As many of you know, quality and safety are the horizontal threads that run through the tapestry of all that we do to provide safe and effective care for our patients. The work to bring this about takes every member of the care team working at the top of their game. We're going to be talking about the importance of team-based care and nourishing an environment for a high-performing team. Think back. All of us have been part of a team for a while, even as kids. Or we've been the new person who's joined an existing team. Think about the qualities that made the team good or bad. Think about how quickly or how long it took you for you to become part of that team. What opportunities and challenges were there to make your team great? Now you are part of a healthcare team, which I would argue is the ultimate team. As you hear this talk, think about how you can include in our discussion to make yours a high-performing team. Many of you have heard of the Triple Aim as promulgated by the Institute of Healthcare Improvement in 2008. The strategic thinking about these aims began in the 1980s with Dr. Donald Berwick, who was a quality and safety guru. The Triple Aim has served as the North Star for healthcare organizations to line their healthcare delivery model to serve these aims to try to achieve better outcomes. However, the Triple Aim was missing out on an important aspect of healthcare, how the team affecting the care of the patients was important. By 2014, this piece became widely recognized as critical to achieving these aims. And in 2020, this came to a head when the COVID pandemic hit. Burnout, job dissatisfaction, exhaustion, cynicism, loss of autonomy, and criticism played havoc with healthcare providers, resulting in the great retirement in which many technicians, allied healthcare personnel, nurses, and physicians left healthcare altogether. Improved clinical experience was recognized as the fourth aim to achieve. And in 2022, a fifth aim was advocated, that of the imperative to advance health equity, the state in which everyone has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances. Health inequities affect many populations, including individuals who identify as Black, Latino, Native American, or LGBTQ+. Individuals in rural communities, individuals living in poverty, individuals with disabilities, and older persons face similar healthcare inequities. The reasons for healthcare inequities are multipoled and include structural racism, which shapes numerous opportunities that influence health, including educational attainment, employment, access to safe environments, affordable housing, healthful food, access to care, social relationships, and networks. So, realizing that team-based care is critical, growth in team-based models of care has emerged. Many of you have seen this in the hospital setting because of the complexity of care delivered there. Yet, models of team-based care have lagged in the outpatient setting. No matter the setting, the lack of focus on those providing the care will result in the lack of achieving the original triple aim, as well as the new quintuple aims. Thus, building an effective team is imperative. How do we define a healthcare team? This is one common definition. What are the goals of a team-based model of care? And here's one common concept. So, we'll come to our first audience response question, and that is, who makes up your team? Who makes up your team? So, Eden, if you could allow us to poll the audience and see where we stand with those that are present here. It looks like we're off to a great start, Dr. Eisenberg. Everyone's had their coffee, and they are ready for the day. We are getting responses fast and furious. And there are your results, Dr. Eisenberg. Very interesting. So, I think that most of us would agree that all of these people are part of our team. Some of you answered my answer might be different, and so it would be interesting to see who you include in that. Data have actually shown that endoscopies are not only, that are not only patient-centered, but also team-centered, have better patient outcomes and greater staff satisfaction, which is a win-win. Most endoscopy teams include all of these people. You may have others on your team as well. Teams are important because they are much greater than the sum of the individuals making them up. Better patient care, more innovative ideas, higher productivity, improved efficiency, and fewer medical errors are seen with high-performing teams. Here's another audience participation question. What principle is emblematic of a high-performing team? And so, we've got our poll up, and please go ahead and answer. Well, it's interesting that people didn't pick ADR report card as being posted in the waiting room as an example of a high-performing team. I would probably argue, and I think most of you would agree, that all of these answers probably are emblematic of a high-performing team. So, really, there wasn't any wrong answer associated with this particular question. If you're going to capture one thing from this talk, I think this is the chart you want to keep and bring to your team. And as you look at it, as you see what the principles are, look at which ones could your team improve on. The chart highlights the principles of high-performing teams, including shared goals, which may even include a mission statement, clear roles, mutual trust or psychological safety, effective communication, and measurable qualitative and quantitative processes, and performance outcomes, including assessment of team structure in of itself to determine whether changes are needed, and the impact on each team member's well-being. So, which one are you going to choose to bring home to your team? I'm going to talk a little bit about how there are six different strategies to consider when you create a high-performing team culture. And just remember that not all teams are created equal. Each endoscopy unit has unique circumstances in which teams are formed. There are different challenges and different resources, as Allie alluded to, in which each team functions depending on the environment the team is in. The first strategy is to develop a North Star mission statement. When there are common purposes and goals, team members share a greater sense of camaraderie and are more motivated. It gives team members themselves a sense of purpose and helps break down and or avoid silos which impair teamwork. In the example of patient care is our priority, which some endoscopy units as a mission statement, many of you can appreciate the story of a custodian whose main job was to clean the restrooms of the endoscopy unit who sat down with the patient who had difficulty in reading his prep instructions and going over them with pictures so he could get it done correctly. The custodian recognized a need and stepped in to assist. Yet, how many of you would consider the custodian or environmental service worker as part of your team? Success is reaching that North Star purpose and it is all about how your team does overall and not on how one physician or nurse does. The second strategy is to develop team agreements. Successful teams have established standards of operations that they work under. When developing these agreements, some questions to consider are what are the behaviors we need from each other to establish greater trust and psychological safety? How do team decisions get made? How do we ensure that everyone's voice is heard? One trick I've used is to have everyone submit their opinion individually and then bring these together anonymously as a team meeting to discuss all of these ideas. This process prevents group think, which can inhibit someone from providing a great idea in the setting of a team meeting. High-performing teams have clear roles and responsibilities. Understanding and knowing them, team members can then find opportunities to help each other, including assisting colleagues when needed, even when it doesn't fill their job role responsibility, like our custodian that I mentioned before. High-performing teams also have clear metrics to help measure goals and processes as a way to define success. Success boosts team morale and reinforces team mission. Helps teams identify factors that contribute to their success. When success is not met, everyone on the team can provide solutions and strategies to address problems that arise. Every team should learn from its mistakes and failures. Michael Jordan, the basketball player, who some say is the greatest of all time, famously said, I've missed more than 9,000 shots in my career. I've lost almost 300 games. 26 times I've been trusted to take the game-winning shot and missed. I've failed all of them. I've lost all of them. I've lost all of them. I've failed over and over and over again in my life, and that is why I succeed. So failure isn't just accepted, it's expected. When you stretch yourself past your current limits, failure is inevitable. It spawns growth. You only reach the top and stay at the top by continuously improving. When teams learn together, they bond together. Discovering reasons for mistakes and learning how to address failure rather than blaming, punishing, or embarrassing team members makes teams stronger. This process should be embedded in your team agreement. Well, one of the things that I think is interesting in providing opportunities for team engagement on a personal level is the process of developing culture as a key way to developing mutual trust. Such things as personality workshops, compliment circles, codename games, lunch and learn workshops, for example, someone who's really good at Excel shows everyone else on the team how to use Excel effectively, or someone who speaks Spanish fluently teaches other people on the team some common phrases to use, or even a healthy cooking course or class could be introduced to your team. Involving your team in a special hospital-wide project or a volunteer community project is beneficial to developing that psychological safety that we talked about before. Celebrate your successes. Celebrate both team accomplishments and personal accomplishments. Make sure to nominate team members for hospital or unit-based awards. And then carve out the time in your schedule for your team to plan and strategize. Consider holding think tank sessions at outside venues that incorporate everybody's input. So team, I love these acronyms. Team stands for together, everyone achieves more. Thank you for listening. I hope this presentation has given you ideas to make your team stronger and more effective.

team-based care

Triple Aim

health equity

high-performing teams

quintuple aims