1. Team Membership: A Necessary Skill Set NH Dartmouth FMR Doug Dreffer MDA. John Orzano MD, MPH William Gunn PhDAimee Valeras PhD Dan Eubank MDRocco Ricci MS Andrew Valeras DO, MPH Dom Geffken MD, MPH

2. Disclosures Doug Dreffer MD: None William Gunn PhD: None Andrew Valeras DO, MPH: None Dan Eubank MD: None Aimee Valeras PhD: None Rocco Ricci MS: None A. John Orzano MD, MPH: None

3. Objectives Review the necessity for high functioning teams as Family Medicine evolves Understand the characteristics of a high functioning team Understand one FMR’s commitment to Team Membership as a core value, results of this commitment and possible ways to teach Team Membership Skills

4. Pair off….. Over the Top

5. What is a Team? A team is a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable The Wisdom of Teams; Jon R. Katzenbach and Douglas K. Smith

6. San Antonio Spurs

7. Think of a team you’re on…

8. Think of teams you are on.. What do they do well? What do they struggle with? Characteristics of:: –high functioning teams? –low functioning teams?

9. The Marshmallow Challenge 18 minutes Teams of 4 Tallest Structure

10. The Marshmallow Challenge

12. A team based on clear hierarchy doesn’t always work….

13. What is a Team? A team is a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable The Wisdom of Teams; Jon R. Katzenbach and Douglas K. Smith

14. Its July….

16. Paradigm Shift From Individual Team Single focus (clinical skills) Dual focus (clinical & team skills) Individual performance Team Performance Under-informed decision-making Informed decision-making Loose concept of teamwork Clear understanding of teamwork Unbalanced Workload Managed workload Having information Sharing information Self-advocacy Mutual Support Self-improvement Team improvement Individual efficiency Team Efficiency www.teamstepps.ahrq.gov/

17. New Context

18. Learning Pathways Single loop learning Double loop learning Triple loop learning

19. 5 Disciplines of a Learning Organization PersonalMasteryPersonalMasteryMentalModelsMentalModels Team Learning SystemsThinkingSystemsThinkingBuilding Shared Vision Building Patient care team Change

21. [systems]

22. [systems] Curricular Components 4 weeks PGY1 –Mindfulness, Healer’s Art; Genograms/Family Systems –Positive Power and Influence 2 weeks PGY2 –Motivational Interviewing; Learning Conversations –Intro to team; Situational Leadership 2 weeks PGY3 –Advanced Positive Power and Influence –Crucial Conversations; Team Learning

23. Colors: Understanding the Impact of Personality at Work ½ day seminar PGY-1 Orientation

24. Situational Leadership 2 day seminar End of PGY-1

25. [systems] : resources needed 8 weeks of residents off services 2 core faculty + others “off the shelf” programs via OD All faculty have gone through majority of [systems] components Staff have done some components

26. First class: 1995 27/102 graduates in Concord Skill sets: “team player”, “fit right in”, “respond to coaching”,

27. [systems] @ FHC/FMR Common language –Colors –Situational Leadership –Inquiry, Advocacy, Reflection, Feedback Clinic Leadership Model (Doc/RN/BH) Staff-wide skill building Complex Continuity Clinic

28. What did we learn Team Based Care is Core Value in PCMH Transformation requires Triple-Loop Learning Install the skills of a Learning Organization Team Membership skill is a valued commodity

29. Thanks… Andrew Valeras, DO, MPH Dan Eubank MD Rocco Ricci MS A. John Orzano MD, MPH Dom Geffken MD, MPH Aimee Valeras PhD Developing Physicians to Learn, Serve and Lead ddreffer@crhc.org wgunn@crhc.org