Science of Improvement: Forming the Team | IHI – Institute for Healthcare Improvement

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Including the right people on an improvement team is critical to a successful improvement effort. Teams vary in size and composition. Each organization builds teams to suit its own needs.

First, review the aim.

Second, consider the system that relates to that aim: What system will be affected by the improvement efforts?

Third, be sure that the team includes members familiar with all the different parts of the process — managers and administrators as well as those who work in the process, including physicians, pharmacists, nurses, and front-line workers.

Finally, each team needs an executive sponsor who takes responsibility for the success of the project.

Examples of Effective Teams

Effective teams include members representing three different kinds of expertise within the organization: system leadership, technical expertise, and day-to-day leadership. There may be one or more individuals on the team with each kind of 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.

Clinical Leader

Teams need someone with enough authority in the organization to test and implement a change that has been suggested and to deal with issues that arise. The team’s clinical leader understands both the clinical implications of proposed changes and the consequences such a change might trigger in other parts of the system. 

Technical Expertise

A technical expert is someone who knows the subject intimately and who 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 collection, interpretation, and display of data.

Day-to-Day Leadership 

A day-to-day leader is the driver of the project, assuring that tests are implemented and overseeing data collection. It is important that this person understands not only the details of the system, but also the various effects of making change(s) in the system. This person also needs to be able to work effectively with the physician champion(s).

Project Sponsor

In addition to the working members listed above, a successful improvement team needs a sponsor, someone with executive authority who can provide liaison with other areas of the organization, serve as a link to senior management and the strategic aims of the organization, provide resources and overcome barriers on behalf of the team, and provide accountability for the team members. The Sponsor is not a day-to-day participant in team meetings and testing, but should review the team’s progress on a regular basis.

Example 1: Improving Care in Office Practices

Aim: We will improve care for all our patients with chronic disease by making improvements in our clinic that impact the six dimensions of quality, as outlined in the Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century.

Team:

• Technical Expert: ____, MD, Physician at downtown clinic
• Day-to-Day Leader: ____, RN, Manager of downtown primary care clinic
• Additional Team Members: Patient educator, medical assistant, clerk/scheduler, laboratory manager, quality expert
• Sponsor: ______, MD, Medical Director for primary care practices 

Example 2: Improving Patient Safety

Aim: Reduce adverse drug events (ADEs) on all medical and surgical units by 75 percent within 11 months.

Team:

• Clinical Leader: ___, MD, Chair, Pharmacy and Therapeutics Committee, Patient Safety Officer
• Technical Expertise: ____, RPh, Director, Clinical Pharmacist
• Day-to-Day Leadership: ____, RN, Manager, Medical/Surgical Nursing
• Additional Team Members: Risk Manager, Quality Improvement Specialist, Staff Nurse, Staff Education, and Information Technology
• Sponsor: ___, MD, Chief Medical Officer 

Example 3: Improving Critical Care

Aim: Redesign the leadership and care systems of our Medical Intensive Care Unit (MICU) in order to reduce harm and improve outcomes for patients.

Redesign the leadership and care systems of our Medical Intensive Care Unit (MICU) in order to reduce harm and improve outcomes for patients.

Team:

• Clinical Leader: ____, MD, Medical Director, Medical Intensive Care Unit (MICU)
• Technical Expertise: ____, MD, Intensivist
• Day-to-Day Leadership: ____, RN, MICU Manager
• Additional Team Members: Respiratory Therapy, Quality Improvement Specialist, Staff Nurse, Clinical Pharmacist, Clinical Nurse Specialist
• Sponsor: _____, MD, Chief Operating Officer

Example 4: Improving Flow

Aim: Ensure that patients receive timely access to appropriate care in our hospital and move through the system efficiently.

Ensure that patients receive timely access to appropriate care in our hospital and move through the system efficiently.

Emergency Department Team:

• Clinical Leader: Medical Director or Physician
• Technical Expertise: Director or Nurse Manager
• Day-to-Day Leadership: Front-line nurse
• Two “continuity staff” with a cross-organizational view of flow (e.g., Operations Engineer or vice president with management responsibilities across departments/services, who will be assigned to this work over time)

Intensive Care Unit Team:

• Clinical Leader: Intensivist or Medical Director
• Technical Expertise: Director or Nurse Manager
• Day-to-Day Leadership: Front-line nurse
• Two “continuity staff” with a cross-organizational view of flow, e.g., Operations Engineer or vice president with management responsibilities across departments/services, who will be assigned to this work over time

Operating Room Team:

• Clinical Leader: Surgeon or Anesthesiologist
• Technical Expertise: Director or Manager of Surgical Services
• Day-to-Day Leadership: Operating Room (OR) Nurse (circulating or scrub nurse)
• Surgery Technician
• One “continuity staff” with a cross-organizational view of flow, e.g., Operations Engineer or vice president with management responsibilities across departments/services, who will be assigned to this work over time

Project Sponsor:

Chief Executive Officer

Chief Executive Officer