© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011

Team Leadership Behaviors

Michael A. Rosen, PhDAssistant Professor, Armstrong Institute for Patient Safety and Quality, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine

Objectives

• Define key leadership functions and behaviors.

• Explain the concept of ‘shared leadership’ and its relationship to ‘role-based’ or formal leadership.

• Identify key leadership strategies for patient care teams, change management / project teams, and more broadly leading organizational change.

Agenda

• Rapid Fire Ideas: The best and worst leaders

• What is leadership for patient safety?– From frontline to improvement teams and beyond

• Leading patient care teams– Exploring leadership in frontline teams

• Leading change / improvement teams– Developing a team charter

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Rapid Fire Ideas: The best and worst leaders

• Think about teams you’ve been on.

• Who was the best leader (no names)?

• Who was the worst leader (please, no names)?

• What made them excel / less than excel?

The Armstrong Institute Model to Improve Care

Comprehensive Unit based Safety

Program (CUSP)

1. Educate staff on science of safety

2. Identify defects

3. Assign executive to adopt unit

4. Learn from one defect per quarter

5. Implement teamwork tools

Translating Evidence Into

Practice(TRiP)

1. Summarize the evidence in a checklist

2. Identify local barriers to implementation

3. Measure performance

4. Ensure all patients get the evidence

• Engage• Educate• Execute• Evaluate

Reducing Surgical Site Infections

• Emerging Evidence

• Local Opportunities to Improve

• Collaborative learning

Technical Work Adaptive Work

What is Team Leadership?

• “The [team leader’s] main job is to do, or get done, whatever is not being adequately handled for group needs.”1

• Four main functions of leadership:2

– Information search– Problem solving– Managing material resources– Managing personnel resources

1McGrath, 19622Fleischman et al., 1991

Team Leadership and Team Performance

• The quality of a team’s leadership is one of the strongest predictors of a team’s success.1

1Burke et al., 2006

10% of team performance 25% of team learning

Leading Teams in Different Contexts

Organizational change

Quality and safety improvement teams

Patient care teams

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What is shared leadership?

• Is leadership a trait or characteristic?• Is it the responsibility or role of one person?• Is it a set of functions shared among people?

Denis et al., 2012

Shared Pooled Spreading

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LEADING PATIENT CARE TEAMS

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Phases of Team Performance

Marks et al., 2001

Action• Executing a task

Transition• Preparing for &

reflecting on performance

Interpersonal• Managing

personal relationships

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Exploring leadership in patient care teams

• Find and review the Mapping and Defining Leadership in Your Team(s) worksheet.– Where are your strengths?– Where are your weaknesses?

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Transition phase leadership functions

• Select team members• Define vision• Establish expectations and goals• Structure and plan work • Train and develop team members• Facilitate sensemaking• Provide feedback

Morgeson et al., 2009

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Action phase leadership functions

• Monitor the team• Manage team boundaries• Challenge the team• Perform the task• Solve problems• Provide resources• Encourage team self-management• Support a healthy social climate

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LEADING QUALITY AND SAFETY IMPROVEMENT TEAMS

Five Conditions Leaders can Put in Place to Facilitate Teamwork

1. Ensure the team is a ‘real’ team2. Compelling direction3. Enabling structure4. Supportive organizational context5. Expert coaching

Hackman, 2002

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Developing a Team Charter

• Find and review the Building Your CUSP Team: Tips from the Science of Teams worksheet– What are your key team leadership strengths?– What are your key areas in need of

improvement?

References

• Burke, C.S., Stagl, K.C., Klein, C., Goodwin, G.F., Salas, E., & Halpin, S.M. (2006). What type of leadership behaviors are functional in teams?: A meta-analysis. The Leadership Quarterly, 17: 288-307.

• Fleishman, E.A., Mumford, M.D., Zaccaro, S.J., Levin, K.Y., et al. (1991). Taxonomic efforts in the description of leader behavior: A synthesis and functional interpretation. Leadership Quarterly, 4: 245-87.

• Hackman, J.R. (2002). Leading teams: Setting the stage for great performances. Boston, MA: HBS Press.

• Heifetz, R., Grashow, A., & Linsky, M. The theory behind the practice. The practice of adaptive leadership, Boston, MA: Harvard Business Press, 2009: 19.

• Pronovost, P.J. (2011). Navigating adaptive challenges in quality improvement. BMJ Qual Saf 20(7), 560-3.