Improvement Teams

Part 1: Introduction

Part 2: The Power of Teams

Part 3: Selecting Members for a Team

Part 4: Defining Roles and Responsibilities

Part 5: Stages of Team Growth

Part 6: Tips from Successful Teams

Part 7: Supporting Information

Part 3: Selecting Members for a Team 

Thoughtful attention toward selecting members for a QI team is critical to successful improvement. While there is not a specific "how-to" guide for QI team selection, there are some worthy guiding principles to consider. An ideal QI team member:

1. Represents any discipline and ideally works directly with the system targeted for improvement
2. Is willing to learn from other team members
3. Is willing to maintain open communication with staff, leadership, and consumers
4. Is willing to assume individual responsibility that contributes to the team's success
5. Commits to the success of the improvement project

• Respected by a broad range of staff
• Team players
• Excellent listeners
• Good communicators
• Proven problem solvers
• Frustrated with the current situation and ready for change
• Creative and able to offer solutions
• Flexible--demonstrated by their willingness to change and accept new technology
• Proficient in the areas and systems focused for improvement

If an organization has many individuals who are eligible and willing to serve on a QI team, the leader may use a chart, such as the one in Table 3.1, to compare potential candidates. ⁽¹⁾ This chart has been used with simple check boxes or with a Likert scale rating of 1 to 5 for each characteristic, with 1 defined as strongly disagree that the characteristic represents the person being evaluated and 5 equaling strongly agree.

Table 3.1: QI Team Selection Chart

1= strongly disagree (this characteristic does not represent this individual) 2= disagree 3= neutral, 4= agree 5= strongly agree.)

Each QI team is unique, melding together the insights and experiences of its individual members. It is important to ensure that the QI team includes members with complementary skills. The Institute for Healthcare Improvement ⁽²⁾ recommends three different types of expertise within an organization be included: 1) system leadership, 2) technical expertise, and 3) day-to-day leadership. There may be one or more individuals on the team with each expertise, or one individual may have expertise in more than one area, but all three areas should be represented in order to drive improvement successfully.

An improvement team needs a leader with authority in the organization to institute a suggested change and to overcome barriers that may inhibit its implementation. The team's system leader understands both the implications of the proposed change for various parts of the system and the remote consequences the change might trigger. It is important that the system leader has authority over all of the areas affected by the change. This person should also be authorized to allocate the time and resources the team needs to achieve its aim. ⁽²⁾

A clinical technical expert knows the subject intimately and understands the processes of care. An expert on improvement methods can provide additional technical support by helping the team determine what to measure, assisting in design of simple, effective measurement tools, and providing guidance on collection, interpretation, and display of data. ⁽²⁾

A day-to-day leader is the driver of the project, overseeing data collection and ensuring that tests are implemented. This person should understand the details of the system and the various effects of making change(s) in the system. The day-to-day leader also needs to work effectively with the physician champion(s). ⁽²⁾

Increasingly, the value of having consumers on a QI team is recognized. Consumers need training to participate in a meaningful way, but they can provide unparalleled insights into the impact of current processes and proposed changes. Those considering inclusion of a consumer on their QI team should learn from experienced improvement teams. A few resources for consideration are listed below:

• A Guide to Consumer Involvement [PDF | 555KB]
• The Two Dimensions of Quality
• The Partnership for Healthcare Excellence
• New Health Partnerships
• Improving Quality Health Care: The Role of Consumer Engagement [PDF | 346KB]
• Families USA
• How to Effectively Present Health Care Performance Data To Consumers
• Maximizing Consumer Understanding of Public Comparative Quality Reports: Effective Use of Explanatory Information
• How to Maximize Public Awareness and Use of Comparative Quality Reports Through Effective Promotion and Dissemination Strategies

Recruiting members for a team that have the right mix of expertise can be challenging--especially in small organizations. Fortunately, many of the clinical technical expertise skills, such as, QI tools, measurement tools, and data collection and display can be learned. An organization that is committed to QI should invest in the necessary training to ensure the team is adequately prepared. Most experienced QI leaders start with volunteers and then assess any gaps in the team's expertise and then recruit specific individuals who can best round out the team.

Before a QI team's membership is finalized, ensure there is buy-in from organizational leadership. It is critical to the success of the project that leadership assumes responsibility for the team entrusted to execute the QI project.

Additional resources for assisting an organization with training or ongoing support of improvement teams are listed in Table 3.2: 

Table 3.2: Additional Support Resources for Improvement Teams

Name of Tool or Resource	Description
Training-of-Trainers (TOT) Program	The TOT Program is designed for individuals with a strong experiential background in quality management; it provides participants exposure to adult learning theories and other available training resources. Graduates of TOT plan engaging and effective workshops, while linking them with QI experts and peers facing similar challenges.
NQC Quality Academy: Using Teams to Improve Quality	Creating a team-oriented environment begins at the top. Each person in an organization performs a unique function, and this module shows how to integrate these disciplines, so everyone is working towards a common goal.
The Team Handbook	The Team Handbook facilitates team building and covers the following topics: Learn how to establish teams Understand team roles and responsibilities Use teams to resolve problems and learn together Learn how to deal with conflicts This handbook is helpful for both leaders and team members and offers many strategies for helping teams work well together.
HIVQUAL Workbook - Guide for Quality Improvement in HIV Care	The HIVQUAL Workbook is a step-by-step, self-learning guide intended to give HIV providers a clear roadmap for making QI a reality in ambulatory care settings. Materials provided are adaptable to facilities, whether or not they participate in HIVQUAL, and are applicable to all HIV programs, regardless of caseload, geographic location or the service delivery model used. This tool has proven useful for many organizations who applied the QI techniques acrossed a wide variety of chronic conditions.
A Team Approach to Quality Improvement	This is a helpful book to assist in team development and highlights successful strategies teams have used to make organizational improvements.
Quality Function Deployment and Lean-Six Sigma Applications in Public Health	The purpose of this book is to introduce the concepts embedded in quality function deployment (QFD) and Lean-Six Sigma to help public health professionals implement QI within their agencies. The tools and techniques of QFD and Lean-Six Sigma are designed to augment a robust PDCA or PDSA problem-solving process--not replace it.
American Society for Quality	This is a Web site devoted to QI including specific information on the value and use of teams in QI.
Quality Improvement & Risk Management Training Module 5: What Works Really Works	Module 5 provides training to further enhance the team's role in QI.