This is the second post in a series on Improving Teamwork within your organization. I’m using healthcare teams in operating rooms, emergency rooms, and intensive care units as an example, but the principles could apply to any high-stakes team in any organization.

My first post framed the overall issue. This post begins to apply the Influencer model you see below. I’ll begin by showing how to clarify measurable results.

“Improve Teamwork” is a nice sentiment, but is too vague to guide any initiative. We need to specify what “improved teamwork” looks like and how we will know when we’ve achieved it. I like to run the results through a sieve of questions. Here are a few I like to ask.

The Money-Grubbing Capitalist Pig Test. Why would a money-grubbing capitalist pig want the people in your OR, ER, or ICU to improve their teamwork? Look at the results through the eyes of a skeptic or cynic who isn’t swayed by any kind of “feel good” motives.

This person would look at bottom-line results, such as: improved productivity, lower costs, fewer errors, and increased quality of care. We might want to make sure we add these measures on top of the employee engagement and patient satisfaction scores that might be less interesting to our pig.

The Can-It-Be-Measured Test. Results need to be measures so that progress can be tracked. Often, the best measures are ones you are already tracking. They’ve been refined over the years and are trusted. But other times you’ll need to involve your stakeholders and jointly determine how to track your success. At the same time, I try to keep Don Berwick’s advice in mind: “Measures are important, but they are never more than the shadow of your heart.” Don’t select a result simply because you can measure it. Make sure it’s the result you really want.

The Sensitivity-To-Change Test. There is a statistical challenge that happens when the Results you care about happen very infrequently. The lower the incidence of the problem, the harder it will be to detect any improvements. This challenge explains why some studies require tens of thousands of participants while others require no more than fifty. You need measures that are sensitive—and often these are precursors or predictors of the Results you truly care about. For example, even if the bottom-line Result you care most about is patient deaths, you will also want to include incidents, adverse events, near misses, and other precursors that are more sensitive measures of change.

Measuring Teamwork. The measures you use will depend on the aspects of “teamwork” you care about most. We’ve developed a survey that measures the key characteristics of highly-reliable teams. These characteristics have proven their worth as precursors to good and bad outcomes in high-stakes healthcare teams.

• Situation Awareness: Team members have the same mental model or perspective, and this common perspective is challenged and updated as needed.
• Resilience and Backup: Team members provide backup support for each other in a way that prevents or minimizes errors and bad outcomes.
• Use of Expertise: Decisions are based on facts and expertise, not authority.
• Full Engagement: Team members are vigilant, not complacent. They always expect the unexpected.
• Team Learning: The team learns from its experience.
• Leadership: There is a leader who encourages positive teamwork.

Our goal is to improve the teams’ scores on this survey by at least 25 percent within the next six months. In addition, we want to see a reduction in intimidation as measured by ISMP’s Intimidation Survey. We’ll also track employee engagement and JHACO readiness. Together this basket of measures capture the heart of what we want to achieve. We call this initiative, Moving from Teams of Experts to Expert Teams.