Using the Team Developme

Measure© (TDM) to Impro

Team P f er ormance

February 1, 2011
Audience

Survey: Survey: Who is on this call? (pick your primary

primary

VACO/national program leaders or staffFacility‐based leaders/staff

VISN‐based leaders/staff

ResearchersOtherPlease write in your questions: CIPRS@va.

submit your questions via LiveMeeting.
Audience

Survey: Survey: Have you used the Team Developmen

Developmen

(TDM) before?

Yes

No

Please write in your questions: questions: CIPRS@va 

CIPRS@va.

submit your questions via LiveMeeting.
Course Outline

• Introduction Introduction to the TDM/Refresher TDM/Refresher Course 

TDM

• Walk th h roug the TDM online system

• Reviewing the TDM report

• Q&A
Presenters

• Susanne Susanne Salem‐Schatz, ScD, Investigator Investigator, VA Center fo

Implementation Practice and Research Support

• Nina S ith m , MPH, Pjt ro ec C di t oordinator, VA C t en er for

Implementation Practice and Research Support

• Craig Roth, MD, Co‐Chief, General Medicine, Minneap

Medical Center

• Steven Krysiak, VISN Support Service Center (VSSC)
Team Development Meas

101

Susanne Salem‐Schatz, ScD

Investigator

VA Center for Implementation Practice 

Research Support
https://srd.vssc.med.va.gov/Pages/UsingEvaluationToImproveOurWork

p // g / g / g p 
Background

• Evaluation group chartered chartered by System

System

Redesign Steering Committee

– Part of the Systems Systems Improvement Improvement Subco

Subco

• “to help all redesign and improvemen

activities maximize learning through sevaluation evaluation of projects projects and sharing sharing of

evaluation results”
Using Evaluation to Improve Our W

Resource Guide V.1.0

• Thanks to support from OQP and QUERI an

– OQP (Dede Ordin, M.D.)– CIPRS (Brian Mittman Ph.D)– Steering Committee: OSR, OQP, ONS (VA

MC), QMO, EES

– Edward Miech, Ph.D. Indianapolis VA
Why the Team Development M

• Valid and reliable

• User‐friendly

• U d t d bl Understandable li kn s to core f t ea ures 

teams

• Promotes reflection and improvemen

• Scores can be tracked over time

• Available to VHA with permission of P

Health
Team Development Mea

• Point in time assessment assessment of Team Developm

Developm

• Easy to take• Easy to understand• Supports reflection for team improvement

– External facilitator is recommended– Teams can review on their own if needed

• Summary TDM Score can be tracked over 
Team Development Mea

• 31 questions questions, 4 key aspects aspects

– cohesion– communication

– clarity of team roles

– clarity clarity of team goals and the means to achieve achieve 

• 4 response categories

– Strongly disagree– Disagree– Agree– Strongly agree
VHA Use of the TDM

VISN Name VISN Total Teams

(V01) VA New England 27

Healthcare System

(V07) VA Southeast Network 3

(V08) VA Sunshine Sunshine Healthcare Healthcare 2

Network

2

(V10) VA Healthcare System ofOhio

1

(V11) Veterans In Partnership 8( ) V12 VA Great Lakes Health 5Care System(V19) Rocky Mountain

Network

1

(V20) Northwest Network 1

(V23) VA Midwest Health Care

N k

38

NetworkTOTAL 86
VHA TDM User Feedbac

• The survey had face validity for leaders/facilitators

– “The teams I think were most dysfunctional really scored the worst.”

• The process made sense to team members

– Made sense to the team in the context of ong g oin team development– Interested in seeing “where the team was”

– “The survey gave them a structure to have conversations that they mig

otherwise.”

• Facilitators created Psychological Safety

– allowed team members to participate, not “manage” the conversation– really helped create sense of safety: safety: people felt safe, so they could say 

• Review process empowered team participants

–

“

...willingness of LPNs and clerks to speak up in a group with some stro

not have h d appened b f e ore. P t u s every one on equal ground. R lt esu s d 

o

the doctor. Everyone’s answer is equally important.”
TDM Resources

TDM Module in the Evaluation Resource Guidehttps://srd.vssc.med.va.gov/Pages/UsingEvaluationrWork.aspxAutomated TDM survey and reporting system1‐paghttp://vaww vssc med va gov/TeamDevelopmentMhttp://vaww.vssc.med.va.gov/TeamDevelopmentMVISN 23 PACT TDM Facilitator Reference Guide, AgeAction Planhttp://vaww.portal.gla.med.va.gov/sites/Research/Evaluation_Resource_Guide/default.aspx
Guide to the TDM online sy

Nina Smith, MPH

VA Center for Implementation

P i ract ce and R h esearch Support
Acknowledgments

• Steve Krysiak (VSSC)

• Tony Broadie (VSSC)

• Dede Ordin (OQP)• Jill Powers (VSSC)• Donna Adorian Rodriguez (VSSC)• Sharon Kwasny (Systems Redesign)

• Susanne Salem

‐Schatz (CIPRS)

• Deborah Jenkins (CIPRS)
Housekeeping

• Questions can be typed into LiveMeeting’s 

function

• Email questions to ciprs@va.gov• Slides posted to CIPRS Intranet Intranet page:http://vaww.portal.gla.med.va.gov/sites/Research/HS

Evaluation

_ _/ p Resource_Guide/default.aspx
Features of the TDM syste

• Automated• Anonymous• Free• Ability Ability to set up multiple multiple teams• Ability to track team progress over time
In the beginning...

Email CIPRS@va.gov CIPRS@va.gov to request request access to the syst
http://vaww.vssc.med.va.gov/TeamDevelop
Setting up a new TDM
Setting up a new TDM (co

Start new surv
Setting up a new TDM (co
Setting up a new TDM (co
Setting up a new TDM (co

Insert 

each t
Setting up a new TDM (co
Responding to

a surve
Responding to a survey (c
Managing

a survey
Managing a survey (con
Managing a survey (con

Produce repo
Managing a survey (con
Managing a survey (con
Managing a survey (con
Managing a survey (con
Producing

a Report

Produce repo
Producing a Report (con

Surve

Never m
Accessing

a Report
Accessing a Report (con
Accessing a Report (con
Tracking over time...
Tracking over time (con

New sur
Tracking over time (con
http://vaww.vssc.med.va.gov/TeamDevelop
Reviewing the TDM repo

Craig Roth, MD

Co‐Chief, General Medicine

Minneapolis VA Medical Center
Teams

• 2 pilot primary care Patient Aligned Care Te

(PACTs).

• Formed March 2010.• Members:

– Selected by GIM Chiefs and Nursing Dire– Att d d Attended VA L i earn ng S i ess ons in Las Veg

2010) + 2 regional learning collaborative

(principles of PACT).
Approach we took

• I told leaders about TDM©, and was invited 

with teams.

• Teams embraced the idea

• I arranged arranged to have e‐mail links set up

• Members completed anonymously• I gath d ere and di t ib t d distributed results to all mem

• I facilitated discussions (~1 hr)
TDM Report Table of Cont

• Guide to Reviewing Your Team Developmen

Measures

• TDM results

• Tips for Successful Successful Teamwork Teamwork
Sample TDM Repo
Sample TDM Repo
Cohesiveness

When a team is cohesive, team members:• Are attracted to the team.• Find membership in the team to be a personally m

experience.

• Enjoy the company of the other team members.

• Support, nurture, and care for each other.

• Feel free to share ideas and suggest ways to impro

function.

• Feel they are using their unique skills for the benef

team.

• Have a strong “we” feeling.

• Routinely develop creative solutions to problems.
Sample TDM Repo
Communication

When a team is effectively effectively communicating communicating, team mem

mem

• Always freely say what they feel and think.• Are always direct, truthful truthful, respectful respectful and positive positive

• Openly discuss all decisions before they are made.

• H dl an e confli tc in a calm, caring and h li ea ng mann

• Openly explore options to solve problems when th

• Do not t lk a ab t ou each other b hi d e n th i e r b k ac .

• Do not have a hidden agenda.
Sample TDM Repo
Role Clarity

When a team achieves achieves role clarity clarity, team members: members:• Feel that accomplishments of the team are placed 

those of individuals.

• Understand the roles and responsibilities of all oth

members.

• Have a clear understanding of what other team me

expect of them.
Sample TDM Repo
Goals and Means

When a team achieves achieves goals and means clarity clarity, team • Have clarified and agreed upon what the real work 

team is.

• Clearly understand the goals of the team.

• Agree on how to reach the team goals.

• Agree upon clear criteria for evaluating the outcom

team.
Sample TDM Repo
Tips for Successful Teamw

• Includes Includes practical practical tips for improving improving each te

te

component (cohesion, communication, role 

goals & means)

• Shows how the report can be used as a tea

future planning guide
Reactions from team

• Very lively discussions. discussions. Full participation participation (m

previously).

• Some surprises:

– Diversity of answers

– Not as development as hoped

• Identified: strengths, areas to work on and 

• Eager to take again to assess progress.
Reviewing TDM Results

• VISN 23 PACT TDM Facilitator Facilitator Reference Reference Gu

– Facilitated process– P id d rovided st t ruc ure

– Provided facilitation tips

• Developed by and used with permissi

Aspire Consulting
Facilitator Reference Guid
Role of Facilitator

• Provides objective leadership• Guides discussion• H l e ps team get results

• Provide a neutral and objective perspective
Preparation

• Checklists for preparations before, du

after the meeting
Structure and Flow

• Sample agenda• Tips on language to support structure

– Structure Structure statements statements “Our plan is to discuss discuss A, 

C”

– Validating Validating questions questions “If I understand understand you correc

correc

saying...”

– Summary Summary statements statements “Now we ve ’ covered covered XYZ,

accomplishing our goal for that topic today”

– Transition statements “Let’s move on to talk ab– Statements of closure “Thanks for your particip

great progress”
Structure and Flow (cont’d

• Four “P s’ ”

– Purpose: Open and close the meeting with a m– People: People: Reinforce Reinforce the importance importance of team and

involvement

– Process: Hig g hli ht the process for accomp 

lishin

– Progress: Set an expectation for how progress w

measured and reinforce how progress will be m
Interactivity

• Techniques Techniques provided provided to engage all team me

me

discussions and action planning, i.e.,

– Emphasize Emphasize the importance importance of sharing sharing ide– Establish 'ground rules' for this discussio– Ask open ended questions to kick things 

engage the group

– Be patient and wait for responses– Write ideas on a flipchart to remind p 

eo 

discussion and to show progress

– Revisit unresolved issues
Interactivity (cont’d)

• Tips for handling handling common challenges: challenges:

– Silence– O t u of cont l ro di i scuss on

– High levels of emotion

– Rigid or inappropriate responses
Action Planning

The goals of the meeting meeting are to

• process TDM results

• pinpoint broad areas of opportunity• identify identify realistic realistic action steps to supp

supp

momentum in each
Facilitator Reference Guid
Q&A

Moderated by:

Susanne Salem‐Schatz, ScD

Investigator

VA Center for Implementation Pract

and Research Support
Fielding the TDM Surv

Automated system by VSSC

http://vaww.vssc.med.va.gov/TeamDevelopmentMeasure/D

1. Email CIPRS@ g va. ov to request access to the 2. Automated by VSSC

3. Once access is granted, need the following in

to set up a survey:

• Name of team

• Names of team members

4. Online survey link sent to team members

5. Can check on the number of respondents respondents, clo

survey, produce a report, and distribute repo

members
Guide to the Team Developmen

Using Evaluation Evaluation to Improve Improve Our Work: A Re

Re

Guide

Module 3: Team Development Development Measure MeasureIntranet:

htt // t l l d / it /http://vaww.portal.gla.med.va.gov/sites/SRD/CIPRS/Evaluation_Resource_Guide/d

Internet:

http://www.queri.research.va.gov/ciprs/R

deV1‐1.cfm
Any additional questions can be sen

CIPRS@va.gov