Effective teams include members representing three different kinds of expertise within the organization: system leadership, technical expertise, and day-to-day leadership. There may be one or more individuals on the team with each kind of expertise, or one individual may have expertise in more than one area, but all three areas should be represented in order to drive improvement successfully.

System Leadership
Teams need someone with enough authority in the organization to institute a change that has been suggested and to overcome barriers that arise. The team's system leader understands both the implications of the proposed change for various parts of the system and the more remote consequences such a change might trigger. It is important that this person have authority in all of the areas that are affected by the change. This person must have the authority to allocate the time and resources the team needs to achieve its aim.

Clinical Technical Expertise
A technical expert is someone who knows the subject intimately and who understands the processes of care. An expert on improvement methods can provide additional technical support by helping the team determine what to measure, assisting in design of simple, effective measurement tools, and providing guidance on collection, interpretation, and display of data.

Day-to-Day Leadership
A day-to-day leader is the driver of the project, assuring that tests are implemented and overseeing data collection. It is important that this person understands not only the details of the system, but also the various effects of making change(s) in the system. This person also needs to be able to work effectively with the physician champion(s).
 

	Example 1: Aim Reduce delays in surgical services for patients on the day of surgery: incision within 90 minutes of arrival for all outpatients. Core Team Nurse Manager, Operating Room Nurse Manager, Outpatient Surgery Anesthesiologist Perioperative Facilitator Nurse, Operating Room Nurse, Post Anesthesia Care Unit Certified Registered Nurse Anesthetist (CRNA) Leadership Support Surgeon Hospital Administrator

	Example 2: Aim Reduce patients’ actual and perceived waiting time in the Emergency Department. Reduce the waiting time for nonemergent patients by 50 percent. Core Team Nurse Manager, Emergency Department Medical Director, Emergency Department Nurses from all three shifts Patient Care Assistant Unit Secretary Paramedic Manager Process Improvement Coordinator Leadership Support Chief Operating Officer Nurse Executive

	Example 3: Aim Reduce the waiting time for patients coming to Ambulatory Care Services (ACS) for outpatient testing by 50 percent. Core Team Physician (Chair,Department of Cardiology) Physician (Chair, QA/UR Committee) Assistant Director, Nursing for Clinical Practice ACS Scheduling Clerk