Build a Team & Team Rules

Quality improvement efforts often originate from just a few thought leaders who see a gap between best practice and current practice. The VTE prevention team should quickly include:

Team Leader:
The team leader should be a physician respected by the medical staff and ideally with some topic expertise on VTE prophylaxis and/or anticoagulation.  This physician is responsible for setting the agenda, the frequency and collaborative tone of team meetings, and communicating directly with administrative and appropriate medical staff committees.

This position of influence is best held by a physician hospitalist leader, pulmonologist, hematologist, critical care physician, surgeon, or other physician leader. Though the team leader does not personally take the minutes, the team leader should edit and “own” the minutes for presentation to senior leadership. The team leader will need the commitment and contributions of other team members to move the initiative forward. The team leader and the team may need to recruit local champions based on service or hospital geography. For example, a pulmonary/critical care physician may lead efforts on VTE prophylaxis in the ICUs while a hospitalist may lead efforts on the floor/wards.  Alternatively, a hospitalist or other individual may lead the entire effort. Whatever the format, a coordinated effort is required across the entire spectrum of care.

Team QI Facilitator:
The QI facilitator, who may or may not be a physician, should be someone with QI experience. The QI facilitator plays the pivotal role of ensuring that the team functions constructively and that the project stays on track. This role requires project management skills and at times may call for ability to balance team dynamics or introduce appropriate QI tools. The QI facilitator need not have mastery of QI tools at the onset of the project, but should have a readiness to acquire new tools and a talent for moving projects forward. Mastery of the VTE literature is not important for this position. For smaller scale projects, the team QI facilitator could be the same person as a team leader, but for more ambitious projects or for projects involving buy-in from disparate physician and nursing groups, a separate facilitator is strongly recommended.

Process Owners:
The frontline personnel involved in the process of providing VTE prophylaxis in the hospital are essential for an effective team wishing to optimize VTE prevention. Process owners should come from each service (pharmacy, nursing, etc) and geography (medical, surgical, ICU, etc).

IT/HIS Experts:
From performance tracking to actual QI interventions, the contributions of information technology or health information system experts will be pivotal. Enlist those who can report ICD-9 code frequencies at discharge, perform data entry, can set up reports from the electronic clinical data warehouse and radiology, and who can be a liaison to medical records.

Team Dynamics:
While meetings with the whole team are invaluable they can occasionally become impractical or impossible to schedule. Team ‘huddles,’ where a fragment of the team meets briefly to advance action items, can be very effective for overall progress. How team members interact with one another is also important. The key dynamic for an effective team is the removal of authority gradients. Since the perspective of every team member is potentially critical, every perspective must be heard. To do that each team member must be comfortable expressing his or her viewpoint. Try to pick people who have reputations for being collaborators. It is up to leader and facilitator to enforce constructive team dynamics.

Listing the names and contact information for the VTE prevention team members, and keeping the list updated, especially electronically or online, is very useful.