Improvement activities are often initiated by an individual or a few individuals who recognize a gap in quality of care. Recruiting additional members who have firsthand experience with the issue or content expertise to the improvement team can help to overcome challenges, enhance interaction and stimulate the brainstorming of solutions.
Who should comprise your QI team?
The leader of a team is a permanent role for the life of the team. He or she should:
- Develop a preliminary plan for each team meeting
- Coordinate and focus the meeting activity on the mission of the team
- Actively participate as a member by contributing ideas and participating in the team's processes and decisions.
- Develop the record of the meeting outcomes and actions needed
The team leader requests assistance from a team facilitator when the team is struggling with its ability to work together and use effective team meeting skills.
The most effective teams have a trained team facilitator in a permanent role to meet with them and guide their use of meeting skills and tools. If assigned, the facilitator should be present at most meetings, especially in the early stages of development when the team is learning how to work together and use the improvement tools. If a permanent facilitator is not assigned to the team, then one should be available to assist the team when members are struggling with team processes or when they need advice or skill training to effectively use problem-solving tools.
- Functions as a team adviser with expertise in the processes and tools that help teams to be effective.
- Works with the team leader to make sure that information is gathered to study the issue being addressed, that an improvement plan is developed and that the meeting record is being completed properly.
- Works as the team’s liaison with the steering committee for resources and time
- Exercises personal discipline and not contribute ideas or participate in decisions regarding the process being studied
- Coaches the team in the use of team meeting skills and tools and gives impartial feedback to the members to improve their communication and meeting process.
The involvement of the facilitator normally diminishes as the team members and team leader gain more knowledge and skills about team processes and tools.
Effective teams usually include four to six members, including the team leader. The team may be larger, but the time commitment usually increases, and the speed with which the team begins to perform is slower.
Team members are normally selected because they represent a part of the cross-functional process that is being improved. Sometimes, a team member from outside of the process is included to give the process “fresh eyes.” All members have a responsibility to participate and share their knowledge with mutual respect for other team members. Team members will also rotate to fulfill the roles or recorder or timekeeper at each meeting.
The recorder is a rotated position selected at the beginning of each team meeting based on the ground rules. The primary role of the recorder is to:
- Record content from brainstorming, consensus building and other tools and processes on a flip-chart or white board that is visible to the team.
- Write down what each team member says rather than what they interpret was said.
Sometimes it is helpful to select two recorders when a lot of information needs to be logged.
Every team member should be encouraged to fill this role and be applauded for the patience and listening skills it requires. The recorder is a full participant in the team process while they are recording. Sometimes the team leader and other members need to make sure that the recorder is participating.
The timekeeper is also a rotated position selected at the beginning of each team meeting based on the ground rules. The primary role of the timekeeper is to call out the time remaining on each agenda item at intervals the team determines is appropriate when developing their ground rules. In this way, the timekeeper assists the team in staying on task and managing its time effectively.
Identifying and including stakeholders in your project team from the beginning is critical for success. It is important to identify existing committees or teams in the hospital that are already working to improve related clinical topics or processes and determine how to link to or integrate existing efforts.
Team membership may include:
It is essential to include individuals who are invested in and see the value standardizing the process. Also, consider including patients/families as content experts on your team, as they have a perspective that is unique and critical to all the efforts of your team.