Build a Team and Team Rules

Pulling the Team Together

In many cases, improvement activities are initiated by a few individuals that identify a big gap between the current and the best-known practices and then recruit others to their improvement team.

Team Leader(s)
Team leaders often include both a physician and a non-physician. For a care transition improvement team, it may consist of a hospitalist or other physician and a nursing leader. These leaders are responsible for calling meetings and communicating directly with administrative and appropriate medical staff committees. The physician team leader should be a respected member of the medical staff with some knowledge about care transitions. He or she need does need to be a content expert in discharge transitions, but should be familiar with the relevant issues at the institution. Additionally, at least 1 team leader should have a working familiarity with the key literature as presented in the Best Practices section of the room. Just as important, the team leaders need to have the commitment and perseverance to drive the entire process forward.

Content Experts
The hospital discharge transition is often excluded as a training topic in medical school and residency, but received considerable national attention in peer reviewed literature (see the Best Practices Literature Review section of the room for the Content Expert Annotated Bibliography). Thus, although physicians may not be the recognized “experts” on the subject, they have a central role to play in the discharge process (either in discharging patients themselves or in seeing patients in follow-up after a hospitalization). Someone on the team should review and summarize the relevant literature, including its applicability to your institution and patient population.

Team Facilitator
The team facilitator’s main duties are (1) maintaining team rules, (2) helping the team leader stay on track by utilizing effective techniques for team and project management, and (3) introducing the appropriate quality improvement (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 discharge transitions literature is not as 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 (eg, nurses, social workers, case managers, residents, hospitalists) is essential to having an effective team that succeeds in optimizing the discharge process.

Download the Care Transition Improvement Team Roster as an example of a form that you can use to document potential team members and develop your team roster.

Establishing Team Rules

At your very first team meeting, you should establish the team “rules,” and everyone needs to explicitly agree to them. It may even be useful to have all team members formally sign a document agreeing to these rules to communicate and stress their importance. The facilitator is usually given the task of gaining consensus on and enforcing the team rules.

Download the team rules task sheet as a starting point. The team should modify the rules as needed and then officially record and acknowledge them.

To some, these rules may appear a bit preachy. However, our experience is that breakdowns commonly occur when these basic rules are ignored or violated.

Key Principle

Everyone on the team must be encouraged to speak up, and his or her 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 consider trying 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.