Build a Team

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 prior to beginning this section. Efforts are often initiated by just a few thoughtful leaders who see a big gap between the current practice and the best-known practice and who then recruit others to their cause. Members of each glycemic control team for each major area of focus should include a team leader, content expert, team facilitator, and process owners.

TEAM LEADER: This is usually a physician hospitalist leader, endocrinologist, critical care physician, surgeon, 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 topic expertise in insulin usage and inpatient diabetes. Just as important, the team leader needs to have the commitment and perseverance to drive the entire process forward. There may actually be several leaders, whose involvement varies as the focus changes. For example, a surgeon may lead efforts on perioperative glycemic control, whereas a hospitalist may lead efforts to improve subcutaneous insulin use on the wards. Alternatively, an endocrinologist or other individual may lead the entire effort. In any case, a coordinated effort is required across the entire spectrum of care.

CONTENT EXPERT: An endocrinologist may not always be the team leader and may not always have the time or expertise to lead the effort to improve glycemic control at your institution. However, endocrinologist buy-in and assistance in reviewing and formulating insulin order sets, protocols, and educational materials are essential and will lend authority to the team's recommendations and interventions. Approaching and enlisting as an active ally a prominent and respected endocrinologist at the onset of your efforts is one of the most important moves to make in forming your team.

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 insulin/diabetes 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 glycemic control and other aspects of care provided to the inpatient with hyperglycemia.

TASK: Fill out the names and contact information of members of your glycemic control teams* and construct a team roster and group e-mail to help the team communicate. *You may identify only three or four key personnel at the outset but may draft others onto the team as additional roster needs become clear.

Download the Glycemic Control Team Roster

We recommend trying to enroll a range of personnel early, within 2-3 weeks

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

View Team Ground Rules