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Section 9  Teams as a Total Quality Management Tool

          In total quality management efforts, teams play a central role. Each team could focus on an objective, task, charge, project, mission, purpose, crisis, or problem as a total quality management tool. All quality activities are aimed at trying to meet the needs of patients in the form of patient satisfaction. They can be in the form of quality cost, or service.

 Some examples in quality management efforts might include: medication errors, outpatient departmental wait times, back safety and patient transport issues. It becomes the role of the organization to create an environment in which mistakes are used as learning tools, and not punishment. Coordinating the efforts of a variety of teams will become the challenge of the manager.

                 An example of total quality management specific to an operating room could be the operating room team identifying problems that affect either real or perceived outcomes to their patients. These problems could include; turnover time, delays, scheduling problems, housekeeping, room cleanliness and procedure start time. None of these problems are the sole responsibility of one person; therefore, it takes a collaborative effort by everyone on the team to solve the problem.

None of the problems listed above have quick fixes, yet they present an opportunity for improving current and future situations. It will become important for the teams to investigate and research the relevant issues as they search for solutions and improve the delivery of patient care.

                Frustration, lack of knowledge and even anger may impede progress. For example if the operating room experiences an average turnover time of one hour and everyone wants the time to be no longer than 30 minutes, changes must take place. If implementation of changes decreases the turnover time to 45 minutes, the team members should celebrate the improvement and work toward achieving its established goal through a willingness to change. 

               The Joint Commission on Accreditation of Healthcare Organizations is also focusing on how organizations identify improvements and outcomes. The object is that changes are evident in the form of outcomes to patients and are understood and articulated by all in the organization.

An example could include hospital policies and procedures as guidelines in the Joint Commission evaluation process. If an organizationís policies and procedures state that a process will be accomplished, then the accrediting body will want to see how it is being done.

                In addition, organizations are finding new uses for total quality management methods, and departments that interact daily are working together to resolve conflicts and problems to improve processes and create alternative systems. For example, the intensive care unit and pharmacy may desire an efficient, effective drug delivery system.

When the two departments work through the quality management process, the outcome could reduce lost charges, ensure that the right drug gets to the right location at the right time and create a user-friendly system for the intensive care and pharmacy personnel.

Questions and Answers to Identify Improvements and Outcomes

        Question: What is the first and most important thing a leader can to help a team get off to a good start? 

Answer: An effective leader orients the team by clarifying the teamís objective, mission, defines the goals, and establishes some work procedures.

        Question: What about managers who may feel afraid or threatened when subordinates are given more responsibility? 

Answer: All managers think they are very capable of making decisions. After all, thatís part of being a manager. So, a manager who wants to develop self-management capabilities in subordinates must encourage them to make decisions.

        Question: Is ďstormingĒ an inevitable part of the team process? 

Answer: Actually, many teams may not go through a storming stage. These teams are able to focus and become productive without strife. Storming might occur, but it doesnít have to. However, if the team assumes it will happen, it probably will.           

        Question: Should a manager leave the team on its own after the initial overview meeting? 

Answer: No. Many organizations underestimate the amount of training and support that the teams need. Teams do not just happen. They need ongoing help and team building to get the job done. 

        Question: Should the manager address individual performance of team members? 

Answer: Team members contribute in different ways. As long as the team is satisfied with individual contributions and the overall performance of the team is acceptable; the manager should not assess individual goals and performance. If the team asks for help to resolve a problem with an individual team member, however, that help should be provided.

        Question: What can be done to control rumors that seem to spread like wildfire from team to team throughout the organization? 

Answer: Rumors can be destructive, so it is important to end them as soon as possible. When you hear a rumor, focus on the facts. Ask the team to commit to discussing only facts. If the topic of the rumor is very pertinent to the team (e.g., organizational downsizing or layoffs), get the appropriate and up to date information from the person who will know the facts. You may even want to consider inviting that person to talk to the team.

        Question: What can be done when the team does not follow its own plan? 

Answer: Being off plan continually can be a team performance problem or issue. It can also stem from being a system or organizational issue. A large percentage of team breakdowns are a result of problems within the organization, not a lack of team commitments.

First, look at system and organizational issues (e.g., frequent shifting of priorities, lack of time and personnel for projects or assignments, failure to support the team process, etc.) that may be driving teams to ignore plans. Then, look at team performance problems.           

        Question: How can my team avoid problems that occur every time itís necessary to coordinate work with other teams? 

Answer: Problems between interrelated teams can often be avoided if the teams begin the project with an open dialogue about needs and expectations. Holding periodic updates and problem-solving meetings with representatives from each team may also be an option.

        Question: How can one team make sure that the other teams communicate and deliver on time? 

Answer: If conflicts do arise, donít ignore them. Get help quickly before resentment builds or the work of the team begins to suffer. 

        Question: How can a team help new team members fit in quickly? 

Answer: First, consider choosing a team member who is a good fit. If member selection is within the teamís control, establish a process for selecting members and decide what skills are needed to round out the team. New team members can make a satisfactory entrance by carefully orienting them to the team mission, group process and roles and responsibilities that they need to fill.

Also, assigning a mentor or preceptor to guide new members and answer questions is often helpful. Sending new team members to and teamwork training and development classes. 

        Question: Is there a way to help teams survive downsizing? 

Answer: The reality of the current work world is that any organization may have to resort to downsizing for survival. Unfortunately, downsizing is emotionally wrenching for those who are laid off and for those who survive. The damage of downsizing can hinder the teamís effectiveness for weeks or months.

Emotional support and open discussion can help. Team members need to understand that layoffs are not a reflection on performance.

                       Team members need a chance to air their concerns and express emotions. The work of the organization must go on, so it is 
                        important to encourage the team members to figure out ways to fill the gaps created by reduced staff in the downsizing effort.