Creating High-Performance Teams on Inpatient Hospital Units

In the fast-paced and complex environment of inpatient hospital units, the formation of high-performance teams is not just beneficial — it's essential. High-performance teams can significantly improve patient outcomes, enhance the quality of care, and increase staff satisfaction and retention. But what are the key strategies for creating and nurturing these dynamic teams in the healthcare setting? And what evidence is there that the Accountable Care Unit (ACU) care model is an evidence based example of how to create and support high-performing hospital teams.

Understanding High-Performance Teams

High-performance teams in healthcare are characterized by their ability to work collaboratively across disciplines to deliver patient care that is safe, effective, efficient, and compassionate. These teams leverage the diverse skills, experiences, and perspectives of their members to innovate and solve problems. The hallmark of such teams is their consistent achievement of high-quality outcomes, even in the face of challenges.

Results achieved on an ACU unit:

•  30% reduction in falls

• 28% decrease in unit mortality along with 24% decrease in discharges to hospice

• 30% reduction in 7-day readmissions

• 25% reduction in 30-day readmissions

• 29% ($1,200) reduction in direct variable costs per hospitalization

• $1.4M annual savings on SIBR unit, based on $1,546 savings in average total cost per case

• 300% increase in family participation on team rounds

• 97% of physicians say SIBR is more effective

• 33% decrease in interdisciplinary rounding duration compared to traditional rounds

    

Key Strategies for Building High-Performance Teams

Foster a Culture of Open Communication

Open, honest communication is the cornerstone of effective teamwork. Encourage team members to share their thoughts, concerns, and suggestions without fear of judgment. Regular team meetings, huddles, and debriefs can facilitate this exchange and help identify areas for improvement or innovation. In ACUs, one of the core pillars is the focus on unit level performance metrics. Successful units feedback and discuss unit performance with the frontline teams in an open way and seek suggestions from staff about how to improve performance.

Define Clear Roles and Responsibilities

Each team member should have a clear understanding of their role and how it contributes to the team's goals. Clarifying responsibilities can prevent duplication of efforts and ensure that all necessary tasks are covered. It also helps team members appreciate the value of their contribution to patient care. ACUs use standardized patient-centered care processes to provide clarity to team members about what their roles are, what their contributions to processes are, and how these impact the delivery of care.

Promote Interdisciplinary Collaboration

High-performance teams in hospitals are often interdisciplinary, comprising doctors, nurses, pharmacists, therapists, and other healthcare professionals. Promoting collaboration across these disciplines enhances patient care by integrating diverse expertise. Encourage respect for each discipline's contributions and foster an environment where collaborative decision-making is the norm. Typically ACUs use Structured Interdisciplinary Bedside Rounds (SIBR rounds) as the core daily interprofessional process. During SIBR the care team meets briefly with each patient and updates the patient on the progress made, and remaining barriers to a safe discharge. The plan of care and plan for discharge are discussed as a team, the patient and any family present.

Invest in Team Training and Development

Continuous learning and development are crucial for maintaining high-performance teams. Provide opportunities for team members to update their clinical skills, learn about the latest evidence-based practices, and develop their teamwork and communication skills. Simulations and role-play exercises can be particularly effective in honing team dynamics. As part of ACU implementation, we run through simulation scenarios to reinforce key learnings and to help staff gain experience in the processes and delivering their inputs in a personable and efficient manner. In our experience, most initiatives under-estimate the upskilling and practice care teams need to overcome the learning curve of new processes. Structured coaching and feedback mechanisms are also vital to continued growth.

Implement Team-Based Recognition and Rewards

Recognizing and rewarding the achievements of teams, rather than just individuals, can reinforce the value of collaborative effort. Celebrate successes, whether they're improvements in patient outcomes, innovative solutions to problems, or exceptional teamwork during challenging situations. Some of the units we have worked with in the past have held celebrations when they achieve their Nurses First or SIBR Excellence status, or get all of the staff verified/certified in the new processes. Never underestimate the power of taking the time to acknowledge the work effort of staff to implement a new initiative (and a big cake helps, just don't forget the night shift).

Encourage a Culture of Safety and Quality

High-performance teams prioritize patient safety and quality of care above all else. This requires a culture where team members feel empowered to speak up about safety concerns and where there is a collective commitment to learning from errors and near misses. Implementing systematic approaches to quality improvement, such as Plan-Do-Study-Act (PDSA) cycles, can support this culture. Reviewing adverse event data with frontline staff as part of weekly quality huddles can be incredibly encouraging, by facing the problem and working together to determine what can be done to improve care delivery.

Focus on Patient-Centered Care

Ultimately, the goal of any high-performance team in healthcare is to improve patient care. This means putting the patient and their family at the center of all decision-making processes. Encourage teams to engage patients and their families as partners in care, respecting their preferences, values, and needs. This is easily done when units implement our patient-centered nursing bedside handover process or SIBR rounds. Both of these place patients at the center of their care and are designed to engage patients as active members of the care team.

Overcoming Challenges

Creating high-performance teams is not without its challenges. Issues such as hierarchical barriers, resistance to change, and varying levels of commitment can hinder team development. Leadership plays a critical role in overcoming these challenges by setting a positive example, providing clear direction, and actively supporting team development. ACUs utilize a unit leadership dyad model, with nursing and physician co-leads responsible for the unit's performance. This dyad model has been extended to a triad model in some hospitals when allied health or patient representatives are sufficiently represented. Short weekly meetings by the dyad to check-in on any issues to resolve, coupled with monthly cross-unit meetings to share lessons learned between units, and quarterly meetings with hospital leadership to align organizational goals with frontline priorities, ensures an efficient exchange of progress,  barriers and innovations.

Conclusion

High-performance teams are the engine of excellence in inpatient hospital units. By fostering open communication, clarifying roles, promoting collaboration, investing in development, recognizing team achievements, prioritizing safety and quality, and focusing on patient-centered care, hospital leaders can create an environment where high-performance teams thrive. The result is not just better outcomes for patients but a more satisfying and engaging work environment for healthcare professionals.