Building a Team A Core Leadership Attribute Seminar on Team Building

1. Building a Team A Core Leadership Attribute Seminar on Team Building Created By: Andrew Jagoda, MD, FACEP Professor and Chair, Department of Emergency Medicine Mount Sinai Medical Center, New York, NY Tenet Editor: Britney Anderson, MD Associate Director, Denver Health Residency in Emergency Medicine University of Colorado School of Medicine

2. Importance of Teamwork Key Terms Creating a Team Achieving Teamwork Maintaining a Team Pitfalls Teamwork Training Outline

3. Importance of Teamwork Teamwork is the ability to work together toward a common vision. The ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results. - Andrew Carnegie

4. Importance of Teamwork To Err is Human: Building a safer health care system. Findings: Preventable medical errors are due to poor teamwork Effective teamwork can improve patient care and reduce burnout - IOM Report, 1999

5. Importance of Teamwork • Culture and the Courage to Change • Organizational culture is as important as organizational strategy • Calls for a redirection of the medical culture to focus on collaboration, shared accountability, and team performance - AAMC President’s Address, 2007

6. Importance of Teamwork The key to the success of an emergency department lies in its ability to integrate into the overall ‘persona’ of a hospital

7. DEFINITION Key Terms- The Team • A group of individuals who might not be equal in their skills, training, backgrounds but who are equal in their commitment to achieving a common goal

8. Key Terms- Teamwork The process of people working together to achieve a common goal Being part of the "team" entails providing assistance and support to one another; thereby striving for a work environment that promotes productivity and efficiency, as well as improving team morale DEFINITION

9. Thomas Edison, when asked why he had 21 assistants, replied… ‘If I could solve all of the problems myself, I would.’

10. Teams- Examples • The Emergency Department • Departmental Leadership • Residency Leadership • Education Committees • ED Crowding Task Forces • Quality Assurance Committees

11. Creating a Team- The basics • The Charge (Mission & Goals) • The Members • Leader • Stakeholders • ‘Skill-holders’ • The Rules

12. Creating a Team- The Initial Steps • Establish a mission statement • Develop clear goals • Identify members with clear roles • Establish values

13. Creating a Team- The Ongoing Process • Empower through training • Nurture trust & respect • Foster Communication • Nurture Growth

14. E G Creating a Team- E.g., The Departmental Team • Mission • Provide safe, efficient quality care • Goals • Provide a caring environment • Recognize and stabilize emergent conditions • Identify clear roles • Techs obtain EKGs • RNs place IVs and give meds, etc • Establish values • Respect, communication

15. E G Creating a Team- E.g., The Departmental Team • Empower through training • Workshops, simulation • Nurture trust & respect • Recognition, awards • Foster communication • Newsletters, email updates • Nurture growth • Consistent and timely feedback

16. Creating a Team- Team Members • Team members must compliment themselves with the various competencies needed to do the job • Knowledge • Skills • Attitude

17. Creating a Team- Team Members You can not build a great team without great players - John Maxwell

18. Adaptable Collaborative Committed Communicative Competent Dependable Disciplined Enlarging Enthusiastic Intentional Mission Conscious Prepared Relational Self improving Selfless Solution Oriented Tenacious Creating a Team- Essential Qualities of a Team Player *Maxwell J. The 17 essential qualities of a team player. Maxwell Motivation Inc 2002.

19. Achieving Teamwork- Core Concepts Together Everyone Achieves More

20. Achieving Teamwork- Core Concepts • Every team member must: • Know the mission of those they represent • Acknowledge the goals of others on the team • Appreciate their role on the team • Respect that others belong on the team

21. Achieving Teamwork- Core Concepts • Every team needs a leader • Every leader needs a team • Communication and respect define both the leader’s and the team’s success

22. Achieving Teamwork- Core Concepts • When you think of your role on a team, which bird do you identify with? • Eagle • Goose • Peacock www.farmbankproject.com/geese_teamwork.htm

23. Achieving Teamwork- Core Concepts • Eagles • Soar high • Brave • Aggressive • Live alone • Die alone www.farmbankproject.com/geese_teamwork.htm

24. Achieving Teamwork- Core Concepts • Geese • Born team workers • Live together • Support each other www.farmbankproject.com/geese_teamwork.htm

25. Achieving Teamwork- Core Concepts • Peacocks • Are just for show… www.farmbankproject.com/geese_teamwork.htm

26. Achieving Teamwork- Core Concepts • Lessons learned from geese • Each goose flaps its wings, creates an "uplift" for the birds following. By flying in a "V" formation the flock adds 71% more flying range than if each bird flew alone. www.farmbankproject.com/geese_teamwork.htm

27. Achieving Teamwork- Core Concepts Lessons learned from geese Whenever a goose falls out of formation, it feels the drag and resistance of trying to fly alone and quickly returns to formation to take advantage of the lifting power of the other birds. www.farmbankproject.com/geese_teamwork.htm

28. Achieving Teamwork- Core Concepts • Lessons learned from the geese • When a lead goose gets tired, it rotates back into formation and another goose flies at the point position. • The geese in formation honk from behind to encourage those up front to keep up their speed. www.farmbankproject.com/geese_teamwork.htm

29. Achieving Teamwork- Core Concepts Lessons learned from the geese When a goose gets sick or wounded, two geese drop out of formation with them, to help and provide protection. They stay with this member of the flock until he or she either is able to fly again or dies. Then they launch out with another formation, or to catch up with their flock. www.farmbankproject.com/geese_teamwork.htm

30. Achieving Teamwork- Core Concepts • Socialize to develop trust & respect • Establish team rules • Clarify mission and set goals • Assess resources • Establish individuals roles

31. Achieving Teamwork- Core Concepts • Expect for the teamwork to be assessed/measured • Press Ganey • CMS benchmarks • Tracking medical errors

32. Maintaining a Team • Reassess expectations • Assure accountability • Re-review goals & process • Consistently communicate • Provide constructive feedback • Evaluate team performance • Reward success

33. Maintaining a Team- Preventing Team Conflict • Create a culture of trust • Delegate authority • Stay focused • Reach compromise

34. Pitfalls of Teamwork- Things to avoid • Letting one person or group dominate • Ignoring those who do not speak up • Mistaking silence for consent • Embarrassing group members • Letting tangential discussion distract the team from its goals

35. Pitfalls of Teamwork- Why Teams Fail • Team Dynamics • Poor Communication • Personality clashes • Competing priorities and goals • Team Structure • Poor coordination of activities • Poor accountability • Inflexibility with conflicting goals

36. Pitfalls of Teamwork- Five Characteristics of a Dysfunctional Team • Absence of trust • Fear of conflict • Lack of commitment • Avoidance of accountability • Inattention to results *Lencioni P. The five dynsfunctions of a team. San Francisco. Jossey-Bass 2002

37. Pitfalls of Teamwork- Special Attention • Complex Teams • Created to solve complex problems • Success requires strong leadership with clear goals • Highest risk for failure • Complex teams are LESS LIKELY to: • Share knowledge • Shift workloads • Meet deadlines • View their goals as compatible

38. E G Teamwork- E.g., ED Crowding • In the crowding crisis, who are the leaders in your department or hospital in finding solutions? • If you were put in charge of solving this crisis, who would you put on your team?

39. E G Teamwork- E.g., ED Crowding Team • What would the overall mission be? • What would be the goals of your team? • E.g., Input, throughput, patient satisfaction, OR throughput, hospital length of stay, billings • Who should be on the team? • Would it be a complex team?

40. E G Teamwork- E.g., ED Crowding Team • Would all team members (i.e., pre-hospital, ED, and hospital members) share the same goals? • Is there potential for conflicting goal? • Challenges: • Input: EMS, triage, registration • Throughput: evaluations / diagnostic testing • Output: discharge / admission

41. Teamwork Training • Teamwork needs to be taught • IOM Report: To Err is Human • ACGME Core Competencies • AAMC Medical School Objectives Project • The Joint Commission patient safety plan • Research is needed Lerner. Teaching teamwork in medical education. Mount Sinai J Med 2009; 76:318-329

42. Teamwork Training - Simulation • Standardized training experiences • Requires debriefing • Commercial aviation experience • Communication failure involved in most accidents • Crew resource management programs (CRM) Sundar. Crew resource management. Anesthesiol Clin 2007:283-300

43. E G Teamwork Training- E.g., Team dimensional training (TDT) • TDT • Developed by the Navy • Provides a common framework for instructors to teach and improve team performance. • Lowers repeat mistakes • Reduces errors • Increase participation • Increase learning

44. E G Teamwork Training- E.g., Team dimensional training (TDT) • Four dimensions • Information exchange • Communication • Supporting behavior • Initiative / leadership • Provides a structural approach to diagnosing and correcting performance problems

45. Team Success • Start with strong leadership and a shared vision • Create a sense of community – one of recognition, helping, sharing • Emphasize communication and conflict resolution • Seek team leaders that are both task and relationship oriented

46. Summary • Teamwork is essential to quality healthcare • A culture of teamwork must be woven into the fabric of the organization • Teams must understand their mission and goals • Teamwork requires communication and respect • Everyone wins with effective teamwork; everyone loses when it does not exist

47. Suggested Readings • Acona D. X-teams: How to build teams that lead, innovate, and succeeed. Boston: Harvard Business School Press, 2007 • Diamond L. Teambuildng that gets results. Soucebook Inc. 2007 • Grigsby R. Faculty and staff teams: A tool for unifying the academic health center and improving mission performance. Acad Med 2006: 81: 688-695. • Guttman H. Great business teams. John Wiley and Sons 2008. • Katzenbach J. The discipline of teams. Harv Bus Rev 1993; 71: 111-120.

48. Suggested Readings Kirch D. et al. Reinventing the academic health center. Acad Med 2005: 80: 980-989. Kohn et al. To err is human. Institute of Medicine. Washington D.C. National Academy Press; 1999 Lencioni P. The five dynsfunctions of a team. San Francisco. Jossey-Bass 2002. Maxwell J. The 17 essential qualities of a team player. Maxwell Motivation Inc 2002. www.aamc.org/meetings/annual/2007/highlights/president.htm

49. National Residency Leadership CurriculumQuestions? ?

50. National Residency Leadership CurriculumSpecial Thanks! Funded By: An American College of Emergency Physicians Chapter Grant Endorsed By: American College of Emergency Physicians Emergency Medicine Council of Residency Directors Emergency Medicine Resident’s Association Society for Academic Emergency Medicine