Building Effective Teams

Kristen Nelson, MDAsst Professor, Pediatric Critical Care Medical Director, Pediatric TransportDirector, Pediatric Cardiac Critical CareJohns Hopkins University School Of Medicine

Disclosures

• I have no financial disclosures.

04/20/23 2

Plan for Session

• Discuss basic concepts and tools regarding team building and techniques for both buidling and evaluating teams

• Transition into smaller groups to cover team building in various settings

04/20/23 3

Objectives:

At the conclusion of this session the learner will be able to:

• Begin to develop a team-based training session specific for a certain skill or purpose

• Discuss several different teaching techniques for such a session

• Demonstrate effective teaching skills by debriefing such a session

Definitions

• Team: Two or more people working interdependently towards a common goal– Synergism

• Team Building: The process of gathering the right people and getting them to work together for the benefit of a project

04/20/23 5

More Definitions

• Team Management: The direction to a group of individuals who work as a unit. Effective teams are result-oriented and are committed to project objectives, goals and strategies

• Role: A unit of defined responsibilities that may be assumed by one or more individuals

04/20/23 6

What is necessary for team structure?• Goals and tasks/objectives• Members• Size • Leadership• Interaction• Time cycle• Decision-making techniques

04/20/23 7

Phases of Team Development(Tuckman)

• Forming

• Storming

• Norming

• Performing– high-quality teams

• Adjourning, dissolving or reorienting– if the project has a completion phase

04/20/23 8

Team Coordination and Collaboration

• Inform everyone of the goals, timetable, possible obstacles and scientific issues

• Define each team members role

• Design communication mechanisms

• Plan for success

• Plan for contingencies

Why Collaborate for Team-Building?

• Inherent complexity of medicine• Single discipline cannot do it alone

• Desire to explore problems and questions that are not confined to one discipline

• Need to solve complex problems• Stimulus of enhanced technologies

O’Sullivan P, Stoddard H, Kalishman S. Collaborative research in medical education: a discussion of theory and practice. Med Ed 2010; 44:1175-1184.

How do you teach team-building?

• Different techniques, depending on the team purpose

• May use different techniques at different phases of team development

• ‘Teacher’ often role of facilitator, not team leader

04/20/23 11

What makes teaching effective?

• Clear and Organized• Enthusiastic and Stimulating• Establishes Rapport• Actively Involves Learners• Knowledgeable and Analytical• Demonstrates Clinical Skill/Procedures• Provides Direction & Feedback• Accessible

Specific Teaching Techniques for Teams

Role Modeling/Demonstration

• Learners are often listening to and looking at everything a facilitators says and does

• Both in simulated and actual environments

04/20/23 14

‘Think Aloud’

• Verbalize thoughts when you are performing a task or observing something on the monitor, for example

• Teaches clinical reasoning steps

04/20/23 15

Asking Open-Ended Questions

• Avoid closed end or pimping (i.e, intimidating) questions

• Instead ask "why do think that therapy was chosen," "what more do you think could we have done, "how do you think the patient is doing now”

• Hypothetical– “What if we did this instead….”

04/20/23 16

Active Observation

• ‘Amygdala highjacking’

• Explain rationale for observation

• Ask the learner what they observed

Independent Learning with Feedback

Identify the need Make an assignment (research the question or

issue and bring back to the group) Identify potential resources Close the loop (learner reports back via

discussion, oral report for example)

Debrief Each Session:5 steps for microskills teaching

• Get a Commitment

• Probe for Supporting Evidence

• Reinforce What Was Done Well

• Give Guidance About Errors or Omissions

• Teach a General Principle

Other Techniques

• Small group sessions– PBL, case review

• Simulation– Role playing

– Task trainers/mannequins

– Team drills/skills

• Large group sessions04/20/23 20

3 break-outs

• 1) Small group-Molly (error identification and resolution within a team)

• 2) Simulation-Kristen (multidisciplinary-role assignment and conflict resolution)

• 3) Large team-Deb (multidisciplinary-development of novel team for high-risk event)

04/20/23 21

Conscious Competence Model of Learning

UnconsciousIncompetence

ConsciousIncompetence

ConsciousCompetence

UnconsciousCompetence

Bristow, 2007

Unconscious Incompetence: requires demonstration of the skill and how it will benefit the person’s effectiveness

UnconsciousIncompetence

ConsciousIncompetence

ConsciousCompetence

UnconsciousCompetence

Conscious Competence Model of Learning

Conscious Incompetence: requires a commitment to learn and practice the new skill Bristow, 2007

UnconsciousIncompetence

ConsciousIncompetence

ConsciousCompetence

UnconsciousCompetence

Bristow, 2007

Conscious Competence Model of Learning

Conscious Competence: requires continued practice (most important factor to move to the next level)

Conscious Competence Model of Learning

UnconsciousIncompetence

ConsciousIncompetence

ConsciousCompetence

UnconsciousCompetence

Bristow, 2007

Unconscious Competence: able to teach others but may have difficulty explaining exactly ‘how they do it’

Small Group Discussions

• State goals and objectives• Introduce the topic

– Show your energy / excitement– Why is this important?

• Reestablish a climate of mutual respect for everyone’s ideas

• Remind the learners that participation is expected

Problem-Based Learning:Case Reviews

• "Let me tell you about the case that is the stimulus for this team development.’

•

• Near misses are very powerful…as are hits

04/20/23 27

Arrange seating to promote discussion

• Ideally in a circle

• Do not sit at the head of the table

• People tend to talk to the person sitting opposite them

• People sitting next to each other tend not to talk to one another

Beard, R. M., and Hartley, J. Teaching and Learning in Higher Education. (4th ed.) New York: Harper & Row, 1984

Barbara Gross Davis Tools for Teaching; Jossey-BassPublishers: San Francisco, 1993.

Bring the Activity to Closure

• Allow time at the end of the discussion to summarize key points

• Ensure that learners leave with a clear understanding of the most important ideas

Basic Steps for Teaching Team-Based Procedural SkillsBasic Steps for Teaching Team-Based Procedural Skills

Introduce the skill– Reading materials, video or PowerPoint presentation, and/or

class discussion

Demonstrate all steps (by the instructor) Communicate the components of the skill

remember that learner may use your language

Ask learner to verbalize steps of procedure

Basic Steps for Teaching Procedural Skills(cont’d)

Basic Steps for Teaching Procedural Skills(cont’d)

Directly supervise performance and give feedback

Provide opportunities for learner to practice procedure/skill

Train learner to self-reflect on skills and level of performance

Debriefing

Get a Commitment

Encourages learner to process further and problem solve

Examples... “What do you think was wrong with the

patient?”

Probe for Supporting Evidence

• Helps you to assess the learner’s knowledge and thinking process

Examples... “What factors supported your diagnosis?” “What was it that made you choose that treatment?”

Reinforce What Was Done Well

• Describe specific behaviors

• Behaviors that are reinforced will be more firmly established.

Example… “I liked that your differential took into account the patient’s age, recent exposures & symptoms.”

Guide Errors / Omissions

• Describe what was wrong (be specific), what the consequence might be, and how to correct it for the future

• Corrects mistakes and forms foundation for improvement.– Hands-on skill review

Example… “I noticed that you had trouble as a group trying to make the defibrillator work. What are the consequences of us not being able to use it? Let’s review the defibrillator”

Teach General Principles

• Share practice ‘pearls’

• Allows learning to be more easily transferred to other situations

What if we don’t debrief our teaching sessions?

• Mistakes can go uncorrected

• Good performance is not reinforced

• Clinical competence is not achieved

• Learners generate their own feedback

Why might a team have difficulty improving?

• External barriers– Failure to follow behavioral norms,

inadequate resources, frequent change in team members

• Internal barriers– Lack of clear leadership, lack of goals/plans,

failure to plan, failure to resolve interpersonal conflict

• Groupthink– Conforming; ‘blinders’04/20/23 39

Summary

• Improve learning through active participation

• Many different techniques can be used to help build an effective team

• Debriefing each session or step of team building and identifying areas for improvement is key to success