LSHP Ch 11

what is Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)

a program developed by the depo of defense and the agency for health care research and quality AHRQ to integrate teamwork practice

what are roles?

a set of expected behaviors that fit right together into a unified whole and are characteristic of persons in a given context

real (command) groups

accomplish tasks in organizations and are recognized as a legitimate organizational entity members are interdependent share a set of norms generally differentiate rolls and duties among themselves are organized to achieve ongoing organizational goals are collectively held responsible

what is a task force

ad hoc committees appointed for a specific purpose and a limited time they work on tasks and problems or projects that cannot readily be handled by the org through normal activities and structures often deal with problems that cross departmental boundaries generate recommendations and disband

what are different types of tasks

additive disjunctive divisible or conjuctive

group

an aggregate of individuals who interact and mutually influence each other

evaluator critic

appraises the quantity and quality of the groups accomplishments

what is storming

as the group develops members wrestle with roles and relationships conflict dissatisfaction and competition arise related to procedures and behavior and compete for power

what three steps does TeamSTEPPS involve and what has been found about it

assessing the need training onsite implementing and sustaining training it was found that safety orientation can be taught and that nurses can learn to practice and evaluate high reliability behaviors in practice

what does homans framework indicate

background factors the managers leadership and the organizational system influence the normal development of the group

why are group norms enforced?

because they serve to facilitate group survival ensure predictability of behavior help avoid embarrassing interpersonal problems express the central values of the group and clarify the groups identity

how can a leader increase meeting effectiveness

by not letting one person dominate the discussion by separating idea generation from evaluation by encouraging members to refine and develop the ideas of others recording problems ideas solutions for all to view checking for understanding periodically summarizing info and group progress encouraging further discussion bringing disagreements out into the open and facilitating their reconciliation

preparing for the first meeting of a temp task force

clarify objectives in specific measurable outcomes, determine membership task completion date plan how often ant to whom task force should report personality is important must have good interpersonal skills also include 1-2 people that oppose the task force in order to solicit their input and involve them in the decision making process

what are roles classified as and what are the 12 roles?

classified as task roles or socioeconomic nurturing roles task roles are initiator-contributor info seeker info giver opinion seeker opinion giver elaborator coordinator orienter evaluator-critic energizer procedural technician recorder

what does preparation for a meeting entail

clearly defining the purpose of the meeting an agenda should be prepared to determine who needs to be there make assignments distrivute relevant material arragne for recording of mimutes and select an appropriate time and place or the meeting agenda should be given 7 to 10 days prior to the meeting

formal groups

clusters of individuals designated temporarily or permanently by an organization to perform specified organizational tasks may be laterally vertically or diagonally

what groups are permanent or temporary

command groups teams and committees are usually permanent where task groups and forces are usually temporary

encourager

compliments members for their opinions and contributions to the group

task group

composed of several persons who work together with or without a designated leader and are charged with accomplishing specific time limited assignments could be a group of nurses selected by colleagues to plan an orientation program for new staff

opinion giver

conveys to group members what their pertinent values should be

what are team building activities?

designed to improve interpersonal workplace relationships but also include meeting goals and accomplishing tasks and also facilitate the normal stages of group development

patient care conferences purpose

determines the composition of the group meetings are usual interpersonal and used for care management for spec patient care problems for example an interrofessional team may form to discuss failure of rehab regimen to help home care patient and to develop new plans of intervention

what do nurturing roles do and what are the 6 of them

differ from task roles they facilitate the growth and maintenance of the group roles are encourager harmonizer compromiser gatekeeper group observer follower

recorder

documents the groups actions and achievements

clinical ladder system

each quarter each staff member is reviewed that is seeking promotion to the next clinical ladder level each applicant fills out a comprehensive application

gatekeeper

encourages all group members to communicate and participate

informal groups

evolve naturally from social interactions and are informal in the sense that they are not defined by an organizational structure such as people who regularly eat lunch together

opinion seeker

explores viewpoints that clarify or reflect the values of other members suggestions

critical differences from formal committees and task forces

few critical differences members of task force have less time to build relationships with each other because they are temporary may be no desire for long term relationships and shows that orgs usual prob solving mechs have failed may cause tension between task force and other units

what does place and time for a meeting entail

find place without interruptions at a time when there is natural time limit to the meeting limit to 50 to 90 minutes starting late positively reinforces latecomers

what are the several stages in the enforcement of norms?

first use rational argument to adhere to norms to the individual second if this is not effective members may use persuasive or manipulative techniques that remind the deviant of the group values third is an attack that may be verbal or physical and sometimes means sabotaging the deviants work final stage is ignoring the deviant

team building

focuses on both task and relationship aspects of groups functioning and is intended to increase efficiency and productivity

committee or task forces

formed to deal with specific issues involving several service area responsible for monitoring and improving patient safety or task force assigned to develop procedures to adhere to patent privacy regulations are example of special work groups

what does homans social system conceptual scheme present

framework for understanding group input processes and outcomes depicts effects of orfanizational and ndicidual backgroup factos on group leadership including dynamics which are tasks activities interactions and attitudes while processes are forming storming norming performing and adjourning

what are committees

generally permanent and deal with recurring problems

conducting the first meeting

goal is to come to a common understanding of the groups tasks and to define the groups working procedure and relationships a standard of participation should be well established leader should remain as neutral as possible and prevent premature decision making

what is an additive task and what is needed

group performance depends on the sum of individual performance which means the more inputs available produce a favorable result example is tug-of-war as it involves combined efforts (working together towards goal)

describe group size and composition

groups consisting of 5 to 10 members is optimal for most complex organizational tasks

what do training sessions for team building do

help participants acquire skills but are not effective if are not reinforced

what groups perform the best together

homogeneous performs best together while conflict arises in heterogeneous groups

what is productivity

how well the work group or team uses the resources available to achieve its goals and produce its services such as if care is satisfactorily completed at the end of a shift then the group has been productive productivity is influenced by work dynamics

how does the formal reward system influence group cohesiveness

if the members in a group receive comparable treatment and pay and perform similar tasks that require group interaction other things that strengthen groups are similar values education social class gender age ethniity

group members include

individuals from a single work group or at similar job levels from more than one work group individuals from different job levels individuals from different work groups and different job levels in the organization

how is group functioning specifically evaluated

involvement in job and willingness to help each other

how do managing teams differ from team building

it depends on the task group size composition productivity cohesiveness the groups development and growth and the extent of shared governance in the organization

coordinator

links ideas or suggestions offered by others

what does participation for a meeting entail

meeting should include fewest number of stakeholders who can actively and effectively participate in decision making with skills and knowledge necessary to deal with the agenda

what happens in larger groups

members contribute less while the leader makes more corrective action do more role clarification manage more distribution and recognization

what does member behavior for a meeting entail and that they all should know

members should be prepared for the meeting having read materials ahead of time ask for clarification if needed offer suggestions and ideas as appropriate encourage members to to contribute their ideas and pinions offer constructive criticism as appropriate help the discussion stay on track assist with implementation as agreed

competing groups

members that compete with each other fr resources to perform their tasks or compete for recognition are also not teams

what types of questions need to be asked in team building

members understanding and acceptance of org goals what if hidden agendas interfere with group performance how effective is group leadership do members understand and except their roles how does the group make decisions how does the group handle conflict what personal feelings do members have about each other do they trust and respect each other what is the relationship between the team and other organizations

ordinary interacting groups

most groups are these usually have a designated formal leader but may be leaderless discussions begin with the statement of a problem by the group leader followed by an open unstructured conversation the final decision is made by consensus

energizer

motivates group to accomplish quantitatively and qualitatively the groups goals

what do norms include?

not calling in on weekends readily accomodating requests for trading shifts and returning from breaks in a timely manner

what is status incongruence

occurs when factors associated with group status are not congruent such as when a younger less experienced person becomes group leader which can have a disruptive impact on the group

what are aspects of a groups context

org structure climate culture mission and goals

what is a formal committee

part of the organization and have authority as well as a specific role

what is simulation based training

participants act out simulated accident receive feedback on performance and repeat the performance incorporating the learned behaviors

follower

passively attends meetings listens to discussions and accepts groups decisions

what is an info giver

person who expands info given by sharing experiences and making inferences

what are hidden agendas

personal goals or needs of an individual that may negatively impact the group

informal or formal how does homans framework show that froups develop

phases of form storm norm perform adjourn or reform

what are the three kinds of interdependence

pooled interdependence sequential interdependence reciprocal interdependence

elaborator

predicts outcomes and provides illustrations or expands suggestions clarifying how they could work

what are informal committees

primarily for discussion and have no delegated authority

what does homans system determine

productivity of the group as well as the members quality of work life

what are the purpose of meetings and the 4 guidelines for conducting a meeting as a nurse

purpose is problem solving decision making and enhancing work relations reasons that need to be justified are socializing giving or clarifying info or soliciting suggestions the four guidelines are preparation participation place and time and member behaviors

what is an info seeker

pursues descriptive bases for the groups work

teams

real groups in which individuals must work cooperatively with each other in order to achieve some overarching goal have command or line authority to perform tasks and membership is based on specific skills required to accomplish tasks may be temp or perm

what is an initiator-contributor

redefines probs and offers solutions clarifies objectives suggests agenda items and maintains time limits

harmonizer

relieves tension and conflict

groupthink

results in the pressure of every member to conform usually to the leaders beliefs even to violating personal norms

completing the task forces report

should prepare written report for commissioning administrators that summarize findings and recommendations share drafts with work force prior to presentation id overlooked or sensitive info and reduce defensive reactions TFL must personally brief admin before the report

why do nursing groups establish norms?

so they know how to deal with absences that affect the workload of colleagues

what is status

social ranking of individuals relative to others in a group based on position they occupy comes from group values such as achievement personal characteristics the ability to control rewards and info control

orienter

summarizes the groups discussions and actions

procedural technician

supports group activity by arranging the environment and providing necessary tools finds the room brings the coffee

compromiser

suppresses own position to maintain group harmony

group observer

takes note of group members processes and dynamics and informs group of them

describe the nurse manager as a team leader

task is to maintain a positive work group climate and building a team

what is a divisible task and what does it need

tasks that can break down into subtasks with division of labor such as the more people provide a greater opportunity for specialization and interdependence in performing the tasks like when the construction of a car being complex each individual helping has a specific task

what is an issue with cohesiveness

that it can produce intense social pressure to conform to norms regardless of practicality or effectiveness

how is leaderships shown in small groups

the ability to accomplish the groups goals sociability good communication skills self confidence and a desire for recognition

communication as a nurse manager

the central component of NM leadership nurse managers can create an atmosphere where they feel free to discuss concerns make suggestions critique ideas and show trust and respect gatekeeping is also essential in keeping communication channels open refocusing attention on critical issues identifying conflic fostering self esteem etc

what is cohesiveness

the degree to which members are attracted to the group and how much they are willing to contribute its related to homogeneity of interests values attitudes and background factors

what are norms linked to? example

the expected contributions of each team member such as performance and products of the teams efforts an example is if a nurse takes on an assignment and does not complete it that is a violation of a norm

what is adjourning

the fifth step where group dissovles after achieving its objectives or does reforming might be a task force that creates standards but then gives it to hospital and disbands

what is performing

the fourth stage is where members agree on basic purposes and activities and carry out work energy becomes task oriented cooperation imroves emotional issues subside members communicate effectively and interact relaxed through sharing and leader provides feedback

what is a disjunctive task and what does it need

the group succeeds if one member succeeds so the greater the number of people the greater the probability that one group member will solve the problem such as in the olympics the more athletes on one team the more likely it is for the team to win a gold metal when this happens the US is recognized and every citizen shares the honor

what is a conjunctive task and what does it require

the group succeeds only if all members succeed with more people the likelihood of one person slowing the teams performance like with a jury unit dashboard

what are norms?

the informal rules of behavior shared and enforced by group members which they think will enable stable group functioning

what is forming

the initial stage where individuals assemble into well defined cluster where group members cautiously approach one another they come together as a group and begin to understand the requirement of group membership members depend on the leader

what is leadership

the most important as leaders are appointed for most of the formal groups such as command groups teams committees or task forces informal leaders tend to emerge over time and in relation to the task to be performed

what is one of the nurse managers job relating to the enforcement of norms?

the nurse manager has the responsibility to help the group deal with deviants such as through counseling or preventing destructive conflict

what is norming

the third stage where the group defines goals and rules of behavior where the group defines what are and are not acceptable behaviors and attitudes the group structure roles and relationships become clearer as cohesiveness develops leader explains standards and behavior defines structure and facilitates rshp bonding

according to homans framework about essential elements

the three essential elements are activities interactions and attitudes activities are observable behaviors of group members nteractions are the verbal and nonverbal exchanges of words or objects among two or more group members attitudes are the perceptions feelings and values held by individual group members which may be positive or negative

how are teams evaluated

through patient outcomes and team functioning through outcome data such as clinical pathway info variances in critical paths complication rates falls med errors eval the performance

how does shared governance factor in

through shared decision making as is the core of shared governance it improves collaboration staff retention jobs satisfaction productivity and patient outcomes increases staff involvement in the organizations functioning and future planning and also increases staff allegiance to the organization

when are groups more likely to be cohesive

when members share similar values and beliefs are motivated by same goals and tasks must interact to achieve their goals and tasks work in proximity to each other such as same unit same shift have specific needs that can be satisfied by involvement in the group

what is re-formign

when some major change takes place in the environment or i the composition or goals of the group that requires the group to refocus its activities and recycle through the four stages

what is pooled interdependence

where each individual contributes but no one contribution is dependent on any other such as a committee discussion

what is sequential interdependence

where group members must coordinate their activities with others in some designated order such as an assembly line

what is reciprocal interdependence

where members must coordinate their activities with every other individual in the group such as team nursing

managing subsequent meetings and subgroups

within a task force if subgroups are formed the leader needs to hold full task force meetings often enough to keep all members informed of progress subgroups are essential leader should be sensitive to conflicting loyalties