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Team Working

Quality improvement is a team sport that should involve members with different perspectives from multiple professions. As a leader in quality improvement, you will need to develop strong skills to help the team work effectively. Think about how you might build your team, deal with conflict, work across different professional disciplines, spread a good change from one unit to another unit and sustain change once an improvement has been made. Problems within teams are often the result of poor communication and lack of team working. Conversely if the team functions well, they are more likely to be successful. This article explores areas you should consider.

Interprofessional Working

The size and composition of your team may vary, but it is important to get the right mix to ensure success. Appreciate the varying types of expertise different professionals can bring to the discussion, as well as how their educational background and professional identify will influence this. Consider who you might include within you team. Examples include managers, administrators, doctors, pharmacists, nurses, health care assistants, patients, families and community members.


Stakeholders are the people who will influence your project and be affected by it. Ensure they are included within your team at a level that makes sense for them. Strike a balance between the level of involvement they can give with the influence they are able to yield.


Low involvement and low influence individuals should be monitored, but your resources and time will limit your interaction with this group.


High involvement with low influence individuals should be kept well informed throughout the process. They are likely to be affected just as much as those with high levels of influence.


Low involvement but high influence individuals should be kept regularly updated on important developments. Ensure they are satisfied with the end result.


High involvement with high influence individuals should be fully engaged. They will be instrumental in achieving a successful outcome.

Read more from NHS Improvement on stakeholder analysis.

Three Levels of Expertise

Teams that work effectively include members with different levels of expertise. It is possible for individuals to possess one or more kind of expertise. Learn to recognise the expertise your team members bring so that you can use them to more effectively.

Authority within the system
These individuals have authority in all areas affected by the change and can overcome the barriers that may arise. This includes allocation of time and resources. They will understand the implications of the proposed change.
Technical expertise
These individuals know the subject and understand the system. They can help determine what needs to be measured and how the data should be collected and interpreted.
Day-to-day leadership
These individuals are the daily driver of the project who can assure tests are implemented and data is collected. They should understand the system and the effects change will have on it.

Establishing Common Goals

A team ought to reach a consensus on a clear purpose and a common goal. Each member should know what the problem is, how they plan to solve it and in what timeframe. In short, each member should know the project aim, the measures being used and how the data will be collected.

The difficulty comes in reaching this consensus. Establish relationships within the team by getting members to know one another and take time to understand the different backgrounds and skillsets they can provide. Once this has been achieved, a case for change should be built using preliminary data and the team should clarify the goal and scope of the project. Once the purpose and composition of the project is established, the team can then be assigned roles. Try to leverage the individual strengths of each team member towards completing the common goal.

Read more from NHS Improvement on the creation of a project charter.

Keep the project on track by defining the ground rules, being timely, completing assignments, keeping clear minutes and setting agendas. Establish a normal routine for meetings where listening to one another is actively encouraged and conflict can be constructively worked through. Ensure to set expectations early on.

Levels of Team Evolution

It is normal to encounter difficulties and conflict among teams. As the team matures, the way in which they interact with one another will also change. Psychologist Bruce Tuckman recognised that there are four stages of team evolution. Teams can go back and forwards between the different levels. They are as follows:


  • Members are unsure of the team purpose, how they will fit in and whether they will work well with one another.
  • Members set aims, boundaries and superficially explore the task.
  • They attempt to define the task, understand their roles identify problems they will have to tackle.
  • Members may feel anxious, curious or excited to get going.


  • Work becomes difficult as the team realises the task is different to what they first expected, and the true characters of members becomes apparent. They learn to recognise and manage conflict.
  • Arguments, competition and concerns arise about the workload. This is made wore if roles and responsibilities aren’t yet clear. Some may challenge the authority and question the way the team is formed.
  • Members may become resistant and hesitate to try something new.


  • Members recognise that there are differences between them, individuals identify roles to get the job done, team structure become more clearly defined and the rules of work become accepted.
  • Feedback begins to become normal. Group decision making becomes the norm and differences are respected. Good decisions are made.
  • Members become comfortable with one another and constructive criticism is offered.


  • The team can recognise problems and prevent them forming or easily work through problems which do occur. Members build on the ideas of others, as well as contest changes. Roles become more fluid with members taking on roles and responsibilities as needed.
  • Feedback is readily given and well received. Members recognise the value that others bring and what they can offer.
  • There is a lot of satisfaction with progress.

Helping the Team Evolve

Use this model to help your team evolve into the norming and performing stages. Simply identify the current stage your team is at, consider what you need to do to move onto the next stage and adjust your behaviour and leadership approach accordingly.

The easiest way to do this is to seek the views of others and by being willing to change your mind on the views of others. Use a balance of advocacy and inquiry to achieve this. State your views (so the team can understand your thinking) and then try to hear other members views. Ask why they think that or how they came to that conclusion. In this way you will be able to understand the current team dynamic and identify any tensions under the surface.

Read more from NHS Improvement on conflict management.