Welcome back! - IHI

Welcome back! - IHI

January 30, 2017 Day 1 Building your team: First things Phyllis Virgil 2 Session Handouts Working Agreement = D 3 Session Objectives

Identify early team tasks that will pay off dividends Discuss the use of working agreements to help to clarify roles and responsibilities List the four essential norms for team success Recognize the importance of healthy ground rules Describe successful team building exercises Revolutionary Common Sense 4 Session Agenda Building Your Team Topic Time

Definitions and Aim 5 minutes Early Team Tasks 25 minutes Reaching Working Agreements 20 minutes Creating Healthy Group Norms 5 minutes

Building Team Relationships 5 minutes 5 Team versus Group? Distinguishing factors: 1. Commitment 2. Purpose 3. Relationship Source: M. K. Key for TIPQC (Tennessee Initiative for Perinatal Quality Care) 6

A high performing team is... A cohesive group. With a common Aim. Who work well together. To get things done. Source: Phyllis M. Virgil, 7 Coach Role is Essential to Team Building Coach Aim: High Coach Involvement

Transfer Knowledge and Skill Achieve self sufficiency Low New Team Graphic Source: Executive Learning , Team Training Materials Content Source: John S. Dowd, Courses in Continual Improvement Time Mature Team

8 Image Source: The Red Fairy Project 9 Early Team Tasks Select a table facilitator Create an affinity diagram of early team tasks (10) Use sticky notes to quickly identify early team tasks - one idea per note (do this silently) Post ideas on your flip charts, organize them into like categories, then label your groupings with a title that represents the category

Be prepared to report out to the larger group (5) 10 Tending to Early Team Tasks Pays Off Dividends Team Progress Amount of Work Progress curve Time >>>>>

11 Early Team Tasks Peter Scholtes List Team Building & Development Objectives Reaching agreements between the team members, coach and leader about their working relationship, roles and responsibilities. Setting Team Ground Rules and defining key processes such as decision making Getting to know each other -- interests, experience, capabilities and contributions Understanding and adopting effective meeting and decision making processes Educational Objectives Understanding and embracing the teams charter and purpose. Exploring and embracing the Model for Improvement and basic improvement tools Understanding and embracing team meeting structure, process and tools

Project Objectives Selecting and orienting members to the mission of the team and a basic roadmap Understanding the scope, boundaries and area of focus Defining and understanding customers or target population Developing a team Aim Statement Identifying resources and obtaining commitments Beginning a storybook and storyboard Adapted from: The Team Handbook, Peter R. Scholtes, et. al., Joiner Associates, Inc, 1988, page 4-15 as presented by Phyllis M. Virgil 12 First Things, A Deeper Dive... 13

Identify Team Leadership The Team Leader should ideally be process owner (person able to directly authorize and sustain changes), they are responsible for running the team, leading meetings, and ensuring results. Be sure to have an Executive Sponsor who takes responsibility for the overall success of the project , assists in removing barriers, links the project to senior management, and champions the project. The Improvement Coach will support the leader and team with help in learning and applying QI concepts and tools and facilitating group processes. The aim of the coach also will be build capacity for team and leader self-sufficiency overtime in both running teams and making improvements. Source: Phyllis M. Virgil and Karen Baldoza 14

Develop Draft Roadmap Contra Costa Regional Medical Center, BH-PC Collaborative Activity Aim and Goals Team Infrastructure Develop Measures Initiate 1st PDSA ID High Priority Areas ID Change Strategy & Ideas Run PDSA Projects Source: Phyllis M. Virgil for Contra Costa Regional Medical Center, BH-PC Collaborative 2rd Qtr 4

5 3th Qtr 6 7 8 4st Qtr 9 10 11

12 15 Craft a Prelimary Aim Every system must have an aim. Without an aim that is clear to all there is no system. - W. Edwards Deming, Out of the Crisis Corollary 1: Every team must have an aim. Without an aim there is no team. Corollary 2: Determination without destination leads to disaster. Source: Phyllis M. Virgil 16

Select Team Members 1. Review the project aim What is the process of focus (boundaries, scope, major steps) Who is involved (persons who supply the process, work within it, manage it, or receive the benefits of it) 2. Select a cross-section of this group Cover skills and knowledge base needed, and Function and role needed (managers, administrators, point-of-

service staff) Be sure to include those who work in the process Source: Phyllis Virgil and Karen Baldoza 17 Selecting Team Members (cont.) There may be one or more people on the team with each kind of expertise Or one person may have expertise in more than one area Dont forget you can have just in time guests, as needed Also, some members may come and go during different

phases of the improvement process Source: Phyllis M. Virgil and Karen Baldoza 18 Team Member Matrix Skills, Knowledge Function, Role Process Knowledge QI Skills Owner Technical Expertise Management Supplier ?

Customer? Front Line/Point of Service etc... Source: Phyllis M. Virgil Bob Sam Pat Tom Sue

Bob 19 Reach Working Agreements With your leader and With your team Article Source: The Role of Contracting in Quality Improvement,, by M.K. Key, Ph.D. Quality Matters, October, 1992, Page 22 Graphic Executive Learning , Team Training

Materials Source: TheSource: Role of Contracting in Quality Improvement,, by M.K. Key, Ph.D. Quality Matters, October, 1992, Page 22, as outlined by Executive Learning Inc. 20 Working Agreements... (aka Contracts) Explicit, though probably unwritten, agreements between two parties (Coach/Leader, Coach/Team). Working agreements specify: 1. Who the client is (remember we are all customers of each other)

2. The aim and objectives of the relationship 3. The roles and responsibilities of each 4. Any other ground rules for the relationship If broken provides opportunity to reflect, learn and rework as needed. Content Source: The Role of Contracting in Quality Improvement,, by M.K. Key, Ph.D. Quality Matters, October, 1992, Page 22, as outlined by Executive Learning Inc. Graphic Source: Executive Learning , Team Training Materials 21 Working Agreement Handout Definition of working agreement Purpose of agreements How to conduct a session Pointers for successful agreements

Pitfalls of making agreements Coaching Tasks Inside meetings Coaching Tasks Outside meeting Coach/Leader Agreements Simulated Pair Share 1. Skim the coach/leader agreement handout. Highlight those items that you feel are most important to discuss in a coach/leader working agreement session. (5 minutes) 2. Simulate a working agreement meeting (5 minutes): Find a partner one is the team leader and one is coach Simulate a meeting to develop your Working Agreement. Include: The aim the relationship The roles and responsibilities of the both parties Any other ground rules for the relationship Be prepared to share significant learnings or insights with the large group

Adapted from: The Role of Contracting in Quality Improvement,, by M.K. Key, Ph.D. Quality Matters, October, 1992, Page 22, as outlined by Executive Learning Inc. 22 25 The Perfect Team - Google's Project Aristotle After looking at 180 groups for more than a year to find the anatomy of the perfect team, Googles researchers found: Success was NOT related to personality type, skills, talent, or background, etc. The who did not matter... Instead they found understanding and influencing group norms were the keys to team success. Specifically, successful teams had norms that allowed members to: Be Heard / Be Understood / Be Known / Be Safe

Source: What Google Learned From Its Quest to Build the Perfect Team , New York Times Magazine February. 25, 2016, as presented by Phyllis M. Virgil 26 Establish Healthy Norms Ground Rules make explicit those norms the group wants to establish regarding expectations and behaviors in their improvement journey, both in and outside of their meetings. They help to establish a culture of collaboration and respect. Are the team members explicit working agreements. Are best recorded in a manner where all can view them. Source: Phyllis M. Virgil 27

Ground Rules Tips from the Trade Ground rules are made, owned and used by the team Best to develop in the first few meetings Ground rules should be specific enough so all understand Should be used for improvement not punishment The coach is not the ground rule cop, but does help point out violations Are the teams working agreement, use PDSA to review and revise Remember Project Aristotle, ground rules should help remember: Be heard, Be understood, Be known, Be safe Source: John S. Dowd, Consultant in Continual Improvement 28 Rules of Engagement, Community Health Center of Buffalo

Effective Meeting Tips, Adopted by CHCB, November 2016 Submitted by Lavonne Ansari, Medical Director, Community Health Center of Buffalo, NY, ICP Fall 2016 29 Here are basic ground rules from this morning: So what do you think? Anything you would add? The group will help enforce the ground rules during the workshop. 30 Build Team Relationships

Being known is key to team performance... Google Project Aristotle Warm-ups Checkins Energizers Source: What Google Learned From Its Quest to Build the Perfect Team , New York Times Magazine February. 25, 2016. Photo Credits: Communication4Health, Pixabay, Flickr,-everly and Pack, Wiki Education Foundation 31 Ice Breakers, Warm-ups, Energizers, Check-ins... Meeting openers like ice-breakers, warm-ups and check-ins help team

members to clear their minds, break away from their previous work, develop team spirit, think creatively and focus on the task at hand. Warm-ups Energizers Effective Meeting Openers Relevant to the group or topic Engaging and/or fun Have an element of self disclosure Source: Phyllis M. Virgil Source: Phyllis M. Virgil,

Diveheart Strategic Quality Planning Retreat, Photo Credits: Communication4Health, Pixabay, Flickr,-everly and Pack,2008 Wiki Education Foundation Checkins 32 Warm-ups, Ice-breakers, Energizers, Check-Ins

Google it.... http://www.teamfirstdevelopment.com/warm-ups/ Energizers http://wilderdom.com/games/Icebreakers.html http://www.training-games.com/pdf/40FreeIceBreakers.pdf https://funattic.com/icebreakers-for-meetings.htm http://www.funretrospectives.com/category/energizer/ http://improvencyclopedia.org/games/ http://resourcecentre.savethechildren.se/library/100-ways-energise-grou ps-games-use-workshops-meetings-and-community Photo Credits: Communication4Health, Pixabay, Flickr-Beverly and Pack, Wiki Education Foundation 33

Warm-ups: ICP All Stars Share your favorite Warm-up 1. Short Name 2. Instructions 3. Your contact info Send to Linson who will add to ICP favorites list: [email protected] Source: Phyllis M. Virgil Photo Credits: Communication4Health, Pixabay, Flickr, Beverly and Pack, Wiki Education Foundation Energize rs

34 Example from Wave 2 Team Line Up Submitted by Kathryn McDaniel [mailto:[email protected]] Wave 2 Fall 16 One of the easiest/quickest, but still effective ice breaker's I've been a part of is a 'superlative' one. You pick a category and the members of the group have to line up in order of that category. If you have multiple teams, the one to do it the fastest wins. eg: Shortest to tallest, distance traveled closest to furthest, birth date by month and day January to December, # of letters in first and last name shortest to longest, etc 35

In Summary... Attending to early team tasks will pay off dividends Forming working agreements with your leader and team helps to clarify roles and responsibilities Having healthy norms and ground rules are essential for high performing teams Getting to know each other enhances team performance, use team building exercises to develop relationships Source: Phyllis Virgil 36 Additional Resources

Date of assessment: _________________ Exercise #4 Evaluating your Teams Effectiveness! 37 All too often team leaders and members THINK they are functioning at a high level. A primary role for an Improvement Coach, therefore, is to continuously assess if the team is in fact functioning efficiently and effectively or if it is drifting

into the land of incompetency. This assessment tool provides a quick and easy way for an Improvement Coach to evaluate a teams ability to achieve its desired outcomes. Conduct this assessment at least three times during the life of the team. Source: Executive Learning Inc., Team Training Materials 38 Break

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