?
  • Can I contribute creatively to the team?
  • Is my experience valued on this team?

If you cannot answer these questions affirmatively, then ask other team members about their perceptions.  Is there a way to increase safety, accountability or creativity on the team? These qualities can seem mutually exclusive, but effective teams and effective leaders use clear professional communication to ensure that each of these aspects of the team’s work is functioning well. Each team member has a role in creating a culture of safety, accountability and creativity.  Whether you are a designated leader or a member of a team, you have a responsibility to yourself and your team members to ensure that your team functions well.

Pohl

Susan Pohl, MD is an Assistant Clinical Professor in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.

 

 

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