What is this session about? • The characteristics commonly seen in high performing teams, and the dysfunctions which undermine them. • Understand your network and use that to develop your teams influence. • Identify sources of resilience for you and your collaborative team.
Examples of High Performing Teams
The apple pie analogy 1. Do you have clear objectives? 2. Are there interdependencies between the roles that require you to work together? 3. Do you meet regularly to review team performance? Michael A. West et al, Lancaster University, 2013
Katzenbach & Smith Definition “A team is a small number of people with complementary skills who are committed to a common purpose, a set of performance goals, and an approach for which they hold themselves mutually accountable .” J.R. Katzenbach and D.K. Smith, ‘The Wisdom of Teams’, Harvard Business School Press, 1993
5 Characteristics of High Performing Teams Specific Meaningful Complimentary Common Performance Skills Purpose Goal Strong Mutual Team Accountability Commitment J.R. Katzenbach and D.K. Smith
Activity Individual Think about your collaborative team. Rate the team against each of the five characteristics using the following scale. 3 – this is a key strength for this team 2 - this characteristic is present but could develop further 1 – this is an area of weakness and needs focussed attention Discuss at your tables What actions can you take to support the team? To further develop a key strength To improve an area of weakness
Look at this another way What stops teams from performing to their highest potential?
5 Dysfunctions of a Team Patrick Lencioni, The Five Dysfunctions of a Team: A Leadership Fable2002 Inattention to RESULTS Avoidance of ACCOUNTABILITY Lack of COMMITMENT Fear of CONFLICT Absence of TRUST
5 Dysfunctions of a Team Inattention to Focus on collective RESULTS OUTCOMES Avoidance of Get commitment and ACCOUNTABILITY BUY-IN Lack of Encourage COMMITMENT CLARITY Fear of Mine for candid DEBATE CONFLICT Courage to be Absence of VULNERABLE TRUST
Circle of Concern Circle of Influence
Team A Team C Our Collaborative Team C
Resilience is our armour to stress
5 Capabilities of Resilience Perspective Emotional Connection Intelligence Managing Purpose, physical Values and energy Strengths Roffey Park Institute (2014)
5 Capabilities of Resilience Individually • Which capability do you feel MOST resilient in? • Which capability do you feel LEAST resilient in? • What action will you take to support yourself now?
Systems Thinking for Everyday Work
Systems Thinking for Everyday Work Small group discussion • Discuss your systems context and culture • What are you particularly good at as a collaborative? • What could you spend more time developing as a collaborative? • Decide on at least 1 clear action.
Lunch
Learning from phase 1: Overview and Q&A #ihubfrailty Improvement Hub Enabling health and social care improvement
Learning from Phase 1 Alison Redpath Data & Measurement Advisor, Healthcare Improvement Scotland Improvement Hub Enabling health and social care improvement
What we learnt • Data systems are complex and varied • Analytical resource can be hard to access at sites • Each team will have different ways of collecting data
What we are most proud of • Being involved in site visits • Teams recognising what help we can give
Our advice for your team • Collect data manually until data from systems is reliable • Review your data regularly and share it • Ask for help from our team
Learning from phase 1: NHS Greater Glasgow & Clyde Lara Mitchell Consultant Medicine for the elderly, clinical lead for acute site, NHS Greater Glasgow & Clyde Carolanne O’Neill Elderley Care Assistant Nurse, NHS Greater Glasgow & Clyde #ihubfrailty
What we learnt • Have clear aims/goals • Understand your system • Involve stakeholders • Share practice • Keep the profile high at a hospital level
What we learnt • Invest in your team- they will flourish • Own your data and work on consistent metrics at hospital level • Feedback and debrief regularly • Be brave • Be accountable to ‘someone’
What are we most proud of? THE DATA 29% Short Stay Short Stay ward reduction 30 20% ward moved £>3M opened in LOS increased cost 25 >40 access avoided >1000 extra 20 patients alive at home 15 10 5 0
What are we most proud of? THE DATA CARE COORDINATION Creation of a pathway. From our own data, we know double the amount of patients are getting to our wards earlier and we are taking less from the medical wards Number accepted to DME from all sources Number transferred directly to DME bed from Medical wards 600 120 Short stay ward opens. Frailty team Short stay ward opens. established 500 Frailty team established 100 400 80 300 60 200 40 100 20 0 0 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17 Oct-17 Jan-18 Apr-18 Jul-18 Oct-18 Jan-19 Apr-19 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17 Oct-17 Jan-18 Apr-18 Jul-18 Oct-18 Jan-19 Apr-19
What are you most proud of ? THE TEAM The consultants trust us [ECAN nurses] to make the right decisions – we had a good relationship with them anyway, this They look after each other work has made it better They have great ideas They educate others They have improved the flow and care for the older adult at QEUH They have changed the culture on Change in culture on the ground floor and improved the ground floor person centred care
Our advice for your team Clear goals Data – if you can’t get it at hospital level- DIY Regular reflection and team meetings Everyone is an expert in something! ‘ Do or do not there is no try’
Learning from phase 1: NHS Forth Valley Sarah Henderson Consultant, NHS Forth Valley Deborah Lynch Senior Quality Improvement Advisor, NHS Forth Valley #ihubfrailty Improvement Hub Enabling health and social care improvement
What we learnt • Timing • Right people • Approach - Structure/reporting/doers meeting • Clear about aims – you can’t change everything in a week • Get a Deborah – Data is the key to everything, IT systems are not always great and manual might have to do
What we are most proud of • Our team – everyone from FIT nurses, AHP’s, QI support, managers, IJB’s, consultants • Progress – changing a whole system and now starting to think even bigger – “whole system approach to frailty” • DATA
Screening for Frailty Percentage of people over 75 years old who are screened for frailty on arrival to front door in FVRH 100 90 80 70 60 Percentage 50 40 Screening commenced 6th Feb 30 call handler A/L 20 10 0 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18 Jul 18 Aug 18 Sep 18 Oct 18 Nov 18 Dec 18 Jan 19 Feb 19 Mar 19 Apr 19
Graph 1: Number of patients screened for frailty Week 4-Feb 11-Feb 18-Feb 25-Feb 04-Mar 11-Mar 18-Mar 25-Mar 01-Apr 08-Apr 15-Apr 22-Apr 29-Apr 06-May 13-May 20-May 27-May 03-Jun 10-Jun 17-Jun 24-Jun 01-Jul Over 75 123 104 123 116 109 120 138 76 151 126 159 122 113 143 137 123 118 127 115 121 128 128 Under 75 229 139 179 198 178 175 225 89 225 205 153 191 172 168 204 162 156 145 150 165 176 174 Total 352 243 302 314 287 295 363 165 376 331 312 313 285 311 341 285 274 272 265 286 304 302 Week 8-Jul 15-Jul 22-Jul 29-Jul Over 75 119 112 128 120 Under 75 184 171 154 145 77 Total 303 283 282 265
Graph 2: % of patients 75 years and over discharged directly from CAU/AAU *source Information Services Inpatient report
Our advice for your team • Be clear about what you want to do so you can tell everyone who’ll listen • Use all those people who have agreed to help • Persevere – you will get there • Listen to what other people are doing, learn and then just steal.
Practical Improvement Scott Purdie Associate Improvement Advisor, Living Well in Communities Team, Healthcare Improvement Scotland #ihubfrailty Improvement Hub Enabling health and social care improvement
Outcomes for session 1. Making changes within a system 2. How to increase your chances of success 3. Making room for improvement
A system
Another system
What is a system An interdependent group of items, people, or processes working together toward a common aim What that practically means, people working together to achieve a shared aim In practise this means….
Move away from this… Move away from this…
… to this Stepping out to see the bigger picture
Move away from this To this, a shared effort understood by all
Over to you, take 15 minutes How well do you understand the system you are working in? What steps have you taken to address the human side of change? Are you confident you understand what may be affecting performance for your system? What information do you already have?
How to make sense of it all
Some things that will help
More sense, more questions?
Over to you, take 10 minutes What tools could be useful and why? What would you hope to achieve by using them? Who needs to be involved? How long will you need? Any resources required?
Develop Change Ideas • How big or small is the change • Buy in • Likely hood of success • Resources required • Can it be scaled up
Rapid testing to full scale AIM D P S A D S AIM P A S D A Measures P S D A S P D S D A P P A S S D A S D Changes D D S A P P A P P A S S S A A A D D A P D S P P S A A P S A S D P D P P D D A A A P A S P P P S D S A S D D P D P P A S A P D D D P S S A A P P D D D D S A S A S S 1 change, 1 test 1 change, Multiple tests Multiple changes, Multiple tests
Decision making on PDSA’s, the 4 As • Abandon • Amplify • Adapt • Adopt
Visual Management CHANGE SECONDARY PRIMARY AIM TESTS OF CHANGE IDEAS DRIVERS DRIVERS P D D S D P S A A D S A S S P A A S A A P D P P P S D M M D S A D A S A P D P P P S D D A S P S D D M P D D S D P S A A S D A S S P S A A A A P D P P P S D D M M M Act on small rocks through testing to impact the big rocks when you scale up
Right People, Right Roles & Responsibilities • Identify the willing and needed • Build relationships and trust • It takes a group • A network of people with shared aims • Buy in at all levels • Roles & Responsibilities • Decision making
Over to you, take 20 minutes Plan and design you next steps What tasks need to be done Decide what will be test, where, how etc Who needs to be involved? How long will you need? Any resources required?
Thoughts and Questions
By now you will… 1.Understand making changes within a system 2.How to increase your chances of success 3.Make room for improvement
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