Build a Team & Team Rules

Assemble an effective team

Quality improvement efforts often originate from just a few thought leaders who see a gap between current practice and the best-known practice. They then recruit others to the cause. You have probably already recruited a few team members for your VTE prevention effort. Your VTE Prevention team should 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 usually going to be a physician hospitalist leader, pulmonologist, hematologist, critical care physician, surgeon, or other physician leader. Though the team leader doesn’t personally take the minutes, he/she should edit the minutes for presentation to senior leadership and “own” them. The team leader will need the commitment and perseverance of other team members to drive the entire process 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 role of the team QI facilitator is essential. The QI facilitator, who may or may not be a physician, should be someone with QI experience. The QI facilitator plays a pivotal role: to ensure 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. Mastery of QI tools at the onset of the project is not necessary. What is necessary is a willingness to learn 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 can 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 very 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. You will have to get process owners from each service (pharmacy, nursing, etc) and geography (medical, surgical, ICU, etc) just like you got for champions.

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, who can perform data entry, who can set up reports from the electronic clinical data warehouse and radiology, and who can be your liaison in medical records.

Team Dynamics
While meetings with the whole team are invaluable they can also be impractical at times. Team ‘huddles,’ where a fragment of the team meets briefly to advance action items or cycles of PDSA, 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 healthy team dynamics.

We recommend listing the names and contact information for your VTE prevention team as you identify them. Keeping this list updated, especially electronically or online is a great help.

Download the VTE Implementation Guide Snapshot