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Case Study Sections


		Getting Started
		Developing a Strategic Plan
		Identifying the Problem
		Describing the Problem
		Analyzing the Problem
		Planning the Solution
		Implementing the Solution
		Monitoring/Evaluating the Solution

Related Topics


		Team Building Tools: Brainstorming
		Team Building Tools: Team Building Strategies

Establishing a Quality Improvement Team

Mrs. Alvarez decides to establish a team to carry out the quality improvement process that she learned about in the quality improvement training. The team will include representatives of both the health center staff and the community, will be based in the health center, and will work with both the center's staff and its clients. The primary tasks for the team to accomplish over a six-month period are:

to define the health center's vision and its mission
to define the strategic plan for quality improvement
to identify the problems to solve
to determine the action steps needed to solve the problem
to monitor both planning and implementation
to encourage acceptance, by both staff and clients, of the recommended changes

The effectiveness of the quality improvement process will depend in great part on the ability of the team to work well together, and, particularly, on their ability to work well with the rest of the health center staff and the community. Mrs. Alvarez realizes that the team should be multidisciplinary and should have a democratic working structure. Until now, the staff at the center worked as a team in providing services, but the team structure was hierarchical rather than egalitarian. She realizes that working in a nonhierarchical manner, where all participants are equal, will be challenging for her staff members and perhaps even for herself. But she also knows that using the tools she has learned about in her training will help the team structure its interactions and focus on identifying the health center's problems and finding solutions that will benefit them all.

In establishing the team, Mrs. Alvarez uses a number of tools that she learned about during her quality improvement training.

Building the Team

First, Mrs. Alvarez asks for volunteers from the Health Center staff to be members of the first quality improvement team. She knows it is important for staff members to decide for themselves to be on the team so that they will be motivated and excited about the process. Next, Mrs. Alvarez utilizes the Strategies for Developing an Effective Team that she learned at her quality improvement training. She learned that characteristics of an effective team include:

Team members share leadership roles.
The team develops its own scope of work.
The team develops concrete work products.
Team members are mutually accountable for work products.
Performance is based on achieving team products.
Problems are discussed and resolved by the team.
Team shares market work with rest of organization formally and informally.

Mrs. Alvarez issues an SOW (Scope of Work) for the team that includes objectives, methodology, and time commitment. She is happy that eight people have volunteered to be on the team. The team is composed of one doctor, Dr. Lozano; one nurse, Nurse Cruz; the Office Manager, Mrs. Gutierrez; the logistics manager, Mr. Diaz; the laboratory manager, Miss Leon; two clients, Mrs. X and Mr. Y; and herself.

Mrs. Alvarez distributes the team's Scope of Work to all other staff and sets up a schedule of information meetings. Next, she asks the team to help her brainstorm a list of ground rules by which they will work. Some of the ground rules the group generates include:

respect one another
listen to each other
share ideas
communicate
discuss and resolve problems as a team
make decisions by consensus

The team members explore how their group -- composed of staff and clients with very different backgrounds and responsibilities -- can find common ground to discuss problems in a mutually respectful manner and work towards satisfactory resolutions.

Mrs. Alvarez supports this process by stressing the unique and valuable contributions each team member has to add to the process of improving the quality of clinical services. She reviews the elements of the consensus making process, underscoring her commitment to supporting each team member and encouraging each team member to share their ideas and thoughts. Team members express their willingness to try, but in private most seem skeptical.

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