Module 2

TEAM STRUCTURE
(DRAFT)

SUBSECTIONS
•
•
•

What Defines a Team?
Partnering With Residents
and Families
Multi-Team System for
Resident Care

TIME: 50 minutes

VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION

INSTRUCTOR OUTLINE: TEAM STRUCTURE
Instructor Note: In this module, you will present information
about the structure of teams. Although team structure does not
address team competencies, it is important for participants to learn
concepts such as the inclusion of the resident as a member of the
team and the components of a multi-team system in terms of
planning their TeamSTEPPS implementation.
The Team Structure module includes the content provided in the
outline below. More content is available than can likely be covered
in the time provided; therefore, optional content and activities are
noted. It is strongly recommended that instruction not focus solely
on lecture, but also include exercises, videos, and other activities.
As such, instructors should use the information below to plan how
the module will be taught within the time available.
Content
1.

Introduction

2.

Definition of a Team

Team
Structure
Slide
MODULE
TIME:
50 minutes

MATERIALS:
• Teams and
Teamwork
Exercise Sheet

5- 6

2 mins

• Flipchart or
Whiteboard
(Optional)

7

2 mins

• Markers (Optional)

Page #

Approx. Time

5 – 10 mins*

3.

Teams and Teamwork
Exercise

8

4.

Partnering With
Residents and Families

9 - 12

5 mins

5.

Multi-Team System

13 - 18

15 mins

6.

Team Structure Video
and Discussion

19 - 20

10 mins

7.

Applying TeamSTEPPS
Exercise

21

• TeamSTEPPS
Opportunity LTC
Video (LTC_
Opportunity
_Complete_
Vignette.mpg)
• TeamSTEPPS
Implementation
Worksheet

5 mins

*Although all instructional content and activities are recommended to
ensure that participants achieve the learning objectives, these
activities may be considered “optional” if time is constrained.

B-2-3

Continued…
TeamSTEPPS for Long-Term Care | Team Structure

VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION B-2-3

Team
Structure
Slide

INSTRUCTOR OUTLINE: TEAM STRUCTURE
(Continued)
Additional Resources: Below are sources of additional
information and videos you may want to use to customize this
module to your participants.
•

TeamSTEPPS 2.0: Includes teamwork success and
teamwork failure videos in multiple hospital settings.
• http://www.ahrq.gov/professionals/education/curriculumtools/teamstepps/instructor/fundamentals/index.html

•

TeamSTEPPS Rapid Response Systems Module (RRS):
Videos in this module demonstrate how the Rapid Response
Team interacts and coordinates with other aspects of the
multi- team system.
• http://www.ahrq.gov/professionals/ed ucation /curriculum tools/teamstepps/rrs/

B-2-4 VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION TeamSTEPPS for Long-Term Care | Team Structure

OBJECTIVES

Team
Structure

SAY:
Upon completion of this module, you will be able to:
•

Discuss the benefits of team structure in teamwork;

•

Define a “team”;

•

Identify the role of residents and their families as part of the
care team; and

•

Describe the components and composition of a multiteam system.

Slide

TeamSTEPPS for Long-Term Care | Team Structure VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION

B-2-5

Team
Structure

TEAMSTEPPS TEAMWORK SKILLS
SAY:

Slide

Team structure refers to the composition of an individual team or
of a multi-team system. Team structure is an integral part of the
teamwork process. A properly structured care team is an enabler
for and the result of effective communication, leadership, situation
monitoring, and mutual support.
Proper team structure can promote teamwork by including a clear
leader, involving the resident, and ensuring that all team members
commit to their roles in effective teamwork.
It is important to identify and recognize the structure of teams,
because teamwork cannot occur in the absence of a clearly
defined team. Further, understanding a team’s structure and how
multiple teams interact in a unit is critical for planning the
implementation of TeamSTEPPS tools and strategies. It is critical
to know which teams are targeted for TeamSTEPPS; who on the
team will adopt the TeamSTEPPS intervention; and how the
intervention may affect other teams in the care environment.

B-2-6 VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION TeamSTEPPS for Long-Term Care | Team Structure

WHAT DEFINES A TEAM?

Team
Structure

SAY:
To effectively understand team structure, let’s begin with defining
a “team.”
A team is different from a group. A group can achieve its goal
through independent individual contributions. Real-time
coordination of tasks between individuals is not required.

Slide

A team, however, consists of two or more people who interact
dynamically, interdependently, and adaptively toward a common
and valued goal, have specific roles or functions, and have a timelimited membership. During the temporal life of a team, the team’s
mission is of greater value than the goals of the individual
members.
Team members:
•

Include anyone involved in the process of resident care who
can take action, including the leader;

•

Have clearly defined roles and responsibilities;

•

Are accountable to the team for their actions; and

•

Must stay continually informed for effective team
functioning.

The teamwork skills you will learn in this course will
provide team members with tools and strategies for being
effective team members.

TeamSTEPPS for Long-Term Care | Team Structure VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION

B-2-7

Team
Structure

(OPTIONAL) EXERCISE: TEAMS AND
TEAMWORK
SAY:

Slide
TIME:
5-10 minutes

Let's look at the team in your own work area. Please take a few
minutes to complete the Teams and Teamwork Exercise Sheet. If
you are sitting near your fellow team members, you may work on
this exercise together. If you are not sitting with your team, please
complete it on your own. I’ll ask a few of you to share your work
with the rest of the class in a few minutes.
DO:
Give the participants several minutes to complete their sheets.
During the discussion, you may wish to document responses on a
flipchart or whiteboard.

MATERIALS:
• Teams and
Teamwork
Exercise Sheet

DISCUSSION:
•

• Flipchart or
Whiteboard
(Optional)

Who are the team members in your unit, department or work
area?

•

How many of you included residents in your list of team
members?

• Markers
(Optional)

•

What characteristics make a group a team?

B-2-8 VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION TeamSTEPPS for Long-Term Care | Team Structure

Team
Structure

PARTNERING WITH THE RESIDENT
SAY:
It is critical to acknowledge that a care team is not complete
without the resident. Residents and their families should be
embraced and valued as contributing partners to care.
Throughout this course, you will learn several teamwork skills,
tools, and strategies that can easily be adapted for use by
residents and their families. Thinking about how to include
residents is an important part of your TeamSTEPPS
implementation planning.

Slide

Examples of effective strategies for involving residents in their
care include:
•

Including the resident in care planning;

•

Providing residents with tools for communicating with their care
team;

•

Involving residents in key committees; and

•

Actively enlisting the resident’s participation.

A number of organizations provide information, materials, and
suggested strategies related to patient and resident
engagement, including AHRQ, the DoD Patient Safety Program,
the Joint Commission, the National Patient Safety Foundation
(NPSF), the U.S. Department of Health and Human Services
(DHHS), the Institute for Healthcare Improvement (IHI), and
Consumers Advancing Patient Safety (CAPS).
Example resources:
• The AHRQ-funded Guide to Patient and Family Engagement:
Environmental Scan Report:
http://www.ahrq.gov/research/findings/finalreports/ptfamilyscan/index.html
• The DoD Patient Safety Program’s Team Up:
http://www.health.mil/Military-Health-Topics/Access-Cost-Qualityand-Safety/Quality-And-Safety-of-Healthcare/PatientSafety/Patient-Safety-Products-And-Services/TEAM-UP

Continued…
TeamSTEPPS for Long-Term Care | Team Structure

VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION

B-2-9

Team
Structure
Slide

PARTNERING WITH THE RESIDENT
(Continued)
Example resources (Continued):
• DoD Patient Activation Reference Guide:
http://www.health.mil/Military-Health-Topics/Access-Cost-Quality-andSafety/Quality-And-Safety-of-Healthcare/Patient-Safety/Patient-SafetyProducts-And-Services/Toolkits/Patient-Activation-Reference-Guide
• The Joint Commission’s Speak Up:
http://www.jointcommission.org/speakup.aspx
• NPSF’s Ask Me 3:
http://www.npsf.org/?page=askme3
• DHHS’ Partnering to Heal:
http://www.hhs.gov/ash/initiatives/hai/training/
• IHI’s Person- and Family-Centered Care Information:
http://www.ihi.org/explore/PFCC/Pages/de fault.aspx
• Information from CAPS:
http://www.patientsafety.org/tools-and-resources.html

B-2-10VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTIONTeamSTEPPS for Long-Term Care | Team Structure

CARE TEAM RESPONSIBLITIES

Team
Structure

SAY:
Working with residents and families as true partners includes:
•

Listening to residents and their families.

•

Asking residents how involved they prefer to be in their
own care.

•

Before launching into detailed status, asking residents about
their concerns; otherwise, they might not listen to or
understand what is being said to them.

•

Speaking in lay terms to ensure that residents and
families understand the information being shared.

•

Allowing time for residents and families to ask questions.

•

Providing residents and families access to relevant information.

•

Asking residents and their families for feedback and to be
proactive participants in resident care—they are also
responsible for transforming relationships between health care
providers and residents.

Slide

TeamSTEPPS for Long-Term Care | Team Structure VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION

B-2-11

Team
Structure

RESIDENT AND FAMILY RESPONSIBLITIES
SAY:
The responsibilities of residents and their families as part of the
team differ from those of the care team members. Resident and
family responsibilities include:

Slide

•

Providing accurate resident information.

•

Complying with the prescribed plan of care. For
example, residents and families are responsible for
scheduling and attending appointments as directed.

•

Asking questions and/or voicing any concerns regarding
the care plan.

•

Monitoring and reporting any changes in the resident’s
condition in a timely manner.

•

Managing family members to prevent disruptive behavior
during care.

•

Following the instructions of the care team.

DISCUSSION:
•

Have you implemented any specific strategies for engaging
residents and their families in your unit, department, or work
area?

•

If so, what has worked well and what has not worked well?

•

What changes have you seen as a result of engaging
residents in their care?

B-2-12VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION
TeamSTEPPS for Long-Term Care | Team Structure

MULTI-TEAM SYSTEM FOR RESIDENT CARE

Team
Structure

SAY:
We have discussed what defines a team, but in health care,
multiple teams are involved in resident care. This slide shows the
model of a multi-team system. Each team within a multi-team
system is responsible for various parts of resident care, but all
must act in concert to ensure quality care.

Slide

A multi-team system is composed of several different teams. The
multi-team system includes the Core Team, the Contingency
Team, the Coordinating Team, Ancillary and Support Services,
and Administration. In addition, it is important to acknowledge the
resident as a critical part of the multi-team system.
As we discuss each of the components of the multi-team system,
think about whether each team should be included in your
TeamSTEPPS implementation plan.

TeamSTEPPS for Long-Term Care | Team Structure VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION

B-2-13

Team
Structure

CORE TEAMS
SAY:

Slide

Core Teams consist of team leaders and team members who are
involved in the direct care of the resident. Core Team members
include direct care providers and continuity providers. Continuity
providers manage the resident from assessment to disposition,
such as case managers. The Core Team is based where the
resident receives care.
Core Teams should be small enough to ensure situation
monitoring, development of situation awareness, and direct,
unfiltered communication between members. To establish a
shared mental model, Core Teams should be large enough to
include skill overlap between members to allow for workload
sharing and redistribution when necessary. Every Core Team has
a leader who is readily identified by all members of the team.
Core Team leadership is dynamic; Core Team leaders are
required to take on different roles at various points in the plan of
care. Often these may be nonleadership roles, such as
supporting a nurse starting an IV.
Examples of Core Teams include:
Dementia Unit:
•

The Core Team may be composed of the attending physician,
physician assistant (PA), advanced practice registered nurse
(APRN), nurse, nursing assistants, and restorative aides
responsible for treating a resident.

Subacute Unit:
•

The Core Team may be composed of the physician, nurse, and
rehabilitation staff responsible for cardiac rehabilitation of a
resident.

B-2-14VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION
TeamSTEPPS for Long-Term Care | Team Structure

Team
Structure

CONTINGENCY TEAMS
SAY:
Contingency Teams are:
•
•
•

Formed for emergent or specific events;
Time limited (e.g., Code Team, Disaster Response Team,
Rapid Response Team*); and
Composed of team members drawn from a variety of Core
Teams.

Slide

*A TeamSTEPPS Rapid Response Systems Guide is available
from AHRQ. For more information, go to:
http://www.ahrq.gov/professionals/ed ucation /curriculum tools/teamstepps/rrs/.
Contingency Teams are responsible for immediate, direct
resident care during emergency situations requiring more
resources than are available to the Core Team. In the nursing
home, this may be referred to as “all hands on deck.” Their role
may be very specific and limited to a certain situation, such as a
Code Team, or they may be responsible for a broad category of
situations, such as disaster response. They generally consist of
preidentified members derived from varying units, work areas, or
Core Teams and have limited time to prepare for emergencies.
Because Contingency Team members are called together for
emergent or specific events, they do not typically spend much
time working together as a team. However, their individual roles
are clearly defined, and leadership is designated based on
resident needs and member expertise in dealing with the
particular situation.
Examples of Contingency Teams include:
Dementia Unit:
• The Contingency Team may composed of the care planning
team, emergent “code” teams, and hospice/palliative care
teams, or a consulting pharmacist who can be called upon to
participate if the medication regimen is complicated and
requires special pharmacological expertise.
Subacute Unit:
• The Contingency Team may compose of the MDS Coordinators
and the care planning team.

TeamSTEPPS for Long-Term Care | Team Structure

VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION B-2-15

Team
Structure

COORDINATING TEAMS
SAY:
The Coordinating Team is the group responsible for:
•

Day-to-day operational management;

•

Coordination functions, such as triaging emerging events
and prioritizing decisionmaking to ensure maximal support to
the Core Team; and

•

Resource management for Core Teams, such as
collaborating with the Administrative and Ancillary Teams to
assign priorities and ensure throughput.

Slide

Direct resident care may be a secondary function with
the exception of small facilities.
Coordinating Teams frequently include experienced personnel
with a strong clinical background. This combination enhances the
ability of the Coordinating Team members to rapidly assess the
overall picture, anticipate the needs or potential needs between
and across teams, and make priority-based decisions.
ASK:
•

Who might be the members of the Coordinating Team on a
dementia unit?
– Nurse supervisors, department heads, and unit managers or
unit secretaries who may be responsible for resource
management and promotion of teamwork for the unit

•

Who might be the members of the Coordinating Team on a
subacute unit?
– The unit charge nurse or the director or nursing responsible
for admissions and resource management for the cardiac
rehabilitation or subacute units

B-2-16 VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION
TeamSTEPPS for Long-Term Care | Team Structure

ANCILLARY AND SUPPORT SERVICES

Team
Structure

SAY:
Ancillary Services consist of individuals who:
•

Provide direct, task-specific, time-limited care to residents;

•

Support services that facilitate care of the residents; and

•

Are often not located where the residents receive their
routine care.

Slide

Ancillary Services are primarily a service delivery team whose
mission is to support the Core Team. In general, an Ancillary
Services Team functions independently.
Support Services are primarily a service-focused team whose
mission is to create efficient, safe, comfortable and clean
health care environments, which affect the resident care team,
market perception, operational efficiency, and resident safety.
ASK:
•

What are some examples of Ancillary and Support
Services teams?

Possible Answers:
•

Ancillary services
– Laboratory
– X-ray
– Pharmacy
– Recreation Services
– Social Services
– Rehabilitation Services
– Dietary

•

Support services
– Housekeeping
– Supply
– Bioengineering
– Human Resources
– Laundry
– Physical Plant
– Staff Development/Staff Education

TeamSTEPPS for Long-Term Care | Team Structure VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION

B-2-17

Team
Structure

THE ROLE OF ADMINISTRATION
SAY:

Slide

Administration includes the executive leadership of a unit or facility
and has 24-hour accountability for the overall function and
management of the organization. The Administrative Team has no
responsibility in the direct delivery of care but provides the
framework and guidance that ensure that each team understands
its role and responsibility and has access to the necessary
resources to succeed.
Administration creates the climate and culture for a teamwork
system to flourish by:
•

Establishing and communicating vision;

•

Developing and enforcing policies and procedures that
clearly articulate the roles and responsibilities of the other
teams and team members;

•

Setting expectations for staff;

•

Providing necessary resources for successful implementation;

•

Holding teams accountable for team performance; and

•

Defining the culture of the nursing home.

Administration should strive to create a learning culture where
there is trust and transparency to create a safe environment to
report, analyze, and share information openly. This philosophy
serves to define a culture of safety; however, as examples in
aviation and other high-risk industries have shown, the change
will not happen overnight.

B-2-18VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTIONTeamSTEPPS for Long-Term Care | Team Structure

TEAM STRUCTURE VIDEO

Team
Structure

SAY:
Please consider how the lack of team structure plays a role in the
situation shown in this video.
DO:

Slide
Play the video by clicking the director icon on the slide.

DISCUSSION: Go to next page >

VIDEO TIME:
3:15 minutes
MATERIALS:
• TeamSTEPPS
Opportunity LTC
Video (LTC_
Opportunity
_Complete_
Vignette.mpg)

TeamSTEPPS for Long-Term Care | Team Structure VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTIONB-B-2-19

Team
Structure

TEAM STRUCTURE VIDEO ANALYSIS
SAY:
Now let’s discuss what you saw in the video vignette.
DISCUSSION:

Slide

•

What members of each of the following teams were involved
in this scenario?
– The Core Team?
– The nursing assistants (Lucy and Carmen).
– The attending physician (Dr. Flores).
– The nurse manager (Gayle).
– The Coordinating Team?
– The nurse supervisor (Liz).
– The Contingency Team?
– No members of this team appeared in the video.
– Ancillary and Support Services?
– The social worker (Christine).
– The recreation therapist (Jennifer).

•

Where did the breakdowns occur between the components
of this multi-team system?
– The nurse manager asked the team to “keep an eye” on Mrs.
Smith, but did not assign a specific task to a specific team
member.
– The social worker did not effectively communicate her
observations and concerns to the nursing assistants, and
the nursing assistants were not receptive to the social
worker’s input.
– The physician was never alerted to the changes in Mrs.
Smith’s behavior until after she had fallen. When the nurse
supervisor did call the physician, she did not effectively
communicate Mrs. Smith’s condition, and he behaved
unwilling to address the concerns.

•

What could the individuals involved in this scenario have done
differently to produce a better outcome?

B-2-20VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION TeamSTEPPS for Long-Term Care | Team Structure

EXERCISE: APPLYING TEAMSTEPPS

Team
Structure

Instructor Note: This slide is intended for the Master
Training course only. The previous slide should be the last one
shown to staff participants at your nursing home.
SAY:
Now return to your TeamSTEPPS Implementation Worksheet.
After the Introduction module, you identified the teamwork issue or
issues that you plan to address with TeamSTEPPS. Now, think
about the area in which you intend to use TeamSTEPPS to
improve performance.
Think about:
•

What types of team members make up each team?

•

How do the teams in your unit, department, or work area interact
with one another?

•

How might each of the teams fit into your TeamSTEPPS
implementation plan?

Slide

MATERIALS:
• TeamSTEPPS
Implementation
Worksheet

DO:
Ask a few individuals to report on the multi-team system that will
be affected by their intended TeamSTEPPS implementation.

TeamSTEPPS for Long-Term Care | Team Structure VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION B-2-21