Transformation of medical-surgical care requires active participation from a cohesive team of leaders, nurses, physicians, and other staff. The culture of both the organization and the unit must support involvement from everyone — clinical and non-clinical staff — to engage the best ideas for innovation and change. The process must be led by a core team, a multidisciplinary group committed to integrating changes that are being simultaneously tested in all four improvement areas: safe and reliable care; vitality and teamwork; patient-centered care; and value-added care processes.
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 Including the right people on a process improvement team is critical to a successful improvement effort. Teams vary in size and composition. Each organization builds teams to suit its own needs.
First, review the aim.
Second, consider the system that relates to that aim: What processes will be affected by the improvement efforts?
Third, be sure that the team includes members familiar with all the different parts of the process — managers and administrators as well as those who work in the process, including physicians, pharmacists, nurses, and front-line workers.
See the Improvement Methods section for more information and general tips on Setting Aims, Establishing Measures, Selecting Changes, Testing Changes, Implementing Changes, or Spreading Changes.
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Any team dedicated to transforming medical-surgical care must be multidisciplinary, with representatives from all members of the clinical microsystem. The team should include front-line nurses, nursing assistive personnel, unit clerical support, physicians, support personnel for the unit (e.g., pharmacists, dietary staff, housekeeping, supply technicians, social workers, and others), and patient and family representatives. (See the Institute for Family-Centered Care website for more information about including patients and family members in your improvement work). It is important that all team members participate in the early activities to generate and test improvement ideas. It is critical to have active participation from physicians who admit patients to the medical-surgical unit and to have active involvement from senior leaders and sponsors.
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Example 1: Reducing waste to increase the value-added time of nurses in direct patient care.
Aim: Increase the percent of value-added time of nurses to 90 percent in 12 months.
Core Team:
The core interdisciplinary team for reducing waste on the medical-surgical unit must include, at a minimum:
Additional team members may include:
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Quality director
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Pharmacist
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Materials Management representative
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Information Technology representative
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Dietary representative
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Organization-level facilitator with expertise in waste reduction (if the organization has one)
Sub-teams as described above may be formed to work on identifying and testing changes for each of the four improvement areas (reducing waste, care team vitality, safe and reliable care, and patient-centered care). However, the core team should coordinate and oversee all tests.
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Example 2: Create a safe environment for patients to avoid needless deaths.
Aim: Reduce unit mortality by 60 percent in 9 months through the introduction of Rapid Response Teams.
Core Team:
The core interdisciplinary team for reducing mortality on the unit must include, at a minimum:
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Physician (perhaps a hospitalist, if the organization has one)
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Front-line nurses
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Nurse manager
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Intensive Care Unit (ICU) representative
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Leadership sponsor
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Patient and/or family representatives
Additional team members may include:
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Pharmacist
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Respiratory therapist
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ICU nurse
Sub-teams as described above may be formed to work on identifying and testing changes for each of the four improvement areas (value-added care, care team vitality, safe and reliable care, and patient-centered care). However, the core team should coordinate and oversee all tests.
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