Music Only Course # - ID-2017-47 1
This webcast includes spoken narration. To adjust the volume, use the controls at the bottom of the screen. While viewing this webcast, there is a pause and reverse button that can be used throughout the presentation. The written version of the narration appears to the right of the screen. Course # - ID-2017-47 2
In previous modules, we have often referred to Quality Improvement or QI Teams. In Module 104, you will learn why QI Teams are integral to achieving long term, sustainable improvement. You will also learn how to facilitate a QI Team. We introduce FOCUS as part of the PDCA model. We will cover how FOCUS is addressed through the W s of QI Teams: Why are QI Teams used? What is a QI Team and how is it different from other groups? Who authorizes convening a team and who comprises the membership of a QI Team? When is it time to convene a QI Team? And, what does a QI Team do? We will also review what you, as QM staff, will do: Select or recommend team members Fulfill your role as a QI Team member Know what to do to convene a team And, as part of knowing how to facilitate the team, guide the team in the use of appropriate QM tools Course # - ID-2017-47 3
So far we have discussed only two quality management models the DDRI and the PDCA. Now we would like to introduce the FOCUS part of the PDCA model into these QM modules. FOCUS succinctly describes each of the W s of QI teams which we will cover in greater detail: F find a process to improve O organize a team that knows the process C clarify what is currently known about the process U understand how the process may vary during implementation S select a strategy to improve the process Let s begin with examining why a QI team should be used Course # - ID-2017-47 4
Why use a QI Team? At its core, quality improvement is a team process. Under the right circumstances, a team harnesses the knowledge, skills, experiences, and perspectives of its members to achieve significant and lasting improvements. Because a QI Team s members are part of the system and know the process well, they generate solutions more likely to succeed. Using a QI Team addresses the O in FOCUS that calls for a team that knows the process well. Citation: "Official Web Site of the U.S. Health Resources & Services Administration." Official Web Site of the U.S. Health Resources & Services Administration. Department of Health and Human Services, n.d. Web. 21 Apr. 2014. Course # - ID-2017-47 5
What then is a QI Team? In the literature, there are various definitions of a QI Team but they are all similar in their descriptions: A group, which is convened to accomplish a specific task But what really makes a group a QI Team are two things: 1. QI Teams apply the tools and techniques of quality management to accomplish the task; and 2. The way a QI Team is structured and how it functions. As we proceed through Module 104, these two concepts will be explained and illustrated in greater detail. Citation: "Quality Glossary T." ASQ. American Society for Quality, n.d. Web. 17 Oct. 2014. Course # - ID-2017-47 6
Let s consider when the situation calls for convening a QI Team. There are numerous reasons for convening a QI Team but most often it is a response to either an internal or external force impacting the organization. It could be that the structure or processes are outmoded or are no longer efficient and sustainable. There may be a need to efficiently use resources or to address the concerns of stakeholders or to improve customer satisfaction. It could be that prior efforts to address a long standing problem haven t succeeded; or it could be to accomplish a culture change. This essentially is the same as the F in FOCUS: Find a process to improve. A QI Team is called for when we want to take advantage of the staff s diverse perspectives and expertise to optimize performance. Citation: Scholtes, Peter R. The QI Team Handbook. 2nd ed. Madison, WI: Oriel Incorporated, 2000. Print. Citation: Brown, Janet A. The Healthcare Quality Handbook. 15th ed. Pasadena, CA: Managed Care Consultants., 2000. Print. Course # - ID-2017-47 7
So, who convenes a QI Team? Actually, anyone can raise the need for a QI Team to be convened but it is leadership that actually authorizes the convening of the team. So once a recommendation has been made, the purpose must be presented to leadership. Only after leadership gives the authority, can the QI Team be convened. It is the responsibility of leadership to fully clarify the work of the team. The process or system to be improved needs to be clearly identified, and the expected outputs and outcomes need to be defined. Leadership also needs to establish the limits of the team s work. These limits may include such things as the team s authority for decision making, the timeframe the team has to achieve its purpose, and what resources are available. Leadership needs to buy in and support the QI Team s work if it is to succeed this includes committing resources. The need for support cannot be emphasized enough. Course # - ID-2017-47 8
Who then comprises a QI Team? There are three key roles that need to be filled. The overarching purpose or objective of the team will guide who is designated by Leadership to be the QI Team Lead. For example, if the process to be improved is a risk management function, the agency s Risk Manager may be identified to be the lead. Leadership, along with the newly named QI Team Lead, will then identify the team facilitator and a proposed list of members. Members are identified who can contribute to achieving the purpose of the team. Representatives that know well the process or system to be improved should be invited to participate, including those whose functions or disciplines might be impacted by the improvement. Course # - ID-2017-47 9
For a QI project team to be effective, it is essential to select the right team members with the right skills. Citation: Lenderman, Harry, Heather Reffett, John Moran, and Margaret Beaudry. "Selecting Quality Improvement Team Members." Selecting Quality Improvement Team Members 1 (2014): n. pag. 19 May 2014. Web. 21 Apr. 2014. Course # - ID-2017-47 10
Identifying each person who should be involved may take time initially as the team evolves. As members are named, they may have their own recommendations for additional members to be considered. Approximately 5 8 members is ideal; however, having a group with expertise and knowledge of the process takes precedence to limiting the size of the group. Representatives from different levels of the organization may or may not be considered. If the system or process is cross functional or incorporates multiple disciplines, members should represent each of the functions or disciplines so their input is incorporated. Team members chosen may or may not currently have a job duty or responsibility with the process or system being improved. Subject Matter Experts (SMEs) and Ad Hoc members are people whose expertise or input may be needed at some point in the work of the QI Team; however, they may not need to attend every meeting, being included or consulted only when their expertise is required. This helps to keep the team a more manageable size. Course # - ID-2017-47 11
Once a team has been identified, the Lead chosen, the Facilitator named, and members selected (or still in the process of being selected) just what makes it a QI Team? Course # - ID-2017-47 12
A QI Team s commitment takes precedence over personal agendas or the agenda of any other group the member represents outside of the QI Team. QI Team members are empowered to act and have the authority to make decisions within the limits established by leadership or sponsoring group when the QI Team was established. QI Teams function in a collaborative way because when the QI Team succeeds all succeed as well as their parent group or organization. QI Team members hold each other responsible and accountable in a collaborative and supportive manner while committee members function as individuals within a group. Course # - ID-2017-47 13
QI Team members use QM tools, methods and practices to achieve results; such as brainstorming, evidence based decision making, and PDCA, or Plan Do Check Act. QI Teams use action plans that are flexible and adaptable as the QI Team s work progresses. When making decisions with consensus, each member agrees. This is in contrast to a vote or compromise, where someone must give up something while other members may not. In establishing their own ground rules, members agree how they will work together as a group to optimize time and outputs. Course # - ID-2017-47 14
So, how do you transform a group of people that may or may not commonly work together to function as a QI Team? By incorporating the practices of quality management into a group s activities, and by adapting the culture of the group to one of collaboration and mutual support. And therein lies the key One of the biggest challenges confronted by organizations is how to turn staff into a highly functional and effective QI Team. Quality Management at its best is a collaborative process that synthesizes the knowledge, experience, expertise, and innovation that each member of the team contributes. Course # - ID-2017-47 15
Everything is in place. Leadership has approved the convening of the team, and has established the purpose and expected results, as well as a timeframe. The QI Team Lead, Facilitator and members have been identified and are all on board. So where do we go from here? As the QI Team Lead convenes the team with an organizational meeting, let s explore each of the roles associated with a QI Team and related responsibilities. Depending on the purpose of the QI Team and the task to be achieved, roles and responsibilities can vary. However, the three key roles every team will have include the Lead, the Facilitator, and the team member. Each role carries with it specific responsibilities. You may also refer to the QM Certification Module 104 Handout: Team Member Roles and Responsibilities. Citation: Scholtes, Peter R. The QI Team Handbook. 2nd ed. Madison, WI: Oriel Incorporated, 2000. Print. Course # - ID-2017-47 16
The QI Team Lead manages the team and represents leadership. From the very first organizational meeting, the Lead continues to educate and keep the team members on track with the group s purpose and priorities, as well as timeframes and limits of decisions and actions. The Lead works to achieve consensus, assesses progress, supports skill development, and asks for volunteers or makes assignments. The Lead is the liaison between the team and others, providing updates of organizational decisions and activities which may impact the team. The QI Team Lead is an advisor and a communicator. Course # - ID-2017-47 17
The QI Team Facilitator is key to the formation of a true QI Team. The Facilitator mentors and models quality management and provides quality management technical assistance. This includes DDRI, data collection and operational definitions, the organization, analysis and interpretation of data and the application of QM metrics. The Facilitator helps the QI Team to develop improvement plans, PDCA, action plans, system design and process steps, and policy recommendations. The Facilitator provides feedback to the team and helps to summarize key points. The Facilitator solicits input from each member, checks consensus, and helps the Lead to assess the QI Team s progress and assures the team is sticking to the meeting agenda, objectives and timeframe. The Facilitator may make suggestions and recommendations for implementation; but does not participate in decision making and does not assign or direct staff. The QI Team Facilitator is not a team member and remains neutral and objective, while helping to clarify the various roles and responsibilities of each member type. The Facilitator assures the team functions effectively by applying quality management methodology. Course # - ID-2017-47 18
Each QI Team member helps move the team s work forward. Members follow the ground rules they brainstormed for how the team will function. Members volunteer to fill different QI Team tasks, complete assignments and meet timelines. Each member needs to communicate clearly and contribute to the QI Team s activities, including discussion, data analysis, reports, and evidence. Members are the ones who identify opportunities for improvement. They also identify obstacles or barriers to the QI Team s work or action plan activities; and consequently propose solutions to these barriers, including recommendations for process or system change. Perhaps most important, each QI Team member needs to attend meetings and come prepared. Course # - ID-2017-47 19
In other words, QI Team members do the work of the team. Team members, one might say, are the wealth of the QI Team. They have the expertise, awareness of issues and concerns, and are the source of solutions and improvements. They are the wealth of the QI Team. Course # - ID-2017-47 20
Special roles may be assigned to team members, or members may volunteer to fill these functions. It is up to the team to determine how and whether to fill these roles when they are developing their team ground rules. It might be helpful to have a technical role filled by someone who is an information specialist. This member could be of great help in providing data displays, spreadsheets, setting up virtual meetings, archiving files, etc. Someone who fulfills the role of scribe would keep track of meeting plans, schedules, attendance, discussion and results. These activities could become problematic if they are not addressed when the group is first formed, so it is essential to decide how these will be managed in those early team discussions. The role of the scribe may rotate among team members if it is so decided. Subject Matter Experts, or SME s, may be called in as needed, they may attend most meetings, or even be a team member. Again, it is an issue to be addressed early on in the team s forming. Ad Hoc members might provide input on a less frequent basis. Stakeholders who may be impacted by the team s work might also be called on to fulfill a special role for the team. Also note that there may be people who play more than one role in the QI Team. Regardless, what is important is that the work of the Team gets completed, no matter who fulfills which role. Course # - ID-2017-47 21
Thank you Ann. Now that we have discussed the various roles and responsibilities within the QI Team, let s go back to that first organizational meeting which the Lead has convened. It is important for members to be aware that all groups go through stages. These have consistently been referred to as: Forming Storming Norming, and Performing Knowing that a QI Team goes through these stages and what occurs during each one, helps the team to be aware, to anticipate, and to address the issues that may arise relative to the stage they are in. It also helps to guide the work of the team: certain activities or outputs are associated with various stages. Course # - ID-2017-47 22
When the group is initially convened, the stage is referred to as Forming. Another descriptor is that it is slow to start. Members are excited, enthusiastic and happy to be on board. They are on their best behavior. However, there is also some uncertainty about just what one s role is, how to contribute, and to learn, as in any group, how to work together and collaboratively. It is a time to begin to understand the task and expectations of the team. It is also a time when members take the opportunity to vent about what they feel is wrong, and to criticize leadership. These are all typical dynamics during the beginning of team formation and serve a purpose in its development. There are some other important things that need to happen during the initial meetings of the group Citation: Scholtes, Peter R. The QI Team Handbook. 2nd ed. Madison, WI: Oriel Incorporated, 2000. Print. Course # - ID-2017-47 23
Establishing ground rules is one important activity that occurs during the Forming stage. Ideally, this is one of the agenda items for the first meeting. It serves various purposes: First, it is an opportunity to utilize the QM tool brainstorming. All team members have equal standing as each contributes to the ground rules by participating in the brainstorming. Establishing ground rules also offers the members an opportunity to become acquainted with one another. This brainstorming session can be conducted as a light hearted and fun ice breaker to kick off the team s work. At the same time, the importance of these ground rules to the team s success cannot be overemphasized. As the group transforms into a QI Team, ground rules communicate to members how to handle situations before they occur. As discussions are held and decisions are made, a reminder about any one of the ground rules can literally help keep the team grounded, address a challenge they are currently facing, and get through the second, Storming, stage. Course # - ID-2017-47 24
The rules do not have to be complicated or confusing. At times they may seem extremely simple. But the important point is that they need to be agreed to through consensus, known and followed. This is not simply an exercise it is the establishment of guiding principles for the team, without which it may not meet success! So, the first rule may be, simply, Members will follow the ground rules. And you can take it from there. Everyone is sure to have a contribution, and it is a good way to know what is important to each member. Examples of some other rules might be: Decisions will be made by consensus Acknowledge that each member has something of value to contribute Feedback will be constructive, not derogatory or personal There is no such thing as a silly question Assignments will be equitable Meetings will begin on time, and Full attention is given to the task at hand, not the mobile phone You may also refer to the QM Certification Module 104 Handout: Example Team Ground Rules. Course # - ID-2017-47 25
Guiding documents can set the stage for the team s work and are introduced during the initial organizational meeting of the Forming stage. The Team Purpose document is developed based on leadership s input. The meeting Agenda is established by the Team Lead with oversight from the QI Facilitator. QI Facilitator oversight of agendas and other team documents is to assure that quality management is embedded throughout and to help guide the team s work. A very high level Action Plan may be introduced to jumpstart discussion. At this point in the team s work, the content would be driven by leadership s specific expectations for outputs and process. As the team s work progresses, the Action Plan develops into a living document that can be modified from meeting to meeting. It also serves the function of a team progress report and gives guidance to those responsible for specific action steps. Course # - ID-2017-47 26
Although each QI Team is unique to its purpose and the interpersonal dynamics of the team members, the stage that the team is in is determined by what occurs during team meetings and discussions. During the Storming stage, individual team members may feel disgruntled and may not look forward to continuing to participate or meet with the team. Some of the progress that was realized during the Forming stage may be lost. Until the team hits its stride, progress may vary. For example, following the initial organizational meeting, the team will begin to clarify what is currently known about the process they seek to improve the C part of the FOCUS model. Depending upon their individual perspectives, members may disagree. Through discussion and with support from the QI Facilitator, the team begins to understand why the process is not functioning in an optimal way. Getting to this point of understanding, the U in the FOCUS model, is a good indication that the real work of the team has begun. The QI Facilitator needs to anticipate disagreement and be ready to intervene with a comment, a reminder, a suggestion, or an activity such as an ice breaker or a fun exercise to lighten the mood. There are many resources on the Internet which the facilitator can explore beforehand to have something in mind should the need arise. The QI Facilitator will also remind the QI Team that this is a normal progression in their evolvement and they are actually making progress because they are evolving through the stages. Also understanding the source of variation is critical to selecting the process steps that need to be improved selecting is the S in the FOCUS model. This, then, lays the foundation for PDCA (Plan, Do, Check, Act) coming up with a plan or list of improvement actions that will be taken and monitored to see if they actually do work. Citation: Scholtes, Peter R. The QI Team Handbook. 2nd ed. Madison, WI: Oriel Incorporated, 2000. Print. Course # - ID-2017-47 27
Again, the QI Facilitator may find it helpful to share information early on about the four stages and the challenges teams face, so that everyone is aware and does not become discouraged when things do not go smoothly it is all part of the birthing process of a highly functional QI Team. Note that there is a difference between what a QI Team does and what happens when an organization engages in team building. The overarching objective for a QI Team is an improved or better product. The overarching objective in team building focuses on how a group or team functions. Citation: Okes, Duke, and Russ Westcott. The Certified Quality Manager Handbook. 2nd ed. Milwaukee, WI: ASQ Quality, 2001. Print. Course # - ID-2017-47 28
To further illustrate the differences, this slide lists what QI Team activities are all about: Monitoring Data analysis Reporting Improvement planning, and Making recommendations This is in contrast to team building exercises such as rope courses or company celebrations. Team building is all about the group dynamics, whereas a QI Team is about the finished product. Citation: "What Is Team Building?" WiseGEEK. Conjecture Corporation, n.d. Web. 21 Apr. 2014. Course # - ID-2017-47 29
The next team stage, Norming, starts to manifest when the members of the QI Team become more familiar with one another, the challenges of the task, and quality management methods. Meetings, discussions and work begin to take on more of an ease and flow; however, that is not to say that on occasion, the team may slide back to that Storming stage! Keep in mind that all it takes is one person to influence or change the dynamics of a team process. This is most often noticed when someone new joins or a member that has been absent for a while begins to participate again. A QI Team that has evolved to the Norming stage will be able to absorb this without much disruption and continue to make progress. Meanwhile, the QI Facilitator continues to support the team but maintains an objective, neutral perspective in order to assure that the team s work products reflect team members collaboration and are not influenced by any one person and truly are a product of the whole. Because quality management is a practice where expertise is developed over time and with experience, the QI Facilitator may find that as the team progresses through the four stages, the need to jump in may diminish with time as the members develop a better understanding. Citation: Scholtes, Peter R. The QI Team Handbook. 2nd ed. Madison, WI: Oriel Incorporated, 2000. Print. Course # - ID-2017-47 30
During the fourth stage, Performing, many of the hurdles QI Teams generally confront during the Forming, Storming and Norming stages have already come up. Over time the ground rules established early on will have been tested and perhaps even modified to meet the team s needs. So by the time the QI Team gets to the Performing Stage, the team has had an opportunity to work through many challenges. They have worked through the FOCUS steps and should be well on their way to the P, or Plan step in PDCA. Citation: Scholtes, Peter R. The QI Team Handbook. 2nd ed. Madison, WI: Oriel Incorporated, 2000. Print. Course # - ID-2017-47 31
So when do you know your group has truly transformed into a QI Team? Here are some clues: QI Team members work to achieve consensus versus majority vote decision making. Terms used or methods suggested to solve problems or improve processes reflect the concepts of QM, its methods and tools. QI Team members utilize QM terminology during discussions; for example, PDCA, evidence based, or sustainable. QI Team members suggest that discussion of an issue would benefit from a QM tool such as a Pareto chart, Fishbone diagram, or flowchart. And Course # - ID-2017-47 32
when the work of the QI Team, using quality management methodology and tools, results in demonstrable continuous improvement. The next part of the QI Process is applying the PDCA model. This helps to identify an improvement strategy to implement. The QI Plan objectives specify what is to be achieved, how it will be measured and the timeframe. The Action Plan details how those objectives will be achieved. Results are monitored and reported by analyzing data to determine the success or likelihood of success of the improvement strategies. Repeating this cycle incrementally helps us to discover what activities lead to success. This results in crafting a process that is efficient and successful. What is learned about what results in the desired outcome is then used to inform policy and training needed to sustain improvement in the long term. Remember at the beginning of this presentation when we asked the question, Why use a QI Team? The answer was that QI Teams do the work of Quality Improvement and this slide, in a nutshell, describes that work. Course # - ID-2017-47 33
A QI Team, unlike an Advisory Board, Executive Leadership or a Committee, does not go on indefinitely. Usually, there is a beginning point and an end point. But how do you know? And who decides anyway? Generally... When the purpose in the original guiding document has been fulfilled When all of the associated work of the QI Team has been completed When recommendations have been made by the QI Team and adopted, or not, by leadership When policy has been developed to embed successful strategies into business operations then the QI Team recommends to leadership to disband the team or leadership decides to disband the team. Course # - ID-2017-47 34
Except you might not be done! There are circumstances when, for a variety of reasons, leadership wants to continue the team. QI Teams are often focused on achieving a process improvement, or a specific desired result, such as a decrease in restraints. But oftentimes, the process being focused on is just one part of a system being developed or improved. Breaking a system down into its individual parts helps to isolate the bottleneck or where the system is breaking down. If there are multiple system failures, the QI Team that has hit its stride and understands QM methodology and has demonstrated success, is now an asset to the organization, because there has been a return on the investment of the resources allocated towards the team s development and purpose. Leadership may want to take advantage of that. Instead of disbanding the QI Team, leadership may utilize the team to address another process within the same system or use their experience to design a new system with quality built in from the start. Course # - ID-2017-47 35
Regardless, it is time to celebrate! The work of quality improvement has been done. QM concepts, methods and tools were practiced. Evidence based decisions were made through consensus. Successful strategies, or Lessons Learned, are now embedded in policy and daily routine tasks to assure improvement is sustained. In other words, Quality is built in and is a way of doing business by everyone in the organization! Course # - ID-2017-47 36
This concludes our presentation for today. We look forward to continuing our discussion with you in Part 2 of the QI Teams module, as we see how the concepts covered in Part 1 are illustrated by a virtual QI Team. Course # - ID-2017-47 37
Electronic resources supporting this Module are available online on MyODP.org at the links provided on this slide. If you have not yet received a user name and password to access MyODP, instructions for obtaining a login are on the website s home page. Course # - ID-2017-47 38
This webcast has been developed and produced by the Pennsylvania Department of Human Services, Office of Developmental Programs in partnership with The Columbus Organization. Thank you for participating in this lesson. Course # - ID-2017-47 39
Quality Management Certification - Module Course # - ID-2017-47 40