Pulling the Team Together

Please review the introduction about team members and how to approach to the scope of your efforts. You should review the slide presentation on Quality Improvement Theory in the QI Basics section of the resource room prior to beginning this section. Efforts are often initiated by just a few thoughtful leaders who see a big gap between current practice and the best-known practice and who then recruit others to their cause. Members of each ACS team for each major area of focus should include a team leader, a content expert, a team facilitator, and process owners.

Team Leader

This is usually a physician hospitalist leader, cardiologist, ED physician, or other physician leader. This leader is responsible for calling meetings and communicating directly with administrative and appropriate medical staff committees. If the team leader doesn’t personally take the minutes, he or she should edit their content for presentation to senior leadership and should “own” them. The team leader should be a respected member of the medical staff with some topical expertise in the treatment of ACS. Just as important, the team leader needs to have the commitment and perseverance to drive the entire process forward. This leader should also have at least some experience or a significant interest in gaining experience in affecting quality improvement efforts or the will to learn. There may actually be several leaders, whose involvement will vary as the focus changes. For example, an ED physician may lead efforts to improve the transition of the ACS patient from the ED to the floor, whereas a hospitalist may lead efforts to improve the timely initiation of therapies and communication among the multidisciplinary team on the wards. Alternatively, a cardiologist or other individual may lead the entire effort. In any case, a coordinated effort is required across the entire spectrum of care.

Content Expert

A cardiologist may not always be the team leader and may not always have the time or expertise to lead the effort to improve ACS treatment at your institution. However, cardiologist buy-in and assistance in reviewing and formulating ACS order sets, protocols, and educational materials are essential and will lend authority to the team’s recommendations and interventions. Approaching and enlisting a prominent and respected cardiologist as an active ally at the onset of your efforts is one of the most important moves to make in forming your team. Because many of the metrics you will be interested will be driven by external organizations, it is important that your lead cardiologist be aware of and open to adapting patient care toward improving these specific metrics.

Team Facilitator

The team facilitator’s main duties are maintaining team rules, helping the team leader stay on track by calling on effective team techniques, and introducing the appropriate QI tools for practical use by the team. Mastery of QI tools at the onset of the project is not necessary. What is necessary is a willingness to learn QI tools and introduce them to the team as necessary. Mastery of ACS literature is not important for this position. Sometimes one person can be both team facilitator and team leader, but for more ambitious projects or for projects involving buy-in from disparate physician and nursing groups, a separate facilitator is very strongly recommended.

Process Owners

Participation of frontline personnel (nurses and pharmacists, for example) is essential to having an effective team trying to optimize the treatment of ACS.

TASK    

Fill out the names and contact information of members of your ACS teams* and construct a team roster and group e-mail to help the team communicate.

*You may identify only 3 or 4 key personnel at the outset but may draft others onto the team as additional roster needs become clear.

Download the Task Sheet

Establishing Team Rules

At your very first team meeting, the team rules need to be established and everyone needs to explicitly agree to them. The facilitator is usually given the task of gaining consensus on and enforcing the team rules.

Use the team rules below as a starting point. The team should modify the rules as needed, then officially record and acknowledge them.

To some, these rules may appear a bit preachy. The key principle that must be maintained is this: everyone on the team must be encouraged to speak up, and their views must be respected. Traditional concepts of rank have to go “out the window.” A unit clerk should feel comfortable telling the lead physician, “I don’t think that will work because of [reason]. Why don’t we try it this way?”

In addition to these rules, it should be made very clear that potential members should notify the leader quickly if they cannot devote the requisite time and effort so a suitable replacement can be found. Timely minutes as well as a quick turnaround for comments/corrections should be the rule.

TASK

Establish team rules and post a large, readable version at each team meeting.  

Download the Team Ground Rules Task Sheet