The Potential and Pitfalls of
Team Science
Peter Pronovost, MD
Armstrong Institute for Patient Safety and Quality
© The Johns Hopkins University, The Johns
Hopkins Hospital, and Johns Hopkins Health System
Disclosures
Name
Type of Financial
Relationship
Name of Company
Dr. David E. NewmanToker
Loaned Research
Equipment
GN Otometrics
Loaned Research
Equipment
Interacoustics
2
Pasteur’s Quadrant
Increasing Dominance of Teams in Production of Knowledge, The. Science.
2007;316:1036-1038
http://www.nature.com/nature/journal/v494/n7438/full/494430a.html
https://www.teamsciencetoolkit.cancer.gov/public/home.aspx?js=1
http://timkastelle.org/blog/2013/
05/innovation-requires-a-bias-
Increasing Dominance of Teams in Production of Knowledge, The. Science. 2007;316:10361038
http://www.nature.com/nature/journal/v494/n7438/full/494430a.html
https://www.teamsciencetoolkit.cancer.gov/public/home.aspx?js=1
The Armstrong Institute
• Purpose: to partner with patients, their loved
ones, and all interested parties to end
preventable harm, to continuously improve
patient outcomes and experience, to
eliminate waste in health care
• Principles
– I am humble and curious
– I respect, appreciate and health others
7/13/2016
– I am accountable to continuously improve my self,
my organization, my community
6
Performance Focused
• Mixing bowl linking clinicians and researchers
• Participatory leadership and infrastructure
• Learning and accountability
7
8
CLA-BSI Rate Per 1,000 CL. Days
CLA-BSI Rate for All ICUS at JHH:
1998 - Q2 2012
13.00
12.00
11.00
10.00
9.00
8.00
7.00
6.00
5.00
4.00
3.00
2.00
1.00
-
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
All ICUs 11.8 7.51 6.86 7.90 4.24 2.53 2.25 2.33 2.73 1.67 1.34 1.22 1.59 0.88 0.90
15-Year Trend in Central Line-Associated
Bloodstream Infections in ICUs Reporting Data to
Centers for Disease Control and Prevention
9.00
87% reduction
7.9
8.00
Mean Rate/1000 Catheter-days
7.00
6.00
81% reduction
81.5% reduction
82% reduction
6.1
6
5.6
80.5% reduction
5.00
4.1
4.00
1992-1999
2013
3.00
2.00
1.00
1.15
1.1
0.8
1.0
1.0
0.00
Medical
Med/Surg (teaching)
Medical/surgical
Surgical
Pediatric
Intensive Care Unit Type
Pronovost et al, unpublished data
2014.
10
Organizational Framework for why
CLABSI worked
• Declare and communicate purpose goals and
measures
• Create enabling infrastructure
• Engage clinicians and connect them in peer
learning communities
• Report transparently and create accountability
Dixon Woods: Milbank Quarterly 2014; Pronovost Academic medicine 2015
Pronovost: TJC 2014: Pronovost
Academic Medicine 2015 i
11
Key concept:
Adaptive and Technical Work
(Heifetz, 1998; Pronovost, 2011)
Technical
Work
Adaptive
Work
12
Participatory Leadership
• Mobilize rather than persuade
• Do things with rather than to people
• Use language that implies power with rather
than power over people
• Look for bright spots in the organization
• Maintain others stature and control
• Balance love over power
13
What tools will you use
•
Be unwavering in hill you climb and humble enough to help you climb it
•
Surface real and perceived loss
•
Be mindful of pressure in pressure cooker
•
Avoid monsters in bathroom
•
Identify WIFM
– Power, agents, constituents
•
Value the dissenter- understand not judge
Heifetz, Kotter, Hackman
Pronovost BMJQS leading adaptive change
14
Biological systems are fractal and derive complexity
by following a simple set of rules
Health System Core of Expert Quality Leaders
Hospital
– QI
leaders
Learning &
sharing
Depts
–
Alignment of
goals,
resources,
accountability,
and learning
throughout
levels of
organization
Quality
&
Safety
Officer
Units –
QI
leaders
&
CUSP
team
Staff –
QI
work
Hospital
– QI
leaders
Learning & sharing
Depts
–
Learning &
sharing
Learning &
sharing
Learning & sharing
Quality
&
Safety
Officer
Units –
QI
leaders
&
CUSP
team
Staff –
QI
work
Hospital
– QI
leaders
Depts
–
Learning & sharing
Quality
&
Safety
Officer
Learning & sharing
Units –
QI
leaders
&
CUSP
team
Learning & sharing
Staff –
QI
work
Clinical
Community
Patient
Involvement
How teams make wise decisions
Independence and Interdependence
Bee Democracy
How might you create productive
team science?
• What is your purpose
• What principles guide you
• What is your performance system
– Leadership style, management structure,
18
Purpose: where are you going
• Create compelling story for high level vision
(why and what) and invite others to cocreate details (how)
• Identify and understand key stakeholders
– Power people
– Agents
– Constituents
Armstrong Institute for Patient
Safety and Quality
19
How leaders communicate
How
What
Why
What is your leadership style
• Change happens at the speed of trust
• Things done to rather than with other
are highly resisted, never implemented
locally, and often do not work
22
What are your management
structures
Mixing Bowl
What are the perils of team
science
Creating a team science program
• Align around a vision, a purpose
• Define principles
• Create performance system
– Create a mixing bowl/ fractal
– Built trusting relationships
– Help team believe and belong
Does Team Believe and Belong
“Never doubt that a small group of
thoughtful committed people can
change the world; indeed, it is the only
thing that ever has”.
Margaret Meade
28
Panel Discussion
• Peter Pronovost, M.D., Ph.D., F.C.C.M.
• Jill Marsteller, Ph.D.
• David Newman-Toker, M.D., Ph.D.
• Hanan Aboumatar, Ph.D.
• Julie Gottlieb, M.A. - Moderator
29