Organizing Teams for Patient Experience Improvement
Organizations that are successful with their quality improvement (QI) work typically develop an improvement team and set up a structure and process for how that team will work together in managing the improvement activities. Some organizations create highly formalized structures; in others, a small, informal group manages the QI effort. Your choices about team membership, roles, and meeting schedule should reflect what will work best for your organization and the people who will be involved.
Building an Implementation Team
The “right” team can play a major role in determining the success of a QI initiative. The key is to carefully select people with the right skill set and mindset for quality improvement. Choose people who:
- Are opinion leaders.
- Are respected by their peers.
- Have appropriate expertise for the purposes of the intervention.
Choosing a Leader
Identify a leader for the team who can serve as the “champion” for the improvement initiative. This person will not only be the key to energizing the team and keeping the work moving forward, but also a visible spokesperson for the initiative within the organization. Useful characteristics of this champion include:
- Being well respected professionally.
- Having influence in the organization (formal or informal) that can help garner support for the work and overcome challenges.
- Having a passion for improving the experience of care for patients.
Related topic brief: Cultivating Leaders of Patient Experience Improvement.
Choosing Team Members
Choose people for the team who are enthusiastic about the chance to improve care, even if they lack some of the formal skills or responsibilities. Sometimes QI leaders select staff for a team because of their titles or their clinical or administrative expertise, even though the staff are clearly not convinced that quality improvement is effective or that patients’ experiences matter. These teams are rarely successful because they spend most of their time debating whether they should even be involved or they simply do not show up to do the work.
In larger organizations, effective performance improvement teams typically include:
- A senior leader responsible for providing resources, removing barriers, and publicizing the work of the team through the organization.
- A physician, advanced practice provider (APP), or nurse leader if the intervention involves any aspect of clinical care.
- A team leader, who is usually someone with administrative or clinical responsibility. This person could be a nurse, a practice manager, a pharmacist, or the supervisor of a call center, depending on the focus of the team.
- A data analyst to track the performance measures and share them with the team and senior leaders
- Other team members who represent the different disciplines or types of staff who own a “piece of the problem.”
Some improvement teams also include a patient or family member who can weigh in on priorities, measures, data interpretations, and the implementation and dissemination of interventions.1
Recognize that there is no one correct answer for how a team should be organized. A team may consist of only one or two people, especially in a smaller medical practice where each staff person may have multiple responsibilities. This approach is fine, as long as it is a conscious decision rather than an oversight.
Learn more about teams:
- Edmondson A. Teaming: How organizations learn, innovate, and compete in the knowledge economy. San Francisco: Jossey-Bass; 2012.
- Katzenbach J, Smith D. The wisdom of teams: Creating the high-performance organization. Boston: Harvard Business School Press; 1993.
- Leebov W. Working together for professionals in health care: Communication skills for collaboration and teamwork. CreateSpace Independent Publishing Platform; 2012.
- Rowland P, Lising D, Sinclair L, Baker GR. Team dynamics within quality improvement teams: a scoping review. Int J Qual Health Care. 2018 Jul 1;30(6):416-422. doi: 10.1093/intqhc/mzy045. PMID: 29617795.
- Scholtes P. The team handbook: How to use teams to improve quality. Madison, WI: Oriel, Inc.; 1996.
Establishing a Team Process and Structure
The improvement team’s job is to initiate the process of improving performance by:
- Assessing issues underlying performance problems.
- Setting goals for improvements.
- Developing a strategy and action plan for making changes.
- Overseeing the implementation of those actions.
During the early part of this work, the team members have to learn how to work together as a group. The leaders can reinforce the positive aspect of this (often messy) process by encouraging team members to express their views, listening carefully, and helping them reach consensus on how best to carry out the work.
Read about developing effective teams:
The Agency for Healthcare Research and Quality’s TeamSTEPPS: an evidence-based program to optimize the performance of healthcare teams.
Edmondson, Amy C. The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth. Hoboken, NJ: John Wiley & Sons, 2018.
Lencioni P. The Ideal Team Player: How to Recognize and Cultivate the Three Essential Virtues. New York, NY: John Wiley and Sons, Inc.; 2016.
Lencioni P. Overcoming the Five Dysfunctions of a Team: A Field Guide for Leaders, Managers, and Facilitators. San Francico: Jossey-Bass; 2005.
Watch Patrick Lencioni talk about “"The Ideal Team Player.”
The improvement team will have to make several decisions about managing its work:
- What is the team’s role?
- How often will the team meet?
- What method will the team use to make decisions and achieve consensus on improvement strategies and actions?
- Should it create other committees for specific parts of the improvement work?
- How will the team interact with others (i.e., stakeholders) who will be involved in or affected by the changes the team introduces?
Critical task: engaging stakeholders affected by changes
Improvement teams must make the effort to understand the perspectives and concerns of the various people who will be involved in or affected by the improvements being made. Many improvement efforts have failed or been slowed because changes were implemented that were not acceptable to one or more stakeholder groups essential to success. On the other hand, some of the strongest efforts have been those that thoroughly engaged stakeholders and empowered them to contribute to achieving sustainable changes.
Leaders of improvement teams need to answer two questions regarding stakeholder involvement:
- Who are the important stakeholders for this QI initiative?
Think broadly to identify the groups who may have an interest in the particular improvements you are pursuing. For most initiatives, stakeholders typically include patients, physicians, nurses, and administrative clerks. Depending on the specific services involved, the list of stakeholders may also include pharmacists, health educators, therapists of various types, administrators, attorneys, staff in other departments in the organization, and representatives from external organizations.
- How should these stakeholders be involved in the improvement process?
Ideally, your improvement team will include representatives of all the stakeholder groups that are important for your initiative. You can engage frontline staff and other stakeholders throughout the implementation process by establishing mechanisms for open communication and regular opportunities to provide feedback on the process and the related tools and practices.
For example, as you begin to develop ideas for changes, ask the people who will be implementing those changes for their suggestions. Then seek their feedback on proposed actions before you begin implementing them.
Read about engaging physicians in improvement work
- Mahbooba Z, Chera B, Evarts L. Engaging Physicians in Quality Improvement in a Hospital Setting: A Scoping Review. Am J Med Qual. 2021 Sep-Oct 01;36(5):328-336. doi: 10.1097/01.JMQ.0000735456.03039.2e. PMID: 33901037.
- Kiran T, Rozmovits L, O'Brien P. Factors influencing family physician engagement in practice-based quality improvement: Qualitative study. Can Fam Physician. 2023 May;69(5):e113-e119. doi: 10.46747/cfp.6905e113. PMID: 37173000; PMCID: PMC10177636.
Visit the Resource Library to learn about engaging staff in improvement work:
Montefiore Hudson Valley Collaborative. Implementation Toolkit: What Matters to You? Version 1: May 2020. A resource available from The Beryl Institute’s “What Matters To You?” Resources page.
1. Grob R, Gleason K, McLean P, McGraw S, Solomon M, Joffe S. Patients' roles in governance of learning: Results from a qualitative study of 16 learning healthcare systems. Learn Health Syst. 2021 May 25;6(1):e10269. doi: 10.1002/lrh2.10269. PMID: 35036551; PMCID: PMC8753297.
