October 2015

The Quality Improvement ProjectMODULE 5: TEAM WORK AND MAKING CHANGE

October 2015

Objectives

1. Explore teams and team function in QI and how this can make a difference in the success of your QI project

2. Explore change management concepts and how these apply to QI

October 2015

SUCCESS IN QI IS STRONGLY RELATED TO TEAM FUNCTION!

October 2015

Who is on a QI Project team? 5-8 people generally (not too big, not too small)

Project sponsor (senior person in your clinic) Content expert (often the facilitator of the team) Champions of your idea People involved in all parts of the process Data support Skeptics (better to know what the resistance will be) Someone knowledgeable about QI/Change Patients

October 2015

Facilitator and Team Member Roles

Facilitator should set out in advance with your QI team what the expectations are

Be aware for team members who are displaying “self-oriented” behaviours that can be destructive

October 2015

Team Member Task Oriented Behaviours

Facilitator Task Oriented

Behaviours

Team Member Relationship

Oriented Behaviours

Facilitator Relationship

Oriented Behaviours

Self Oriented Behaviours

Provide information

Ask for clarification

Bring discussion back to purpose

Collect and analyze data

Summarize what has been said

Ask clarification questions

Suggest alternative ideas or solutions

Record PDSA plans on worksheets

Set agenda

Honour timelines

Define the work (Charter)

Provide data

Teach & use QI tools

Set up work groups and plans for between meetings

Summarize

Facilitate team consensus

Use PDSA worksheets

Offer encouragement and positive feedback to other members

Listen – one voice at a time

Indicate agreement – voice, nod, smile

Ask open ended/ exploratory questions

Check with the team for agreement

Design warm ups that help team to know each other

Establish ground rulesWrite on flip chart so all can see

Use parking lot – and come back to it!

Ensure opportunities for all to contribute/ participate

Use active listening

Make sure members are heard by team

Give positive recognition

Acknowledge feelings of frustration or anxiety

Celebrate successes Provide treats!

Side conversations

“Talking over” others

Multi-tasking

Negative body language (eye rolling, crossed arms, move away from table, shake head)

Not participating

Bringing up the same issue repeatedly; stalling the team discussion

Arriving late

October 2015

The teams for the QI project

You (the residents) are the leaders of the team For the QI Project you must demonstrate that you have consulted

with at least two other staff members (and not just physicians) You should try to meet them face to face Consider having an agenda and objectives for the meeting This is NOT about blaming anyone for the gap you found Thank them for their time Keep them informed

October 2015

Sample Agenda for a resident meeting with clinic staff

Meeting to discuss Practice Improvement projectDecember 1, 2014, 12-1pm in conference roomInvited: Resident 1, Resident 2, Clerk 1, Nurse 1

Objective for the meeting: To gain input from team members in the FHT to help us complete our Practice Improvement project on the topic of FOBT screening

1. Introductions (who are you, why you called the meeting, everyone introduces themselves)2. Approval of agenda (ask for input/changes/questions)3. Approval of minutes (from past meeting)4. Presentation of practice audit results (Resident X will lead, 10 min)5. Root cause analysis using process mapping exercize (Resident Y to lead, 15 min)6. Discussion about next steps (Resident 1 to lead, 5 min)7. Next meeting (if required)

October 2015

Role play a meetingGroups of 4+ residents

Assign roles: Resident (Chairs meeting)NurseClerkAnother doctorOthers… (patient, allied health, executive director, lab tech)

Resident should introduce your practice gap and tell them that you are seeking to understand root causes of that gap.

Feel free to use the tools your previously learned: 5 Whys, Cause and Effect diagram/Fishbone, Process Map or other brainstorming techniques

October 2015

Debrief…

Was it a successful meeting?

Did you feel it was easy to explain your project goals and get input?

Who was missing from the meeting?

What would be the next step you would take?

October 2015

Making change

October 2015

Making Change

Expect resistance to your idea

You need to be the constant champion for the change you want to make

Some people are early adopters, some are laggards, some are in between

Physicians can be particularly resistant to change

October 2015

Making Change: Key elements for change

Beckhard Change Model C = D x V x F > X

C = changeD = desire for changeV = vision for the futureF = practical first stepsX = cost of change

October 2015

Goals of patient care more pressing than system problems Inbuilt sense of autonomy, “lone healer” so may want to solve the problem on their own Critical thinkers (look for negative) and need certainty so can shoot down ideas MDs more accepting of “technical” change but less so “adaptive” change (more on this…) so can shy away from complex solutions

Hussey, R et al. (2013) NHS Improving Healthcare White Papers. Doctors: leaders of change

Barriers to MDs making change

October 2015

Technical vs Adaptive Change – QI is a bit of both

TECHNICAL CHANGE Uses knowledge that has been

proven/tested

Implemented by “authority”

Simple

ADAPTIVE CHANGE Learn new ways of doing, experiment

Implemented by the people with the problem

Complex, takes time, can be stressful

October 2015

Reflection on making change

Think about a time that you went through a change in an organization or team that you were a part of

What made the change process go well?

What made it more difficult?

How can you apply these lessons to making change with your QI idea?