Please be sure not to copy any answers verbatim. original answers needed will be scanned through the safe-assign system.

please read notes provided below and answer below problem

Scenario

When the number of COVID-19 cases and positivity rate started to increase high above the rolling average, the CEO of your hospital has assigned you the responsibility of convening a QI team to assist in preparing for this increase and possible overflow of hospital and ICU beds.

1. What disciplines would you select for the team and how many individuals should participate?
2. Develop a mission statement and goals for the team.
3. What methodology will they utilize for their planned process? hint PDSA is one type.
4. Map out the plan to address the potential 2nd surge in COVID-19 cases utilizing the

methodology selected, example--Plan, Do, Study, Act.

a. What barriers or challenges did the QI team face along the way, as well as during

during the implementation process?

b. What criteria do you believe the team needs to meet to be successful?

c. How would you measure the team's success?

d. Once the team has implemented their interventions, would you disband them?

Notes

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Plan Do Study Act ASL QI Methodology(PDSA cycle is a means for testing a changeby planning it, trying it, observing the results, and acting on what is learned

The steps in the PDSA cycle are: Step 1: PlanPlan the test or observation, including a plan for collecting data step 2: DoTry out the test on a small scale step 3: StudySet aside time to analyze the data and study the results step 4: ActRefine the change, based on what was learned from the test QI focuses on improvement of systems, processes, and does not look to place blame on individuals.

MAKING IT HAPPEN WITH.... WHO?" Quality Action Teams (QAT)-can be convened to address an issue/topic that requires a minimum of one month to resolve and involve individuals most closely related to the process at hand. Departmental/Multidisciplinary QI Initiatives-are completed.

LAUNCHING A TERRIFIC TEAM The right number of people and right people should be on the team from the beginning. The team should: Establish easily defined goals and roles and responsibilities early on (by second meeting). Set ground rules that everyone agrees to. Decide how the team will conduct business. A facilitator should be selected to keep the team on track, maintain records of the team's work and provide positive reinforcement.

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IMPROVEMENT TEAMS

The goals of this module are to provide an overview of the characteristics and benefits of an improvement team for quality improvement (QI) work, the functioning roles and responsibilities of the various team members, and the stages of growth as a team evolves into a cohesive entity with a single focus. The module also provides strategies, tools, and additional resources that experienced QI teams use to become effective and successful in achieving their aims. Part 1: IntroductionImprovement work within an organization is typically coordinated through an improvement team, also known as a quality improvement (QI) team. The effectiveness of the QI process often depends on the ability of the improvement team members to work well together, and especially with the rest of the health system. This module describes:

The importance of an improvement team in QI projects

How to choose effective members for a QI team

Roles and responsibilities of an improvement team's members

Tips from successful improvement teams

The purpose of a QI plan is to describe the targeted quality improvement activities for an organization. Often, quality improvement activities are distributed across multiple QI projects. These QI projects should have a clearly defined aim statement [link to glossary] The aim statement should specify resource constraints, reporting frequency, and pertinent ground rules for completing the project. The work of the QI project is accomplished by a team of individuals, which is the QI team. In order for a QI team to be successful, there must be clear objectives to guide its activities, explicit support from its leadership, and the resources necessary to complete the project. Additional information on QI plans can be found in the Developing andImplementing a QI Plan module. Part 2: The Power of TeamsFor a QI project to succeed, an organization must use the knowledge, skills, experiences, and perspectives of a wide range of people. A QI project requires problem-solving, multiple decisions, and effective solutions that involve complex systems. A comprehensive multidisciplinary approach by a QI team is preferred over individual decision makers, especially when:

A task is complex Creativity is necessary

The path to improvement is unclear

Efficient use of resources are required

Cooperation is essential to implementation

Team members have a stake in the outcome

The process involved is cross-functional

No one individual has sufficient knowledge to solve the problem effective improvement team is flexible enough to respond to the ongoing challenges of QI work. Even though a team may assume many roles, this module describes a QI team that is focused on improvement using clinical quality measures. Part 3: Selecting Members for TeamThoughtful attention toward selecting members for a QI team is critical to successful improvement. While there is not a specific "how-to" guide for QI team selection, there are some worthy guiding principles to consider. An ideal QI team member:1. Represents any discipline and ideally works directly with the system targeted forimprovement2. Is willing to learn from other team members3. Is willing to maintain open communication with staff, leadership, and consumers4. Is willing to assume individual responsibility that contributes to the team's success5. Commits to the success of the improvement projectOne strategy is to consider the attributes of an individual who is identified as a potential candidate for the QI team. Leaders of successful QI teams suggest that an organization should seek individuals who have the following attributes:

Respected by a broad range of staff

Team players

Excellent listeners

Good communicators

Proven problem solvers

Frustrated with the current situation and ready for change

Creative and able to offer solutions

Flexible--demonstrated by their willingness to change and accept new technology

Proficient in the areas and systems focused for improvement If an organization has many individuals who are eligible and willing to serve on a QI team, the leader may use a chart, such as the one in Table 3.1, to compare potential candidates.1 This chart has been used with simple check boxes or with a Likert scale rating of 1 to 5 for each characteristic, with 1 defined as strongly disagree that the characteristic represents the person being evaluated and 5 equaling strongly agree Each QI team is unique, melding together the insights and experiences of its individual members.It is important to ensure that the QI team includes members with complementary skills. the institute for Healthcare Improvement recommends three different types of expertise within an organization are included: 1) system leadership, 2) technical expertise, and 3) day-to-day leadership. 2 There may be one or more individuals on the team with each expertise, or one individual may have expertise in more than one area, but all three areas should be represented in order to drive improvement successfully.

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

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

A day-to-day leader is the driver of the project, overseeing data collection and ensuring that tests are implemented. This person should understand the details of the system and the various effects of making change(s) in the system. The day-to-day leader also needs to work effectively with the physician champion(s). 2Increasingly, the value of having consumers on a QI team is recognized. Consumers need training to participate in a meaningful way, but they can provide unparalleled insights into the impact of current processes and proposed changes. Those considering inclusion of a consumer on their QI team should learn from experienced improvement teams. A few resources for consideration are listed below: A Guide to Consumer Involvement The Two Dimensions of Quality The Partnership for Healthcare Excellence New Health Partnerships Improving Quality Health Care: The Role of Consumer Engagement Families USA How to Effectively Present Health Care Performance Data To Consumers Maximizing Consumer Understanding of Public Comparative Quality Reports: effective use of Explanatory Information How to Maximize Public Awareness and Use of Comparative Quality Reports ThroughEffective Promotion and Dissemination StrategiesRecruiting members for a team that have the right mix of expertise can be challenging--especially in small organizations. Fortunately, many of the clinical technical expertise skills, such as, QI tools, measurement tools, and data collection and display can be learned. An organization that is committed to QI should invest in the necessary training to ensure the team is adequately prepared. Most experienced QI leaders start with volunteers and then assess any gaps in the team's expertise and then recruit specific individuals who can best round out the team Before a QI team's membership is finalized, ensure there is buy-in from its leadership. It is critical to the success of the project that leadership assumes responsibility for the team entrusted to execute the QI project. Additional resources for assisting an organization with training or ongoing support of improvement teams are listed in Table 3.2: Part 4: Defining Roles and ResponsibilitiesWithin a QI team, members often organize themselves to effectively accomplish the work by defining specific roles. Multiple roles may be fulfilled by one person, and some roles may be rotated among team members. The following is a list of key team roles: Team Leader fully understands the processes targeted for improvement and the breadth of the project in order to effectively lead team meetings.

Improvement Teams6 Team Facilitator assists the team leader in planning meetings and developing agendas. The Team Facilitator tends to the meeting process by ensuring the participation of all team members, monitoring the agenda, and keeping track of time. Team Members agree to contribute their knowledge and insights to QI project. They agree to support suggested improvements in their areas of the organization to facilitate buy-in for changes that result in improvement. For clinical performance improvement work, having a physician or provider champion on the team is important. The champion should have a good working relationship with colleagues and the day-to-day leader(s), and be interested in driving change in the system. A physician/provider who is an opinion leader in the organization makes an effective champion Each team member may have a different communication and social style. These differing styles serve to move the team forward when the interaction is constructive and all members are focused on a common goal. At times, there may be less harmony, and a team needs guidance to use its diversity to an advantage. There are many resources available that describe successful strategies in managing team dynamics. [link to resources section at the end of this module] In successful QI teams, members are flexible, embrace diverse ideas, constructively leverage conflict, and contribute to the teams' achievements of completing their QI projects. With the new team formed, it is critical to align expectations for the work to be performed. Building a sense of "team" and generating enthusiasm for the work are also important from the beginning. The team leader is responsible for these tasks, and often a QI Project Launch meeting is held. Critical elements of the launch meeting include:1. Introduce the members and identify team roles.2. Clarify why improvement is necessary and define the aim for improvement, which is outlined in the QI Project documentation.3. Provide general ground rules about how the team will function, such as, meeting times, expectations for punctuality and participation, record keeping, and accountability of the team and its members The work of the team is to design, manage, and monitor performance improvement activities to achieve the aim of the QI Project. This work is more specifically detailed in the performance management and Measurement module. The team leader must orchestrate this work and ensure that the system changes, suggested by the team and tested by staff, result in the desired improvement. A well-functioning team directly correlates to a successful completion of the project. There are many available resources regarding team building, team dynamics, and overcoming challenges in teamwork.

Part 5: Stages of Team GrowthAccording to The Team Handbook, teams go through fairly predictable stages of growth as they learn to work effectively together.4 The following subsections briefly describe each stage. Stage 1: FormingAt this stage, team members are exploring the boundaries of acceptable group behavior and are trying to establish their positions and status within the team. While being somewhat excited about the opportunity to be on a team, they may be suspicious and anxious about the job ahead.It is normal at this stage to see little progress, as the team may complain about the task and have lofty, abstract discussions, which cause some members to become impatient. Stage 2: StormingAt this stage, team members realize the task is different and more difficult than first imagined. Some may become impatient with the lack of progress and begin to assert their ideas, resisting the need to collaborate. Some simply withdraw as discussions become contentious and argumentative. They are beginning to understand one another and realize how the different communication and social styles are affecting them. Storming takes on many different forms,but it almost always occurs before progress can begin Stage 3: Norming

Improvement Teams8This is the stage team members begin to accept the individuality of each person, trust the ground rules to maintain equality in the process, and realize competitiveness must yield to cooperation. They look forward to the contribution of others on the team, and a sense of team spirit and dedication to a common goal unfolds. With this shift in team energy, they start to make significant progress.Stage 4: PerformingTeam members now have insights into personal and group processes in this stage. They recognize, and even anticipate, how they can each contribute to the mission. They quickly identify and resolve interpersonal communication problems and develop a synergy that enables rapid progress.Evidence about the characteristics of successful teams can be gleaned from understanding the pitfalls associated with failure. In the Risk of Quality Team Project Failure Index (RTFI), the following characteristics can be extrapolated as correlating with success or failure of the team:1. Training regarding teamwork, quality methods, and problem solving sequences2. Facilitation skills3. Measurable objectives4. Visible senior leadership support5. Regular meetings at minimum monthly6. High percentage of team member attendance at every meeting7. Small tests of change that can be successfully implemented in a short time8. Disciplined to follow change methodology Regardless of the strategies employed, leading a QI team requires a balance of cheerleader and task master. Knowing team dynamics, understanding differing proclivity to change, and bringing the best out in individuals all contribute to a successful QI team.Part 6: Tips from Successful teams in addition to the prerequisites previously mentioned, successful teams emphasize the importance of an organized infrastructure to support the work. This section discusses tools that facilitate ground rules for meetings and effective meeting processes, including use of agendas and discipline for documenting the work. Set Ground RulesGround rules are a code of conduct for meetings. This is particularly important for quality improvement Teams as members should participate equally, regardless of the hierarchical role they may have in the delivery of care. Putting these rules on the table, in the beginning, facilitates team dynamics by making the expected behavior explicit. Typically, ground rules are

Improvement Teams9discussed and agreed to early on at an initial meeting of the team. Again, there are no required ground rules, but these are examples of those that teams often adopt:5 Start the meeting on time Have a prepared agenda with an objective and expected outcomes End the meeting on time Parking lot discussion items that don't relate to this meeting's objective Complete action items as committed One person speaks at a time All team members are equals Leave rank at the door Address conflict by dealing with the issue not the person Turn of cell phones / pagers Notify the team in advance if you will be absent Listen actively Be a participant, not a lurker What's said in the room, stays in the room. Have fun, but not at the expense of someone else's feelings. Be present, both physically and mentally Establish an Effective Team Meeting ProcessHaving a well-defined meeting process helps the entire team focus on the important meeting tasks.Steps to an Effective Team Meeting1. Provide an effective environment for the meeting. Team members should be in a room or area that is conducive to good communication. They should be seated at a table or in an open-ended circle with a flipchart at one end where all team members can easily see each other and the flipchart. Make sure there is an adequate supply of markers for writing on the flipchart. If the flipchart paper is not self-adhesive, have tape available so that the filled flipchart paper can be hung on a wall where it continues to be easily seen by everyone. This process of keeping all of the information visual to everyone is an important part of empowering the entire team.2. Clarify the purpose and objectives of the meeting. Make sure that all team members are inagreement.3. Determine who will be the timekeeper and recorder and review at what time intervals the timekeeper should give feedback based on the ground rules Review the prior meeting's action list. This provides team accountability for between-meeting assignments and brings relevant information to the current agenda.5. Review the meeting agenda in detail and make sure that all team members understand and agree with the agenda and its time frames. If there is disagreement, the team leader should try to get a consensus agreement from the team on how the agenda should be changed.6. Work through the agenda items within the time allotted to each. If time runs out on any item,the team must follow the ground rules to agree on how to proceed.7. Review the meeting record by reviewing the flipchart information recorded during the meeting. Decide which charts or information should be included in the meeting record and which should be discarded.8. Develop the items that should be included on the next meeting agenda and determine what assignments should be given to prepare for the next meeting.9. Evaluate the meeting by asking what the team did well and what the team could do differently to improve the meeting process. This is an important step. Any improvement opportunities should be noted in the meeting record and incorporated into the next meeting. Meeting AgendaIn order to have an effective team meeting, the team leader should develop a meeting agenda that uses the above steps. Every team member should have a copy of the meeting agenda and agree to its content. It is very important that the meeting agenda include the time that each agenda item will begin. The team leader estimates the amount of time for each topic when preparing the agenda. The ability to estimate the time improves with practice. Using the ground rules, the team members should agree to adjust the time whenever necessary to accomplish their goals. The team leader can develop a template in Word or Excel for the meeting agenda based on the following sample: Meeting Outcomes/ActionsCreating a record of the outcomes and actions from each meeting is a vital part of the team communication process. Unlike keeping detailed minutes of a meeting, the following form identifies three key components of this record:1. The key activities and decisions reached.2. Actions needed before the next meeting.3. Improvements to be embraced during the next meeting. The easiest way to prepare a record is for the team leader to make notes on his or her agenda related to each outcome, action needed, and improvement. Some of the information can also beSet start time for each item

Improvement Teams12collected from the items recorded on the flipchart by the recorder during the meeting. The following model works well for a record. The record should be distributed to each team member within several days after the meeting, so that team members are reminded to follow-through on the action items. Special IssuesEven with clear guidance and an organized approach, difficulties may arise within a QI team that has a negative impact on the work. There are several resources available that provide insights into common situations within a team, although discussion is beyond the scope of this module. The number of successful QI teams is a testament that leadership support, a clear focus, and the tools to perform the work, enable most teams to overcome their challenges and achieve their aims. Part 7: Supporting InformationReferences1. Institute for Healthcare Improvement (IHI) website HTTP://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/formingtheteam.htm2. HIV QualWorkbook, Guide for Quality Improvement in HIV Care New York state department of Health AIDS Institute; Health Resources and Services AdministrationHIV/AIDS Bureau; page 95.3. Scholtes, Peter R. and other contributors, The Team Handbook., Third Edition Madison,WI: Joiner Associates, Inc. 20034. As the Team Doc; Setting Team Ground Rules:http://www.askteamdoc.com/index.php/2007/08/26/setting-team-ground-rules/#ixzz0roHkBMMyResources and Related Reading1. Susan M. Heathfiel. Twelve Tips for Team Building: How to Build Successful WorkTeams (Available:http://humanresources.about.com/od/involvementteams/a/twelve_tip_team.htm2. Reinertsen JL, Gosfield AG, Rupp W, Whittington JW. Engaging Physicians in a SharedQuality Agenda. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007. (Available on www.IHI.org)3. National Quality Center http://nationalqualitycenter.org/4. Prochaska JO et al. In Search of How People Change. American Psychologist 1992 Sept;1102-1114