Lecture 17 - Evaluating Individual Teams Flashcards
1
Q
Whole teams are evaluated on the basis of what 2 things?
A
(1) goal achievement
(2) whether the teams have the characteristics of effective teams
2
Q
Where does qualitative information come from? What is an example?
A
comes from observation of qualities that cannot be measured numerically
Example: praise or complaints from patients or fellow teammates
3
Q
T/F: Direct observation is far superior to secondhand reports
A
TRUE
4
Q
What is quantitative information? Example?
A
measures quantities or other measurable properties with metrics
Example: numerical ratings by supervisors, team leaders
5
Q
T/F Multirater feedback comes from only one source
A
FALSE, Multirater or 360 degree feedback comes from multiple sources (supervisors, peers, subordinates, and patients or other clients)
6
Q
What is the main advantage of the multirater/360-degree evaluation style ?
A
Less bias– anonymous written evaluations yield lower ratings than face to face evaluations
7
Q
What is a weakness of Multirater feedback?
A
Collusion among employees to give good feedback
–>raters may fear retaliation for honest comments if anonymity is compromised
–>team members who are not liked for reasons not related to their performance can suffer
8
Q
What is inflation bias?
A
giving better reviews in order to be kind due to fear of conflict
-involves empathetic buffering
9
Q
What is empathetic buffering?
A
reluctance to transmit bad news to a poorly performing teammate, which makes the bearer of news feel badly as well
10
Q
What is Homogeneity bias?
A
Evaluators rate others who are similar to themselves more favorably than those who are different from them
11
Q
What is Halo bias?
A
when a rater knows one positive (or negative) fact about someone, the rater tends to perceive newly acquired information about that person as conforming to the perceptions acquired earlier
BASICALLY: first impressions matter and the the evaluator is going to judge every action of the person (whether good or bad) based on the first impression they had
12
Q
Who should be included in the evaluation process? Who should be excluded?
A
Included:
Core members that have a good understanding of their team members
Supervisors who know the identities of the raters so they can filter out biased responses
(AKA we would give Jamie a terrible rating because we hate her)
Excluded:
Peripheral members might affect the evaluation negatively because if they’re required to provide feedback when they don’t want to, their evaluations are more likely to be inaccurate/hateful
13
Q
What do performance reviews measure within healthcare and why are they important?
A
measure members’ contributions to team processes and outcomes
used in promotion and merit review decisions
14
Q
T/F: Team leaders need to examine individual competencies as a root cause of team effectiveness and ineffectiveness when trying to improve performance
A
TRUE
15
Q
Why is there resistance to individual evaluation in healthcare? (3)
A
- individuals in general are uncomfortable giving negative feedback to others- want to avoid conflict or giving bad news to others
- team leaders lack experience and training in giving constructive evaluations
- most individuals, including team leaders, do not like to be evaluated, and they assume the same for others
16
Q
How can we overcome resistance to individual evaluation in healthcare?
A
emphasize that providing feedback to others is a sign of commitment to the team and a sign of respect for the contribution of other members
feedback is important for change
-keeps each other accountable and necessary for team effectiveness
17
Q
Guidelines for giving individual feedback
A
Deliver feedback in private place
Describe behavior using specific examples
Provide feedback on positive and negative behaviors
Be supportive and encouraging
Give person time to respond + listen
Agree on issue
Agree on action plan
Identify ways to make positive contributions to improve the team
Follow up
18
Q
Guidelines for receiving feedback
A
Value feedback as a way to improve team performance Listen to the positive remarks, don't focus on negative Seek out feedback to improve + change Decide to commit to change Reflect on input Develop an action plan ask for support follow up with provider of feedback
19
Q
Different levels of performers
A
Top performers
Middle performers
Low performers
20
Q
Goal of top, middle, low performers?
A
Top: to maintain their enthusiasm and contribution
Middle: praised and encouraged to improve as well (sandwich technique??)
Low: confront reality and do not start on a positive note but rather starting by observing shortcomings in behavior and
Assign small, achievable goals and then follow through and take action
21
Q
Steps to evaluation team performance
A
- clarify the team’s main goals
- Identify any subsidiary goals
- requires sponsor to obtain information about the team from the team leader
- review the goals of the Department plus the characteristics of effective teams and, for each goal and characteristic of interest, to determine whether performance is satisfactory or appears to need improvement
- done by sponsor and team leader
22
Q
An evaluation instrument needs strong ____ and _____
A
validity (accuracy) and reliability (consistency)
23
Q
What is Team Diagnostic Survey (TDS) ?
A
popular tool for assessing how well teams are meeting conditions for effectiveness
24
Q
What are the 7 seven categories of TDS?
A
Foundation Functioning Performance Skills Leadership Climate and Atmosphere Identity
25
Example: Identify goals, subsidiary goals, and sponsor gathering info
Thomas Napier, MD, was the Chair of the Orthopedic Surgery Department in a multispecialty group practice. He had been appointed 2 years previously by the Chair of Surgery, Raphael Flores, MD. The Orthopedic Surgery Department consisted of 5 orthopedists, 3 physician assistants, 3 orthopedic technicians, 1 registered nurse, several certified medical assistants, and several front desk clerks.
All was not well in the Department. The most pressing problem was a series of postoperative infections caused by methicillin-resistant Staphylococcus aureus (MRSA), a bacterium that is untreatable with nearly all antibiotics and is thus a serious threat to patients' health. Also, the Department's scores on the Patient Experience Questionnaire used by the medical group had deteriorated over the past 9 months. In part, this deterioration appeared to be caused by the behavior of one particular orthopedist. His angry outbursts in the operating room were well known to the Chief of Surgery, and patients reported his dictatorial manner and refusal at times to answer their questions.
Dr. Flores had discussed some of these issues with Dr. Napier from time to time over several months. They discussed approaches to correcting the problems, and Dr. Napier had asked for advice about how to deal with the orthopedist who was generating complaints from both nurses and patients. After 6 months had passed, Dr. Flores asked to meet with Dr. Napier for an extended discussion of how the Department was performing and how performance might be improved. Prior to the meeting, Dr. Flores obtained postoperative infection data, patient experience data, surgical procedure counts for the 5 orthopedists, and data on several other topics. He also thought about how to present the information to Dr. Napier and how to encourage him to talk about how he might deal with the performance issues in the Orthopedic Surgery Department.
Goal: Providing excellent orthopedic care
Subsidiary goal: Orthopedic reduction of MRSA infections
Sponsor gathering info: Dr. Flores might want information on waiting times to get appointments, functional outcome information obtained from patients, survey information about work life obtained from people working in the Department
26
T/F Swaziland is a rural and landlocked country with low life expectancy at about 50 y/o
TRUE
27
Is swaziland a male or female dominated society?
- Male dominated society that is very traditional
- Polygamy and traditional belief in procreation
- Ideally 5 children per women
28
HIV tx in Swaziland has been _____
-HIV treatment has been “feminized”
29
T/F Healers/witch doctors (that appeal to men) are common in Swaziland
TRUE
30
What type of healthcare is provided for HIV in Swaziland? What effects has this had of people with HIV in Swaziland?
Provides ARTs for everyone diagnosed with HIV
*number of new infections among adults has nearly halved since 2011
80% of positive adults are on ARTs, one of the highest rates in Africa
31
What is the most common cause of death in ppl with HIV?
TB
HIV co-infection is the most powerful known risk factor for progression of M. tuberculosis infection to active disease, increasing the risk of latent TB reactivation 20-fold
32
HIV influences the severity of TB by?
- Destroying cellular response allowing latent disease to become active
- up-regulation of M. tuberculosis entry receptors on macrophages
- manipulation of macrophage bactericidal pathways
- deregulated chemotaxis
- impairs tumor necrosis factor (TNF)-mediated macrophage apoptotic response to M. tuberculosis
33
TB influences the severity of HIV by
exacerbate HIV replication in macrophages and lung cells
Increase the efficiency of transmission from infected macrophages to T cells
TNF, necessary for the control of TB by the body, upregulates HIV replication
increasing the expression of co-receptors CXCR4 and CCR5 regulated by M. tuberculosis products
34
Is TB cofinfection an issue in Swaziland?
80% of ppl with TB are coinfected with HIV
lack of medical staff, both doctors and nurses, is recognized as the main obstacle
35
What was the Swaziland Dual Epidemic? Who intervened to help?
TB + HIV
MSF
36
What were the main things that MSF did to handle dual epidemic?
1. decentralizing services from health centers and hospitals to smaller clinics
nurses, rather than doctors, are trained to initiate antiretroviral treatment, and administer drugs for uncomplicated TB, while counsellors are taught how to test people for HIV, thus freeing up nurses for other work.
2. shifting tasks to lesser-trained workers to free up nurses and doctors’ time
HIV-positive community members are trained to provide counselling on testing and adherence to HIV and TB clients
3. MSF opened up more TB wards in regional hospitals
preventing people from having to travel
37
What is the long term goal for the dual epidemic?
establish 'one-stop services' providing fully integrated HIV and TB care
-Full screening, testing, treatment + monitoring
38
Guidelines for giving individual feedback
Deliver feedback in private place
Describe behavior using specific examples
Provide feedback on positive and negative behaviors
Be supportive and encouraging
Give person time to respond + listen
Agree on issue
Agree on action plan
Identify ways to make positive contributions to improve the team
Follow up
39
Guidelines for receiving feedback
```
Value feedback as a way to improve team performance
Listen to the positive remarks, don't focus on negative
Seek out feedback to improve + change
Decide to commit to change
Reflect on input
Develop an action plan
ask for support
follow up with provider of feedback
```
40
Different levels of performers
Top performers
Middle performers
Low performers
41
Goal of top, middle, low performers?
Top: to maintain their enthusiasm and contribution
Middle: praised and encouraged to improve as well (sandwich technique??)
Low: confront reality and do not start on a positive note but rather starting by observing shortcomings in behavior and
Assign small, achievable goals and then follow through and take action
42
Steps to evaluation team performance
1. clarify the team's main goals
2. Identify any subsidiary goals
3. requires sponsor to obtain information about the team from the team leader
4. review the goals of the Department plus the characteristics of effective teams and, for each goal and characteristic of interest, to determine whether performance is satisfactory or appears to need improvement
- done by sponsor and team leader
43
An evaluation instrument needs strong ____ and _____
validity (accuracy) and reliability (consistency)
44
What is Team Diagnostic Survey (TDS) ?
popular tool for assessing how well teams are meeting conditions for effectiveness
45
What are the 7 seven categories of TDS?
```
Foundation
Functioning
Performance
Skills
Leadership
Climate and Atmosphere
Identity
```
46
Example: Identify goals, subsidiary goals, and sponsor gathering info
Thomas Napier, MD, was the Chair of the Orthopedic Surgery Department in a multispecialty group practice. He had been appointed 2 years previously by the Chair of Surgery, Raphael Flores, MD. The Orthopedic Surgery Department consisted of 5 orthopedists, 3 physician assistants, 3 orthopedic technicians, 1 registered nurse, several certified medical assistants, and several front desk clerks.
All was not well in the Department. The most pressing problem was a series of postoperative infections caused by methicillin-resistant Staphylococcus aureus (MRSA), a bacterium that is untreatable with nearly all antibiotics and is thus a serious threat to patients' health. Also, the Department's scores on the Patient Experience Questionnaire used by the medical group had deteriorated over the past 9 months. In part, this deterioration appeared to be caused by the behavior of one particular orthopedist. His angry outbursts in the operating room were well known to the Chief of Surgery, and patients reported his dictatorial manner and refusal at times to answer their questions.
Dr. Flores had discussed some of these issues with Dr. Napier from time to time over several months. They discussed approaches to correcting the problems, and Dr. Napier had asked for advice about how to deal with the orthopedist who was generating complaints from both nurses and patients. After 6 months had passed, Dr. Flores asked to meet with Dr. Napier for an extended discussion of how the Department was performing and how performance might be improved. Prior to the meeting, Dr. Flores obtained postoperative infection data, patient experience data, surgical procedure counts for the 5 orthopedists, and data on several other topics. He also thought about how to present the information to Dr. Napier and how to encourage him to talk about how he might deal with the performance issues in the Orthopedic Surgery Department.
Goal: Providing excellent orthopedic care
Subsidiary goal: Orthopedic reduction of MRSA infections
Sponsor gathering info: Dr. Flores might want information on waiting times to get appointments, functional outcome information obtained from patients, survey information about work life obtained from people working in the Department
47
T/F Swaziland is a rural and landlocked country with low life expectancy at about 50 y/o
TRUE
48
Is swaziland a male or female dominated society?
- Male dominated society that is very traditional
- Polygamy and traditional belief in procreation
- Ideally 5 children per women
49
HIV tx in Swaziland has been _____
-HIV treatment has been “feminized”
50
T/F Healers/witch doctors (that appeal to men) are common in Swaziland
TRUE
51
What type of healthcare is provided for HIV in Swaziland? What effects has this had of people with HIV in Swaziland?
Provides ARTs for everyone diagnosed with HIV
*number of new infections among adults has nearly halved since 2011
80% of positive adults are on ARTs, one of the highest rates in Africa
52
What is the most common cause of death in ppl with HIV?
TB
HIV co-infection is the most powerful known risk factor for progression of M. tuberculosis infection to active disease, increasing the risk of latent TB reactivation 20-fold
53
HIV influences the severity of TB by?
- Destroying cellular response allowing latent disease to become active
- up-regulation of M. tuberculosis entry receptors on macrophages
- manipulation of macrophage bactericidal pathways
- deregulated chemotaxis
- impairs tumor necrosis factor (TNF)-mediated macrophage apoptotic response to M. tuberculosis
54
TB influences the severity of HIV by
exacerbate HIV replication in macrophages and lung cells
Increase the efficiency of transmission from infected macrophages to T cells
TNF, necessary for the control of TB by the body, upregulates HIV replication
increasing the expression of co-receptors CXCR4 and CCR5 regulated by M. tuberculosis products
55
Is TB cofinfection an issue in Swaziland?
80% of ppl with TB are coinfected with HIV
lack of medical staff, both doctors and nurses, is recognized as the main obstacle
56
What was the Swaziland Dual Epidemic? Who intervened to help?
TB + HIV
MSF
57
What were the main things that MSF did to handle dual epidemic?
1. decentralizing services from health centers and hospitals to smaller clinics
nurses, rather than doctors, are trained to initiate antiretroviral treatment, and administer drugs for uncomplicated TB, while counsellors are taught how to test people for HIV, thus freeing up nurses for other work.
2. shifting tasks to lesser-trained workers to free up nurses and doctors’ time
HIV-positive community members are trained to provide counselling on testing and adherence to HIV and TB clients
3. MSF opened up more TB wards in regional hospitals
preventing people from having to travel
58
What is the long term goal for the dual epidemic?
establish 'one-stop services' providing fully integrated HIV and TB care
-Full screening, testing, treatment + monitoring
59
Guidelines for giving individual feedback
Deliver feedback in private place
Describe behavior using specific examples
Provide feedback on positive and negative behaviors
Be supportive and encouraging
Give person time to respond + listen
Agree on issue
Agree on action plan
Identify ways to make positive contributions to improve the team
Follow up
60
Guidelines for receiving feedback
```
Value feedback as a way to improve team performance
Listen to the positive remarks, don't focus on negative
Seek out feedback to improve + change
Decide to commit to change
Reflect on input
Develop an action plan
ask for support
follow up with provider of feedback
```
61
Different levels of performers
Top performers
Middle performers
Low performers
62
Goal of top, middle, low performers?
Top: to maintain their enthusiasm and contribution
Middle: praised and encouraged to improve as well (sandwich technique??)
Low: confront reality and do not start on a positive note but rather starting by observing shortcomings in behavior and
Assign small, achievable goals and then follow through and take action
63
Steps to evaluation team performance
1. clarify the team's main goals
2. Identify any subsidiary goals
3. requires sponsor to obtain information about the team from the team leader
4. review the goals of the Department plus the characteristics of effective teams and, for each goal and characteristic of interest, to determine whether performance is satisfactory or appears to need improvement
- done by sponsor and team leader
64
An evaluation instrument needs strong ____ and _____
validity (accuracy) and reliability (consistency)
65
What is Team Diagnostic Survey (TDS) ?
popular tool for assessing how well teams are meeting conditions for effectiveness
66
What are the 7 seven categories of TDS?
```
Foundation
Functioning
Performance
Skills
Leadership
Climate and Atmosphere
Identity
```
67
Example: Identify goals, subsidiary goals, and sponsor gathering info
Thomas Napier, MD, was the Chair of the Orthopedic Surgery Department in a multispecialty group practice. He had been appointed 2 years previously by the Chair of Surgery, Raphael Flores, MD. The Orthopedic Surgery Department consisted of 5 orthopedists, 3 physician assistants, 3 orthopedic technicians, 1 registered nurse, several certified medical assistants, and several front desk clerks.
All was not well in the Department. The most pressing problem was a series of postoperative infections caused by methicillin-resistant Staphylococcus aureus (MRSA), a bacterium that is untreatable with nearly all antibiotics and is thus a serious threat to patients' health. Also, the Department's scores on the Patient Experience Questionnaire used by the medical group had deteriorated over the past 9 months. In part, this deterioration appeared to be caused by the behavior of one particular orthopedist. His angry outbursts in the operating room were well known to the Chief of Surgery, and patients reported his dictatorial manner and refusal at times to answer their questions.
Dr. Flores had discussed some of these issues with Dr. Napier from time to time over several months. They discussed approaches to correcting the problems, and Dr. Napier had asked for advice about how to deal with the orthopedist who was generating complaints from both nurses and patients. After 6 months had passed, Dr. Flores asked to meet with Dr. Napier for an extended discussion of how the Department was performing and how performance might be improved. Prior to the meeting, Dr. Flores obtained postoperative infection data, patient experience data, surgical procedure counts for the 5 orthopedists, and data on several other topics. He also thought about how to present the information to Dr. Napier and how to encourage him to talk about how he might deal with the performance issues in the Orthopedic Surgery Department.
Goal: Providing excellent orthopedic care
Subsidiary goal: Orthopedic reduction of MRSA infections
Sponsor gathering info: Dr. Flores might want information on waiting times to get appointments, functional outcome information obtained from patients, survey information about work life obtained from people working in the Department
68
T/F Swaziland is a rural and landlocked country with low life expectancy at about 50 y/o
TRUE
69
Is swaziland a male or female dominated society?
- Male dominated society that is very traditional
- Polygamy and traditional belief in procreation
- Ideally 5 children per women
70
HIV tx in Swaziland has been _____
-HIV treatment has been “feminized”
71
T/F Healers/witch doctors (that appeal to men) are common in Swaziland
TRUE
72
What type of healthcare is provided for HIV in Swaziland? What effects has this had of people with HIV in Swaziland?
Provides ARTs for everyone diagnosed with HIV
*number of new infections among adults has nearly halved since 2011
80% of positive adults are on ARTs, one of the highest rates in Africa
73
What is the most common cause of death in ppl with HIV?
TB
HIV co-infection is the most powerful known risk factor for progression of M. tuberculosis infection to active disease, increasing the risk of latent TB reactivation 20-fold
74
HIV influences the severity of TB by?
- Destroying cellular response allowing latent disease to become active
- up-regulation of M. tuberculosis entry receptors on macrophages
- manipulation of macrophage bactericidal pathways
- deregulated chemotaxis
- impairs tumor necrosis factor (TNF)-mediated macrophage apoptotic response to M. tuberculosis
75
TB influences the severity of HIV by
exacerbate HIV replication in macrophages and lung cells
Increase the efficiency of transmission from infected macrophages to T cells
TNF, necessary for the control of TB by the body, upregulates HIV replication
increasing the expression of co-receptors CXCR4 and CCR5 regulated by M. tuberculosis products
76
Is TB cofinfection an issue in Swaziland?
80% of ppl with TB are coinfected with HIV
lack of medical staff, both doctors and nurses, is recognized as the main obstacle
77
What was the Swaziland Dual Epidemic? Who intervened to help?
TB + HIV
MSF
78
What were the main things that MSF did to handle dual epidemic?
1. decentralizing services from health centers and hospitals to smaller clinics
nurses, rather than doctors, are trained to initiate antiretroviral treatment, and administer drugs for uncomplicated TB, while counsellors are taught how to test people for HIV, thus freeing up nurses for other work.
2. shifting tasks to lesser-trained workers to free up nurses and doctors’ time
HIV-positive community members are trained to provide counselling on testing and adherence to HIV and TB clients
3. MSF opened up more TB wards in regional hospitals
preventing people from having to travel
79
What is the long term goal for the dual epidemic?
establish 'one-stop services' providing fully integrated HIV and TB care
-Full screening, testing, treatment + monitoring
