The Common Sense Guide to Improving Palliative Care > 2.3 Establishing a Good Team

Sick To Death book cover This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

Establishing a Good Team

Having the right people on the team—which may mean including people from other areas of your organization—is key to your success. Shortcomings in healthcare processes almost always involve multiple people. Few important changes can be implemented by a single individual; you need a group to make it happen. You probably have colleagues who also see problems and are willing to work to correct them. These are the first few people you should consider to enlist for your team.

Get together with them and forge the commitment to make changes. Describe your ideas about possible aims, and ask for their thoughts on other goals.

Once you have the general goal settled, think about the kinds of expertise the team will need. If you are working on pain, you may need a pharmacist. If you are working on the transfer of advance care plans, you may need admissions clerks. Try to include people whose expertise covers the four areas described below, and you will be on your way to having an effective team. (Remember, however, that one person may play several roles.)

Picture of a person looking puzzled.

What is the Core Team?

The people who meet regularly to go over progress and make action plans are the core team. Other people may help you with some part of the project and they come and go as needed, but the core team stays through the whole effort. Most teams work best with 5-7 core team members.

Why Limit the Number of Team Members?

Everyone is busy, and QI projects require frequent and regular team meetings. With 5-7 team members, the team will be able to include those responsible for enough of the problem while staying small enough to make decisions rapidly. This size group can usually find time to meet regularly and stay in touch with one another. A project that really requires 12 or more on the core team probably should split up the jobs and coordinate efforts.

Organization Leader Invite someone who has enough clout to insist on the changes you want to test and who can help you get the time and resources you will need. For example, bring in the vice president for patient services or the director of palliative medicine. This person may not attend all team meetings, but it really helps to have a leader who understands the importance of the project, can help with personnel or resource issues, and is up-to-date on its progress.

Content Expert Someone on the team has to have the clinical knowledge about your problem area and a thorough understanding of care processes in your system. This person is most likely a clinician who is also a champion for the improvement team. This "clinical champion" can guide the team and also engage other clinicians.

Improvement Expert You need someone with expertise in improvement methods to help the team implement the QI model. Many of the tools and processes of teamwork, measurement, and implementation are applicable across all sorts of improvement activities. This person can be someone from the QI department, if your organization has one. With the help of this book, you, too, will become an improvement expert.

Team Leader This person drives the project on a day-to-day basis. The team leader understands the details of the system and makes sure work is getting done. A nurse manager, pharmacist, or clinical social worker often takes on this role, but background does not matter as much as whether the person is willing to commit to the project and stay with it. Very often, this is the person who makes sure that meetings happen, updates are sent out, and data are collected.

The team leader needs to keep the team motivated and draw on the strength of each team member. To prevent and resolve any conflict that may arise among your team, try the following.

  1. Ensure that members agree on the aim.
  2. Identify areas of agreement within the team regarding its work.
  3. Determine if the differences within the team are actually interfering with its work. If so, then try to resolve those differences.
  4. Decide which issue is most problematic for the team as a whole and discuss alternative ways of accomplishing your goals.
  5. Keep up enthusiasm by getting positive statements from patients and managers back to the team or by pointing out successes.

Everyone on the team should have a clear understanding of who is doing what and then arrive at meetings with their assigned task done. It is good to ask for a commitment from each team member in which they agree to be involved for the duration of the project. Even in environments where there is high staff turnover, role delineation is important. If a team member does leave, the project need not lose steam: Find another person to join, and assume the duties and tasks of the person who has left. For QI teams, the tasks to cover include the following:

Although people tend to shy away from conflict, encourage team members to talk about their concerns. You want everybody to participate, not just those who speak first or loudest. Of course, conflict is unacceptable if it is about personalities. Agree on some ground rules for team behavior, including the following:

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