Team Development Co-ordinator Guide

Transcription

1 Team Development Co-ordinator Guide Welcome to the Team Development Co-ordinator Guide. This document provides you with all the information you will need to administer the TCAM questionnaire, give feedback to the team and facilitate Team Development sessions. We suggest that you first read through the Introduction, Section 1, Initial Measurement of the Team Climate, and Section 2, TCAM Questionnaire Feedback Session A, of this Guide to develop an understanding of the TCAM Programme and the TCAM questionnaires. This Guide includes: an introductory section, with useful information about the TCAM notes to support each stage of the TCAM Team Development Programme TCAM checklist: As well as this document (the Team Development Co-ordinator Guide) you should have the following TCAM documents downloaded from the NPSA website: Team member Resource Book. The TCAM questionnaire Template for Scoring TCAM (Excel file) Template for the TCAM Report TCAM theory (optional). 1

2 Contents Team Development Co-ordinator Guide...1 This Guide includes:...1 TCAM checklist:...1 Contents...2 Introduction...4 Background to the TCAM Programme...4 What You Will be Doing as the TCAM Co-ordinator...7 Initial Measurement of the Team Climate...10 Initial Administration of the Questionnaire...10 Frequently Asked Questions...12 Producing the Initial TCAM Report...12 Sample Letter to Team Members...13 TCAM Questionnaire Feedback Session A...14 Session Objectives...14 Agenda and Timings...14 Preparing for the Session...15 Administering the Session Elements of Effective Team Working...21 Session Objectives...21 Agenda and Timings...21 Preparing for the Session...22 Administering the Session Effective Team Meetings...28 Session Objectives...28 Agenda and Timings...28 Preparing for the Session...29 Administering the Session Clarifying Team Roles...34 Session Objectives...34 Agenda and Timings...34 Preparing for the Session...35 Administering the Session Effective Communication...39 Session Objectives...39 Agenda and Timings...39 Administering the Session

3 3.5 Effective Decision-making...44 Session Objectives...44 Agenda and Timings...44 Preparing for the Session...45 Administering the Session Team Learning from Incident Management...50 Session Objectives...50 Agenda and Timings...50 Preparing for the Session...51 Administering the Session...52 Final Measurement of the Team Climate...55 Final Administration of the Questionnaire...55 Chasing the deadline...56 Frequently Asked Questions...57 Producing the Final TCAM Report...57 TCAM Questionnaire Feedback Session B...58 Session Objectives...58 Agenda and Timings...58 Preparing for the Session...59 Administering the Session...59 Case Studies...63 Session 3.1 Elements of Effective Team Working...64 Session 3.2 Effective Team Meetings...68 Session 3.4 Effective Communication...71 Session 3.5 Effective Decision-making...74 Session 3.6 Team Learning from Incident Management...77 TCAM Team Development Co-ordinator Log

4 Introduction Introduction This Introduction explains what the TCAM Team Development Programme will involve for both you, as a TCAM Co-ordinator, and your team. It explains the background to the development of the TCAM Programme as well as providing definitions and descriptions for you to refer to when working with your team. Background to the TCAM Programme Researchers at Aston University and Aston Organisation Development, with the support of the National Patient Safety Agency (NPSA), have constructed a measurement tool and a Development Guide to enable teams to assess and, where necessary, improve the climate within their teams. This tool, which is in the form of a questionnaire, is called the Team Climate Assessment Measure (TCAM), and the associated support programme is referred to as the TCAM Team Development Programme. Why is the TCAM Programme Important? There is increasing evidence that the climate within a team has a major impact upon patient safety and care. Findings from an analysis of the NHS National Staff Survey data collected in 2003, 2004 and 2005 indicate that working in teams appears to increase the number of errors or incidents witnessed by Team Members. However, the existence of well-structured and effective teams produces a decrease in errors and incidents while also improving the well-being of Team Members. There is, therefore, an urgent need to provide real support for teams to develop effective processes and climates that support healthcare professionals. The type of team climate required is one in which Team Members not only trust and feel safe with each other, but also one in which they are encouraged to reflect upon and learn from adverse patient incidents. 4

5 Introduction Definitions and Descriptions The TCAM (Team Climate Assessment Measure) This is a questionnaire that measures the degree to which the team demonstrates features and behaviours that are essential to effective team working. In particular, it looks at features and behaviours that affect the maintenance of patient safety and effective patient safety incident management in clinical settings. These features and behaviours are represented by 11 Dimensions (see Table 1), which are grouped into those describing the team s organisation, and those describing the culture within the team. Within some of the Dimensions listed in the table there are Components that specifically relate to patient safety and effective patient safety incident management in clinical settings; these are marked with asterisks. Team Organisation Team Culture Team Stability Participative Trust and Safety * Effective Leadership Mutual Trust * Regular Contact * Inter-professional Credibility * Team Efficacy * Individual Development * Task Reflexivity * Team Learning Behaviour * Inter-professional Learning * Table 1 The features and behaviours (Dimensions) essential to effective team working * Dimensions containing Components that specifically relate to the maintenance of patient safety and effective patient safety incident management in clinical settings The TCAM questionnaire is completed by Team Members at the beginning of the TCAM Programme and again at the end. This allows the impact of the TCAM programme on team climate to be measured. A TCAM Report is produced from the data collected and feedback is given to Team Members during Team Feedback sessions facilitated by the TCAM Co-ordinator. 5

6 Introduction The TCAM Team Development Programme The TCAM Team Development Programme comprises the following six sessions: Team Development Session 1 Team Development Session 2 Team Development Session 3 Team Development Session 4 Team Development Session 5 Team Development Session 6 Elements of Effective Team Working Effective Team Meetings Clarifying Team Roles Effective Communication Effective Decision-making Team Learning from Incident Management Table 2 The six Team Development sessions It is desirable for all Team Members to attend all six Team Development sessions if at all possible. These sessions last between 90 and 120 minutes and are facilitated by the TCAM Co-ordinator. At each session the team is expected to develop plans to bring about changes in the way the team works. Team climate Put simply, team climate is the way it feels to work here or the way things are done around here. It is the shared perception of behaviours, practices and procedures (both formal and informal) within a team. More information about the concept of climate is available in the TCAM theory file, available for download from the NPSA website The TCAM Team Member Resource Book The TCAM Team Member Resource Book is a collection of exercises, with supporting information. These exercises have been found to help teams develop and improve the various Dimensions of team climate measured by the TCAM. The TCAM Team Member Resource Book is organised by Team Development session, and each session follows the format below: Session Objectives Session Agenda Relevant materials for Team Members to use during the session. 6

7 Introduction What You Will be Doing as the TCAM Co-ordinator To enable you to be successful in your role as the TCAM Co-ordinator for your team you will need to undertake the following tasks. Identify Team Members It is important from the outset to be very clear about exactly who is in the team you are working with and who is the Team Leader. Gain the support of the Team Leader It will help you tremendously if the Team Leader understands what you are trying to achieve at each stage and how you plan to go about it. Gain the commitment of the team to participate To enable you to manage the TCAM Programme effectively in your team, you will need Team Members to be engaged in the process. This will work best if all those involved understand the purpose of the Programme and are involved in deciding how the Team sessions are organised. Develop your own knowledge To enable you to manage the TCAM Programme in your team and, if appropriate, facilitate the Team Development sessions confidently, you will find it useful to the read the appropriate sections in this Guide and familiarise yourself with the Team Member Resource Book. Organise team meetings and training sessions It will be helpful to think about who will be able to support you in this work for example, consider the following questions: How will you book rooms? How will the necessary equipment be arranged? How will you communicate times to Team Members (phone, , letter?). You will be most successful if you plan well ahead for each session. 7

8 Introduction Maintain your credibility with the team It is important to remember that you are not expected to be the team climate expert in this team; your role is to: organise and plan meetings lead Team Members through the material in the Team Member Resource Book facilitate discussions. It is the joint responsibility of the whole team to identify any changes that may be required, decide how they can be brought about and do what is necessary to bring about the change. Your role as the TCAM Co-ordinator for your team will involve you in a number of different activities: Initial questionnaire administration Ensuring that each Team Member completes the TCAM questionnaire. Analysing the responses and producing a feedback report TCAM Questionnaire Feedback session A Providing feedback to the team from this Initial TCAM Report. Session facilitation Facilitating a series of six Team Development sessions. Final questionnaire administration Ensuring that the TCAM questionnaire is re-administered to Team Members and then producing a feedback report. TCAM Questionnaire Feedback session B Providing feedback to the team from this Final TCAM Report. The complete TCAM process is illustrated on the next page. 8

9 Introduction Initial Questionnaire Completion - Team Members complete the TCAM Questionnaires analysed by the TCAM Co-ordinator TCAM Co-ordinator produces report TCAM Questionnaire Feedback Session A Team Development Session 1 Elements of Effective Team Working Team Development Session 2 Effective Team Meetings Team Development Session 3 Clarifying Team Roles Team Development Session 4 Effective Communication Team Development Session 5 Effective Decision-making Team Development Session 6 Team Learning from Incident Management Final Questionnaire Completion - Team Members complete the TCAM Questionnaires analysed by the TCAM Co-ordinator TCAM Co-ordinator produces final report TCAM Questionnaire Feedback Session B 9

10 1 Initial Measurement of the Team Climate 1 Initial Measurement of the Team Climate This Section describes how to undertake the first stage of the TCAM process the initial measurement of the team climate. This measurement provides a baseline level of team climate to compare against after your team has been through the TCAM process, and so changes in team climate as a result of the process can be assessed. The basic process for you to follow in this first stage of TCAM is to: Identify your team members Provide them each with the TCAM questionnaire for them to complete Enter each team member s questionnaire responses into the Template for Scoring TCAM Excel file to produce a baseline level of team climate. Create the initial TCAM report using the Template for the TCAM Report Word file. Each of these steps is explained in more detail below. Initial Administration of the Questionnaire The TCAM questionnaire needs to be completed by all Team Members at the beginning of the TCAM Programme. To administer the TCAM questionnaire you will need to do the following. 1 Identify your Team Members Work with your Team Leader to identify who is a member of the team for the purposes of the TCAM Programme. In our complex healthcare organisations it is likely that people work in several teams. It is also likely that you will have some people who work closely with your team who you may or may not regard as members of the team. For the purposes of the TCAM Programme you will need to identify which people you regard as full members of the team. We define a team as a group of up to 15 people who: have a common task to perform it can be helpful to ask What is the main goal or objective of this team? work closely together to achieve the task that is, Who needs to be involved on a regular basis to successfully achieve this task? have a team identity they regard themselves as a team, and others outside the team also regard them as a team. 10

11 1 Initial Measurement of the Team Climate 2 Make copies of the TCAM questionnaire Download the questionnaire from the NPSA website, and make a copy for each team member. 3 Decide how you will administer the TCAM questionnaire For the TCAM Programme to be successful it is important that as many Team Members as possible complete the questionnaire - it is desirable for all team members to complete the questionnaire. The best way to achieve this is to arrange for everyone to come together to complete the questionnaire. You will need to book a room for about an hour to give you time to: explain why the Team Members are being asked to complete this task allow enough time for the TCAM questionnaire to be completed. If this is not possible, you will need to think about how you can organise the questionnaire completion by individuals at a time of their choice; options might include: describe the TCAM questionnaire and the need for its completion at a regular team meeting, distributing them for Team Members to complete and return or send a short letter to each Team Member (a sample letter is provided at the end of this section) explaining the process for completion of the questionnaire. Whichever method you use, you will need to give Team Members the following information. Outline of the TCAM Programme Include how the questionnaire fits into the Programme. Aims of the TCAM Team Development Programme Explain why you are using the Programme with the team and what outcomes you hope to achieve. Explanation of questionnaire completion Explain that the questionnaire will be completed twice: once at the beginning of the Programme to benchmark the Team Climate and once at the end to measure any changes that have occurred during the Programme. Deadline for questionnaire completion Details of the date by which the questionnaire must be returned to you, preferably no later than 10 working days from the date of distribution. Confidentiality issues Explain the process, ensuring that Team Members understand who will see their completed questionnaire. Give an assurance that their responses will be treated confidentially. Feedback Detail the plans for giving feedback to Team Members on the team results. If possible, giving a date and venue for TCAM Questionnaire Feedback session A. 11

12 1 Initial Measurement of the Team Climate Frequently Asked Questions Although there are clear directions provided at the beginning of the TCAM questionnaire, it will be helpful if you are clear about the process and the purpose of using the measure. Given this familiarity, you can answer any questions from Team Members that arise at this stage. Here are some of the most frequently asked questions, together with suggested responses. Why do I need to complete these questionnaires? We need your views about the current climate in the team to identify what is working well and what could be improved. This information is needed to ensure that the team is able to manage patient safety and learn from any incidents that may occur. What will happen to my answers? Your answers will be collated with those of all the other Team Members and a summary report will be produced. You will receive a copy of this report at the Feedback Session when we will have an opportunity to talk in more detail about the team climate. Will my answers be confidential? Yes. When you have completed the TCAM questionnaire you should put it in an envelope and send it back to me (the team co-ordinator). I will use the data to produce a summary report. It will not be possible for anyone to identify your individual answers. Producing the Initial TCAM Report Once you have received the completed questionnaires from all team members you will need to produce the initial TCAM report which shows the team s baseline team climate measure. In order to produce the initial TCAM report you will need to download two files from the NPSA website: the Template for Scoring TCAM Excel file and the Template for the TCAM Report Word file. Use the Template for Scoring TCAM Excel file to enter the response scores of each Team Member. The spreadsheet automatically calculates the scores for the 11 Dimensions, and the Patient Safety components. These are the team s initial team climate measure. Once you have completed this, you will need to enter these scores into the Template for the TCAM Report Word file. This will be the team s initial TCAM report that will be used as feedback during the TCAM Questionnaire Feedback Session A. 12

13 1 Initial Measurement of the Team Climate Sample Letter to Team Members ((your address)) The TCAM Team Development Programme Dear As you know, our team is taking part in the TCAM Team Development Programme to investigate ways in which we need to improve team climate in order to improve patient safety. One of the first things each member of the team needs to do is to complete a questionnaire: the Team Climate Assessment Measure (TCAM). The TCAM is being used to assess the climate in the team at the beginning of the Programme and then again at the end after the team has worked through the Team Development Sessions. It is important that all Team Members complete the questionnaire and so I would urge you to do this as soon as possible and no later than ((no later than 10 days from distribution)). Please place your completed questionnaire in an envelope and return it to me. Be assured that any information you give will be totally confidential. The biographical data that you provide will not be used to identify you personally. When all Team Member responses are received, I will produce a report summarising the views of the whole team. We will then meet together, as a team, to review this report. This meeting is arranged for 2007 / this meeting will take place before If you have any questions at all about the completion of the questionnaires, or about the TCAM Programme then please do contact me. Yours sincerely TCAM Co-ordinator 13

14 2 TCAM Questionnaire Feedback Session A 2 TCAM Questionnaire Feedback Session A This section provides you with details of how to prepare for and facilitate TCAM Questionnaire Feedback session A. Session Objectives To introduce Team Members to the TCAM Dimensions and the TCAM Programme. To give feedback to Team Members from the Initial TCAM Report. To develop agreement about the team s strengths and development needs. Agenda and Timings Minimum time required 90 minutes time in minutes A-1 Introduction 5 Objectives and Agenda The TCAM Programme A-2 Ground-rules for the Team Sessions 20 A-3 The TCAM Dimensions 10 A-4 TCAM Feedback Exercise 45 Purpose of the Feedback Nature of the Discussion Structuring the Discussion Interpreting the Team s Initial TCAM Report A-5 The Next Steps 10 Outline of the Programme for this Team Session Summary 14

15 2 TCAM Questionnaire Feedback Session A Preparing for the Session Prior to running TCAM Questionnaire Feedback session A you will need to: Familiarise yourself with the processes and materials The process for feedback that takes place during this Session. Programme materials Programme materials used throughout the TCAM Team Development Programme described in Section 3.1 to 3.6. Supporting information provided for the Team Development sessions in this Team Co-ordinator Guide and the material in the Team Member Resource Book. The Initial TCAM Report Review the Initial TCAM Report that you have produced. Arrange the date and venue Date and venue If you have not already done so, arrange a date and venue for Questionnaire Feedback session A, and notify Team Members. Plan the session and prepare the following materials Ground-rules for the Team Sessions (for A-2) Prepare a flip chart headed Ground-rules for Team Sessions. TCAM Feedback Exercise (for A-4) Produce a copy of the Initial TCAM Report for each Team Member. Prepare a flip chart headed Strengths and Opportunities for Development in our Team. 15

16 2 TCAM Questionnaire Feedback Session A Administering the Session A-1 Introduction 5 minutes Objectives and Agenda Welcome Team Members and describe the objectives and content of TCAM Questionnaire Feedback session A. Refer the Team Members to the Session Objectives and Session Agenda on page 4 of the Team Member Resource Book. Explain that this feedback session will focus on the Initial TCAM Report. The TCAM Programme Explain the background to the TCAM Programme in your Trust, talking about: who will be involved How the TCAM Programme is sponsored by the National Patient Safety Agency (NPSA) and is part of the national focus on patient safety within the NHS as a whole. Explain that the team will be completing the TCAM at the beginning and at the end of the Programme. Describe the Team Development Programme using the diagram Main Events in the TCAM Programme on page 2 of the Team Member Resource Book to explain the stages in the Programme. A-2 Ground-rules for the Team Development Sessions 20 minutes Explain to Team Members that this is the first of a eight sessions where the team will meet together to discuss how well the team is working and ways in which it could be even better. Explain that it would be useful to have some ground-rules for how these sessions will work. Ask Team Members to work in pairs to complete the exercise entitled Ground-rules for Team Sessions on page 5 of the Team Member Resource Book. Allow five minutes for this exercise. At the end of the five minutes, ask Team Members for their responses to Question 1. Write these on the flip chart sheet headed Ground-rules for Team Sessions. Make sure that you have noted down all the points recorded by the group, and then go through their answers to Question 2. Revise the list of points on the flip chart by converting these additional points into positive statements. 16

17 2 TCAM Questionnaire Feedback Session A After the session, produce copies of these ground-rules to distribute to Team Members at the next team session. Encourage Team Members to give as full a description as possible of the conditions and behaviours they would like to experience in team sessions. These may include the following. Timekeeping: starting on time and keeping to the agenda. Full participation: all Team Members contributing to discussions. Listening: Team Members taking time to listen to each other s views. Challenging: Team Members explaining why they disagree with the views of a colleague and asking questions to understand the other viewpoint. Respect: Team Members treating colleagues and their views with respect. Openness: Team Members feeling safe to share their views. Focus on quality: focusing the discussion on ways to develop and increase the quality of service for the patient or client. Clear action plans: producing plans after each team session to change things that Team Members feel to be important. Commitment to action: Team Members carrying out actions they have committed to during the sessions. Confidentiality: Team Members agreeing at the end of each team session what will and will not be discussed outside the team. When the list is complete, ask Team Members if they agree that this is the way that team sessions should be run. Discuss any potential difficulties. Explain that you will bring copies of these ground-rules to the next session, one for each Team Member, and will review them at the beginning of each session as a reminder of the way in which the team will work together. A-3 The TCAM Dimensions 10 minutes Explain that the TCAM Report for your team has been produced from data provided by Team Members through the TCAM. Refer the Team Members to the Features and Behaviours Essential to Effective Team Function table on page 6 of the Team Member Resource Book. The table lists the features and behaviours (called Dimensions ) of the team climate, assessed by the TCAM questionnaire. The 11 Dimensions are organised into two groups: those describing the team s organisation and those describing the culture within the team. This division is shown in the table. 17

18 2 TCAM Questionnaire Feedback Session A Now refer the Team Members to the asterisks against nine of the eleven Dimensions listed in the table. Explain that each Dimension is associated with a general area of effective team functioning and that most also include a specific Component relating to patient safety and effective patient safety incident management in clinical settings; these are the Dimensions marked with an asterisk. Direct Team Members to the blank TCAM Report included on pages 7 9 of the Team Member Resource Book. Explain that the numbered headings, e.g. 1 Team Stability, are the same as the Dimensions. Point out that the Components relating specifically to patient safety, are described more fully here. Either talk through each Dimension and patient safety Component briefly or ask Team Members to read through the descriptions. Answer any questions they may have. Explain that Team Members will become much more familiar with the Dimensions and Components when they are looking in depth at the team s own Initial TCAM Report. A-4 TCAM Feedback Exercise 45 minutes Before beginning this exercise, it is helpful to consider the following. Purpose of the Feedback The purpose of this exercise is to discuss the feedback relating to both the team climate Dimensions and the specific patient safety Components within them. This exercise gives the whole team an opportunity to discuss and reflect on the feedback from the team s Initial TCAM Report and start to think about its strengths and development needs. Nature of the Discussion The feedback discussion should be a positive experience for the group. Actual scores can be misunderstood so it is more helpful to focus on the interpretative banding, i.e. below average, average, above average (as shown on page 10 of the Team Members Resource Book). Do not refer to the numbers too often. Instead, try to give concrete descriptions of the Dimensions based on the banding indicated in the Initial TCAM Report. Structuring the Discussion Prior to entering into the full discussion, it can be helpful to review the process taken to create the Report you are about to discuss. This can be summarised as follows. Team Members gave their views through the TCAM. The responses of all Team Members to the TCAM were collated and averaged. 18

19 2 TCAM Questionnaire Feedback Session A Interpreting the Team s Initial TCAM Report Provide each Team Member with a copy of the team s Initial TCAM Report. Explain that your team s TCAM Dimension and patient safety Component scores can broadly be interpreted as described in the TCAM Report Interpretation Table included on page 10 of the Team Member Resource Book. Suggest the Team Members look at the score for each Dimension and Component, and then read the description for the range within which the score falls on this table. Ask the Team Members to turn to the section TCAM Feedback Exercise A, included on page 11 of the Team Member Resource Book and to spend the next 10 minutes, working on their own, answering Questions 1 4. At the end of 10 minutes, lead a discussion about any points that have emerged. The following guidelines can be helpful for organising the discussion that follows. Encourage a balanced discussion Focus on the positive as well as any weaknesses identified to ensure there is a balanced discussion. Discuss expectations For Dimensions with scores that are below average, it is helpful if Team Members indicate whether they expected this. You can then agree that this area doesn't seem to be particularly strong and encourage the team to discuss further the aspects of team functioning that may explain this lower score. Summarise key features If the team did not expect a low score on some Dimensions, summarise the key features of the Dimension s description and invite Team Members to discuss what they would have expected. Review the discussion Summarise what the team has said at points during the discussion to check that you have understood. Agree a set of TCAM findings with the Team Members and note them on the flip chart sheet headed Strengths and Opportunities for Development in our Team. Ask Team Members to make a note of these on the chart TCAM Dimensions strengths and areas for development included on page 12 of the Team Member Resource Book. 19

20 2 TCAM Questionnaire Feedback Session A A-5 The Next Steps 10 minutes Provide the Team Members with an overview of the programme, as follows. Outline of the Programme for this Team Explain how the TCAM Programme will work with your team, referring back to the diagram Main Events in the TCAM Programme on pages 4 of the Team Member Resource Book. Briefly talk through the six Team Development sessions as detailed in the table Overview of The Six Team Development Sessions included on page 13 of the Team Member Resource Book. You may wish to point out that the six Team Development sessions together provide support for the team to further develop in all of the Dimensions and Components of the TCAM. Explain when and where these sessions will take place, asking the Team Members to make a note of these dates and locations on the table Session Dates and Locations included on page 13 of the Team Member Resource Book. Explain that the first Team Development session will focus on the key elements of effective team working, and confirm the date, time and venue for this session. Session Summary Invite Team Members to comment on what they liked about the session and what they would like to change for the next session. Finally: ensure that everyone is clear about the next steps for this team and the date and the venue for the next session. thank Team Members for their hard work and commitment to the programme. complete your TCAM Team Development Co-ordinator Log for this session in Section 7 of this document. 20

21 3.1 Elements of Effective Team Working - Team Development Session 3.1 Elements of Effective Team Working Team working is important for patients and staff, with research evidence suggesting benefits that include lower patient mortality, lower staff turnover, and increased levels of error reporting and subsequent learning. A good team has identifiable characteristics: this Session involves your team discussing what these characteristics are, and also involves discussion of the key concepts in a team of listening and feedback. Finally, you and your team will agree a way forward to implement changes suggested in the Session to improve on team working. Session Objectives To identify the benefits of team working. To define the characteristics of effective teams. To further enhance listening within the team. To enable effective feedback to take place within the team. Agenda and Timings Minimum time required 120 minutes time in minutes 1-1 Introduction * The Benefits of Team Working The Characteristics of Effective Teams Listening: A Key Team Working Skill 40 Effective Listening Skills Improving Listening Skills 1-5 Effective Feedback 40 The Importance of Feedback Effective Feedback Skills Planning for Feedback Improving Feedback Skills 1-6 Planning for Change 5 * Note: If any Team Members were not at the TCAM Questionnaire Feedback Session A, you may wish to add 20 minutes to the Introduction to review the highlights of the Initial TCAM Report. 21

22 3.1 Elements of Effective Team Working - Team Development Session Preparing for the Session Before running Team Development Session 1 review all session materials and prepare the following. 1-1 Introduction Prepare an overview of the TCAM Programme in your team so far (this can be on a slide or a flip chart). Produce copies (one for each Team Member) of the sheet of ground-rules created at TCAM Questionnaire Feedback session A 1-2 The Benefits of Team Working Familiarise yourself with the lists under the title The Key Benefits of Team Working on page 17 of the Team Member Resource Book. Prepare a flip chart headed Potential Benefits of Team Working. 1-3 The Characteristics of Effective Teams Prepare a flip chart headed A Great Team. 1-4 Listening: A Key Team Working Skill Familiarise yourself with the lists, Common Barriers to Effective Listening, The Benefits of Effective Listening and Rules for Effective Listening on pages of the Team Member Resource Book. Familiarise yourself with the relevant Case Studies to be used in this exercise and make a copy for each team member (see Case Studies Section 6). Prepare flip charts headed Threats to Patient Safety and Rules for Effective Listening. 1-5 Effective Feedback Familiarise yourself with the list, Rules for Effective Feedback on page 24 of the Team Member Resource Book. Prepare flip charts headed Who I give Feedback to, Why I give Feedback Effective Feedback and Improving Feedback Systems and Behaviours. Administering the Session 1-1 Introduction 5 minutes Welcome Team Members. Review the structure of the TCAM Programme by displaying the flip chart or slide you have prepared. Distribute copies of the ground-rules for team sessions, created by the team at the TCAM Questionnaire Feedback session A, and review these. If there are Team Members present who did not attend TCAM Questionnaire Feedback session A, allow slightly more time to review the TCAM Feedback session and the outcomes. Briefly outline the Session Objectives and Session Agenda for Team Development session 1. Refer the Team Members to page 14 of the Team Member Resource Book. 22

23 3.1 Elements of Effective Team Working - Team Development Session 1-2 The Benefits of Team Working 15 minutes If the team has seven or more members Divide the Team Members into groups of three or four and ask the groups to think of as many potential benefits of team working for patients and staff as possible within three minutes. They should note these down in the spaces provided under the headings Potential Benefits of Effective Team Working for Staff and Potential Benefits of Effective Team Working for Patients or Clients on pages 15 and 16 of the Team Member Resource Book. One person from each group should be chosen to jot down the group s thoughts. After three minutes, collect all the ideas onto your flip chart headed Potential Benefits of Team Working. Note the areas of agreement between groups and ask Team Members to point out which ones they think would particularly impact upon patient safety. Refer Team Members to the three lists relating to The Key Benefits of Team Working on page 17 of the Team Member Resource Book. These lists show: 1. the evidence the effects of team working for which there is research evidence 2. the benefits the benefits of team working, predicted by several senior clinical teams with which the Aston research team has worked 3. patient safety those factors that are predicted to impact on patient safety. If the team has fewer than seven members For this smaller number of Team Members, run the exercise as above, but instead of working in small groups, ask Team Members to work in pairs to produce their ideas on the potential benefits of team working for patients and staff. 1-3 The Characteristics of Effective Teams 15 minutes Ask Team Members to think about and discuss with their neighbour the best team they have ever worked in or the team they would love to work in. During the discussion, they should note down the things that made that team so good for them, under the heading A Great Team on page 18 of the Team Member Resource Book. Emphasise that Team Members should be as specific as possible about the elements they felt to be important. 23

24 3.1 Elements of Effective Team Working - Team Development Session After three or four minutes collect the elements noted by Team Members and note these onto your flip chart headed A Great Team. Through discussion try to ensure that the list contains the following: All Team Members are clear about the team s aims Everyone is committed to team objectives Everyone is clear about their role Effective communication processes are in place There are high levels of trust and respect There is little conflict The team is focussed on the patient or client The team has good relationships with other teams Ways of working are regularly reviewed There is clear leadership. You may wish to ask Team Members to say how often this team demonstrates these characteristics and if there is any room for development. Ask Team Members to say which skills they believe they must have to enable the development and maintenance of effective teams; note these on the flip chart. If listening and feedback are not listed, ask Team Members if they feel these to be important. Explain that these appear to be two of the basic skills that are often forgotten but that seem to be most influential in teams. 1-4 Listening: A Key Team Working Skill 40 minutes Effective Listening Skills Distribute copies of the relevant case study to Team Members. These case studies are located in Case Studies Section 6 of this document (you should have copied sufficient quantities of the appropriate case studies for the Team Members prior to this session). Case Studies 1A and 1B are appropriate for Acute Care environments. Case Studies 1C and 1D are appropriate for Primary Care environments. Case Study 1E is appropriate for Mental Health environments. Allow the Team Members five minutes to read these case studies. Now ask them to work in groups of three or four to identify examples of ineffective listening that occurred which threatened patient safety and what caused these to happen. Team Members should note down their thoughts under the heading Threats to Patient Safety on page 19 of the Team Member Resource Book.. Allow the Team Members 15 minutes to complete this exercise. 24

25 3.1 Elements of Effective Team Working - Team Development Session After this period, ask the Team Members to share their observations, and summarise the key points, noting these onto your flip chart headed Threats to Patient Safety. The following lists of key points from the case studies can be used as a basis for your discussion. Case Study 1A Acute Trust Teams The nurse, distracted by the equipment and by other staff, did not listen attentively to the anaesthetic registrar. The nurse did not record the information provided and did not remember the detail of the information. The anaesthetic registrar did not ask the nurse to listen and to make a note of the information being provided. Case Study 1B Acute Trust Teams The nurse was distracted by another patient. The patient was not listened to when he expressed concerns about the medication. The sister did not believe that a mistake could have been made and therefore there was no opportunity for review and learning from the incident. Case Study 1C Primary Care Teams Team members did not listen to the concerns of another Team Member. Assumptions were made based on availability of materials; rather, there appeared to be no consideration given to the final objective of the work being undertaken. The new Team Member did not feel able to insist that she was concerned that an error had been made. Case Study 1D Primary Care Teams There was a lack of communication between Team Members as well as a lack of clear protocols and procedures. The patient s explanations were not listened to. Case Study 1E Mental Health Teams The bank nurse was distracted and too busy to listen. There appeared to be no hand over between shifts There was no time to reflect or plan to listen more carefully when things were quieter It appears that there was little regard for the potential input from a patient. Improving Listening Skills Refer Team Members to the lists headed Common Barriers to Effective Listening, The Benefits of Effective Listening and Rules for Effective Listening on pages of the Team Member Resource Book. 25

26 3.1 Elements of Effective Team Working - Team Development Session Ask Team Members to reflect on these points in relation to what happens in this team and answer the questions on the Individual Action Log entitled improving listening skills on page 21 of the Team Member Resource Book. All types of Trust teams should complete this log. Invite Team Members to share key points, noting these onto your flip chart headed Rules for Effective Listening. Finish this part of the session by referring Team Members to the Rules for Effective Listening on page 20 of the Team Member Resource Book, comparing your conclusions. 1-5 Effective Feedback 40 minutes The Importance of Feedback Ask Team Members to say to whom they need to give feedback to in their work roles. Note their responses onto your flip chart headed Who I give Feedback to. Ensure that the following individuals or groups are included: the Team Leader other Team Members clinical leads members of other teams that work with our team patients or clients. Now ask Team Members, Why do you give Feedback? Note their responses onto your flip chart headed Why I give Feedback. Ensure that the chart includes the following: to ensure the best possible care for the patient to improve care processes and procedures to ensure that learning from errors and mistakes is shared with others to celebrate successes to provide support to others in the team to resolve differences with team colleagues. Effective Feedback Skills Ask Team Members to work in pairs to complete the exercise Experiences of Feedback, on pages of the Team Member Resource Book. Ask the Team Members to share the key points from the good experience with the team (Questions 1 3). Note these up onto your flip chart headed Effective Feedback. 26

27 3.1 Elements of Effective Team Working - Team Development Session Ask Team Members to share the key points from the less than good experience with the team (Questions 4 6). Use these, turned into a positive statement, to supplement the Effective Feedback flip chart where necessary. Refer Team Members to the Rules for Effective Feedback on page 24 of the Team Member Resource Book. Planning for Feedback Ask Team Members to think of something, related to working practices that needs to be changed and that requires someone from outside the team to do something differently. Agree one issue to work on. Now ask Team Members to work in pairs or groups of three to complete the exercise Planning for Feedback on page 25 of the Team Member Resource Book. Allow five minutes for small group discussion. Collect ideas about who might take what actions to bring about the required changes. Improving Feedback Skills Each Team Member should now complete the Individual Action Log entitled improving feedback skills on page 26 of the Team Member Resource Book. Invite team members to share their thoughts about the ways in which the team could improve its feedback systems and behaviours. Note these up onto your flip chart headed Improving Feedback Systems and Behaviours. 1-6 Planning for Change 5 minutes Review the suggestions for changes that have been produced during the session and, as a team, agree which specific actions will be undertaken and by whom. Remind Team Members that progress on these Actions will be reviewed at the next Team Development Session. Make a note of the agreed actions in your TCAM Team Development Co-ordinator Log for this session in Section 7. Finally: ensure that everyone is clear about the date and the venue for the next Team Development session thank Team Members for their hard work and commitment to the programme. finish completing your TCAM Team Development Co-ordinator Log for this session.. 27

28 3.2 Effective Team Meetings - Team Development Session 3.2 Effective Team Meetings Research has shown that healthcare teams that meet regularly are more innovative than those that do not. Meetings are one of the most effective ways teams have for sharing information, co-ordinating activities and making decisions together. In addition, team meetings give Team Members an opportunity to build mutual trust and respect. It is therefore crucial for meetings to be run effectively and for all Team Members to feel able to contribute. This Session identifies desirable key features of team meetings, discussion of ways to assess existing effectiveness of meetings, and ways to improve meetings in the future. Session Objectives To review actions taken since Team Development session 1. To identify the key features of effective team meeting management. To assess the current effectiveness of team meetings. To develop plans to improve meeting processes and outcomes. Agenda and Timings Minimum time required 90 minutes time in minutes 2-1 Introduction and Review 15 Review of Actions Session Introduction 2-2 The Key Features of Effective Team Meetings Meetings for Patient Safety The Effectiveness of Current Meetings 30 Features of Effective Meetings Improving the Effectiveness of Meetings 2-5 Planning for Change 10 28

29 3.2 Effective Team Meetings - Team Development Session Preparing for the Session Prior to running Team Development session 2 review all session materials and prepare the following. 2-1 Introduction and Review Prepare an overview of the TCAM Programme in your team so far (this can be on a slide or a flip chart). Prepare a flip chart listing the ground-rules created by Team Members at TCAM Questionnaire Feedback session A. Remind yourself of the actions agreed at the end of Team Development session 1 (as detailed in your TCAM Team Development Co-ordinator Log). Prepare notes on the reasons for including a session on effective team meetings. 2-2 The Key Features of Effective Team Meetings Prepare flip charts headed: Before the Meeting, During the Meeting, After the Meeting. 2-3 Meetings for Patient Safety Prepare a flip chart headed Meetings for Patient Safety, 2-4 The Effectiveness of Current Meetings Familiarise yourself with the relevant Case Studies to be used in this exercise and make a copy for each team member (see Case Studies Section 6). Produce sufficient copies of the relevant case study for use by Team Members during the session. Familiarise yourself with the Meetings for Patient Safety Checklist on page 31 of the Team Member Resource Book. Prepare a flip chart headed Increasing Effectiveness in Team Meetings. Administering the Session 2-1 Introduction and Review 15 minutes Welcome Team Members and review the structure of the TCAM Programme and where this session fits in. Display the flip chart or slide you have prepared to illustrate this. Turn to your flip chart showing the ground-rules developed at TCAM Questionnaire Feedback session A (or ask Team Members to look at their copy) and review them. 29

30 3.2 Effective Team Meetings - Team Development Session Review of Actions Remind Team Members of the actions planned at the end of the first Team Development session (you will have copied these to your TCAM Team Development Co-ordinator Log and can work from this). Ask Team Members to say what they have done in relation to these or other areas of team working since the last session. Ensure that they identify and make plans to complete any unfinished actions. Remember to note the actions taken in your TCAM Team Development Co-ordinator Log. Session Introduction Briefly outline the: Session Objectives and Session Agenda for Team Development session 2. Refer the Team Members to page 27 of the Team Member Resource Book. Explain to Team Members the reason for including a session on effective team meetings in the TCAM Team Development Programme; you may wish to include the following information: Research has shown that healthcare teams that meet regularly are more innovative than those that do not. Meetings are one of the most effective ways teams have for sharing information, coordinating activities and making decisions together. In addition, team meetings give Team Members an opportunity to build mutual trust and respect. It is therefore crucial for meetings to be run effectively and for all Team Members to feel able to contribute. 2-2 The Key Features of Effective Team Meetings 15 minutes Divide the team into three subgroups and ask each subgroup to focus on one area in the exercise entitled What Makes a Meeting Effective? on page 28 of the Team Member Resource Book. Explain: subgroup 1 should focus on before the meeting subgroup 2 should focus on during the meeting subgroup 3 should focus on after the meeting. Allow five minutes for this exercise. After five minutes, ask Team Members to share their thoughts about the factors that contribute to an effective meeting. Note onto your flip chart sheets headed Before the Meeting, During the Meeting and After the Meeting what Team Members felt had made the team meetings they remembered successful. 30