Team Work for Patient Safety and Care Michael West

Aston Business School

Patient Safety Federation Conference10th February 2011

The Ark, Basingstoke

Leading culture change for safety• Searching for new ways to meet clients’

needs and ensure quality and safety

• Leadership is upbeat and self confident. There’s no problem that can’t be solved, no status quo that can’t be bettered

• Listening to clients/patients .....

• Leadership is about doing the difficult not managing the inevitable

Results

80

85

90

95

100

105

Below average Average Above average

Mortality

The HR system variable explains 16.9% of the variance in subsequent mortality (p < .01)

Even taking prior mortality into account, the HR systems variable explains a further 7.8% on top of this (p < .01)

> 25% more appraisers trained, associated with a reduction of 12.3% of the number of deaths after hip fracture

> 25% more staff working in teams associated with 275 fewer deaths per 100,000 following emergency surgery or 7.1% of the total number of deaths following emergency surgery

West et al,2001 International Journal of HRMWest, Guthrie, Dawson, 2006 Journal of Organizational Behavior

Implications

The Dance of Teams

Employee Involvement Programme*

> The extent of team working in hospitals predicts:

> job satisfaction> organisational commitment> adherence to organisational

rules and procedures> individual and organisational

innovation> cooperation with co-workers> patient mortality

West et al., 2005. Working together: Staff involvement and OrganizationalPerformance in the NHS. Final Report

Four conditions for effective teams:

• Having a real team -  bounded, stable, interdependent with a real team task

• Having a clear team purpose, challenging and consequential with clear objectives

• Making the right choices about who should be on the team - skills and roles, enablers not derailers

• Developing through regular coaching and self-coaching

Real Teams

 Having a real team - bounded, stable, interdependent with a real team task

• Bounded?•Team A CEO: 11; Members 7-84;

•Team B CEO 5; Members 5-9.

•Only 11/120 agreed on the size of the team

• Team size?

• Team stability?

Wageman et al, Senior Leadership Teams, Harvard University Press

Working in Teams in the NHS‘Do you work in a team?’

If yes (91%) …> Does your team have clear objectives?

> Do you have to work closely together to achieve these objectives?

> Do you meet regularly to review your team effectiveness and how it could be improved?

> 38% of 1.4 million employees

Team working in Primary Care300 PCTs50,000 respondents

% working in real teams

% working in pseudo teams

Organizational health and safety overall .41 -.43

% staff suffering injury at work in previous year -.30 .36

% staff witnessing potentially harmful errors/near misses in previous month

-.32 .30

% staff experiencing physical violence in previous year

-.36 .34

% staff experiencing bullying, harassment or abuse in previous year

-.29 .30

Working in Team and Errors, Stress and Injury(170 acute trusts, 120,000 respondents)

1.00

1.57

1.26

1.00

1.91 1.88

1.00

1.70 1.69

1.501.61

0.91

1.31

0.870.90

0.70

0.90

1.10

1.30

1.50

1.70

1.90

Not Working inTeam

Pseudo III Pseudo II Pseudo I Real team

Types of Team Working Patterns

Odd

s Rat

io

ErrorsStressInjury

www.nhsstaffsurveys.com

Staff absenteeism

5% more staff working in real teams associated with 0.27% in overall absenteeism rate (p < .001)

For an “average” acute hospital, this represents a potential estimated saving of over £1 million per year in direct salary alone

3.00

3.20

3.40

3.60

3.80

4.00

4.20

4.40

4.60

4.80

5.00

Low (< 35%) Moderate (35-40%) High (> 40%)

Extent of real team working

Abse

ntee

ism

(%)

Patient mortality

5% more staff working in real teams associated with 3.3% drop in mortality rate (p = .006)

For an “average” acute hospital, this represents around 40 deaths per year

90

92

94

96

98

100

102

104

106

108

110

Low (< 35%) Moderate (35-40%) High (> 40%)

Extent of real team working

Mor

talit

y ra

tio

Mortality

Cooperationacrossteams

Clear roles

Team vision &objectivesReflexivity

Failures of team-based working

Four conditions for effective teams:

• Having a real team -  bounded, stable, interdependent with a real team task

• Having a clear team purpose, challenging and consequential with clear objectives

• Making the right choices about who should be on the team - skills and roles, enablers not derailers

• Developing through regular coaching and self-coaching

ABS Management Team Objectives

1. Increase staff and student satisfaction

2. Improve student staff ratio

3. Improve collaboration with central services and the three other schools and manage university initiatives effectively

4. Balance the budget and ensure strategic investment ambitions are met (4%)

5. Successfully implement DLMBA and associated changes in processes of learning and teaching

6. Ensure improvements in employability of students by building links with employers and student skills

7. Achieve accreditations

Three things we must always do

1. Provide leadership by focusing on what is difficult and important rather than inevitable or unimportant

2. Encourage and reward risk and innovation to create a climate of engagement and excitement

3. Share responsibility for management team decisions and support each other

Three things we must never do

1. Lose sight of our common purpose

2. Intentionally mislead each other or staff

3. Neglect promoting, learning from and supporting the whole organization

Four conditions for effective teams:

• Having a real team -  bounded, stable, interdependent with a real team task

• Having a clear team purpose, challenging and consequential with clear objectives

• Making the right choices about who should be on the team - skills and roles, enablers not derailers

• Developing through regular coaching and self-coaching

Four conditions for effective teams:

• Having a real team -  bounded, stable, interdependent with a real team task

• Having a clear team purpose, challenging and consequential with clear objectives

• Making the right choices about who should be on the team - skills and roles, enablers not derailers

• Developing through regular coaching and self-coaching

Regular honest review and feedback

Developing through regularly taking time out to review performance and how to improve

Coaching the team Reflexivity

How to lead dream teams

Team Leadership - Managing• Team members enabled to work interdependently

• A high degree of autonomy in achieving objectives

• Accurate and timely feedback on team performance

• Sufficient forming time to build rapport

• Encourage, model and reward positive group attitudes towards diversity

Positivity Opens Us

Barbara Fredrickson www.positiveemotions.org

Positivity ratio > 3:1; Maximum 11>1

Fredrickson & Losada, American Psychologist (2005) 60, 678-686

(... and negativity is necessary)

Team Leadership - Coaching

• Encourage positive, supportive relationships in teams

• Resolve and prevent intense conflicts

• Inquiry plus advocacy

• Ensure regular and positive team meetings

• Encourage optimism in teams by modelling

“Where do good new ideas come from? That’s simple! From differences. Creativity comes from unlikely juxtapositions. The best way to maximize differences is to mix ages, cultures and disciplines.”

Nicholas Negroponte

The Value of Team Diversity

Team Leadership - Leading

• Offer an inspiring vision

• Ensure that team leadership is clear

• Be attentive and listen carefully to the team

• Lead inter-team cooperation and effectiveness

• Model organisational loyalty

Where does team working fit in?

> Patient focus> Clear aligned goals and objectives at every level> Good people management> Positive emotional environments and relationships> Employee engagement> Real team working> Values based leadership

LEADERSHIP VALUES - How can you promote these values and virtues in the organization?

The Dance of Teams