Building Effective Teams
Kristen Nelson, MD
Asst Professor, Pediatric Critical Care
Medical Director, Pediatric Transport
Director, Pediatric Cardiac Critical Care
Johns Hopkins University School Of Medicine
Disclosures
• I have no financial disclosures.
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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
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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
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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
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What is necessary for team
structure?
• Goals and tasks/objectives
• Members
• Size
• Leadership
• Interaction
• Time cycle
• Decision-making techniques
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Phases of Team Development
(Tuckman)
•
•
•
•
Forming
Storming
Norming
Performing
– high-quality teams
• Adjourning, dissolving or reorienting
– if the project has a completion phase
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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
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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
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‘Think Aloud’
• Verbalize thoughts when you are
performing a task or observing
something on the monitor, for example
• Teaches clinical reasoning steps
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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….”
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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 sessions
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3 break-outs
• 1) Small group-Molly (error identification
and resolution within a team)
• 2) Simulation-Kristen (multidisciplinaryrole assignment and conflict resolution)
• 3) Large team-Deb (multidisciplinarydevelopment of novel team for high-risk
event)
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Conscious Competence Model of Learning
Unconscious
Incompetence
Conscious
Incompetence
Unconscious
Competence
Conscious
Competence
Unconscious Incompetence: requires demonstration of the
skill and how it will benefit the person’s effectiveness
Bristow, 2007
Conscious Competence Model of Learning
Unconscious
Incompetence
Conscious
Incompetence
Unconscious
Competence
Conscious
Competence
Conscious Incompetence: requires a commitment to
Bristow, 2007
learn and practice the new skill
Conscious Competence Model of Learning
Unconscious
Incompetence
Conscious
Incompetence
Unconscious
Competence
Conscious
Competence
Conscious Competence: requires continued practice (most
important factor to move to the next level)
Bristow, 2007
Conscious Competence Model of Learning
Unconscious
Incompetence
Conscious
Incompetence
Unconscious
Competence
Conscious
Competence
Unconscious Competence: able to teach others but may
have difficulty explaining exactly ‘how they do it’
Bristow, 2007
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
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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 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)
 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’
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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