Chapter 4 – Creating Performance-Driven Teams PDF

**CHAPTER 4: CREATING PERFORMANCE-DRIVEN TEAMS** **4.1 INTRODUCTION** -------------------- Globally competitive companies continuously strive to improve performance to attract more clients and to secure the future of the business. A company is comprised of individuals grouped into teams. It is imp...

**CHAPTER 4: CREATING PERFORMANCE-DRIVEN TEAMS** **4.1 INTRODUCTION** -------------------- Globally competitive companies continuously strive to improve performance to attract more clients and to secure the future of the business. A company is comprised of individuals grouped into teams. It is important for the success of a business that these teams work well together to achieve the goals of the business. Performance-driven teams can achieve these goals. **A performance-driven team is a natural working team that organises and manages itself like a small business. This means it has:** - Client teams and supplier teams - Clearly defined roles and responsibilities and accountability in each role - Team values and Key Performance Indicators (KPI's) - A place where it meets to discuss performance and to make decisions on how to improve the team performance and business IMPORTANT INFORMATION --------------------- A performance-driven team incorporates many of the same policies and practices as the full business and is therefore an important part of the value chain and must aim to provide client teams with improved services. Value chain is a term that businesses use to describe their whole 'chain' of processes -- from start to finish, end-to-end processes. For example, in a hospital environment, this starts at patient admission from a doctor (or even much earlier in the process) as an 'upstream' process and ends at patient discharge (or even up to full recovery post, e.g. sub-acute care and rehabilitation) as a 'downstream' process. All this forms part of the total value chain. **4.2 UNDERSTANDING THE VALUE CREATION OF THE PERFORMANCE-DRIVEN TEAM** Performance-driven teams help every part of the company to focus on valuing its clients -- in Mediclinic's instance the primary external client is the patient. There are many relationships between departments and to manage all of these relationships effectively seems impossible. For this reason, teams are empowered to manage their own relationships with their own client teams and supplier teams. In order to manage the value chain of a performance-driven team successfully, the technique of drawing up simple inter-team agreements, or Service Level Agreements (SLA's) can be applied. The team must function as a system within the organisation. Inter-team agreements can be viewed as the arrows in the picture below, between the team, its supplier teams, partners and client teams, i.e. reflecting both inputs and outputs. **IMPORTANT INFORMATION** ------------------------- **Each team must answer the question: 'What are we in the business of doing?'** - This will assist in understanding how inputs are transformed through a process into outputs. - Remember: In order to support the company's strategy and create more value for the patient, always consider the next process as your immediate client. To give clarity on reporting relationships and who acts in different roles within the team, an organogram should be displayed in each team. The following descriptions from the image above can assist with these discussions. Supplier teams are the previous (upstream) process of the team, who must be helped to provide inputs precisely and according to the needs of the team. The team leader must communicate effectively with these suppliers in order to improve their service. The performance-driven team is a mirror-image of its suppliers. For this reason, supplier team communication and development is very important. Client teams are the next (downstream) process of the team, whose precise requirements must be understood and met. The performance-driven team must always provide first-class outputs to the next process. The business can only survive, grow and make a profit if the needs of the end client are satisfied. Interactions between supplier teams and client teams must always be done with the ultimate goal of achieving outcomes that are desirable by the patient. The Team Leader has an important role to play. Team Leaders are responsible for managing these relationships as they are at the centre point of interactions between internal teams. They need to manage the value chain in and out of their own team (e.g. nursing unit or theatre). The Team Leader should not expect that the correct information or requests will automatically come into the team. It is important for them to be up-to-date with what is happening in the supplier teams, in order to ensure that their own team can deliver quality work or services on time to the next process. Client teams (next process) requirements must therefore also be clearly understood. Team members are the people working within the team. A performance-driven team can only be successful if its team members are competent and committed towards working together to achieve the objectives of the team and ultimately the business. The Team Leader should view team members as essential contributors each with a specific role to fulfil in the team. A team also needs to discuss what is expected from each team member and what their roles and responsibilities are within the team. **The Department Manager's role and expertise is extremely important.** This person has a very important role as a coach to their department's Team Leaders and even team members. The importance of the critical role of a coach is clearly illustrated by the results of world-class vs. less well performing international sports teams. The Department Manager should be viewed as the coach of the performance driven teams within his/her department. They enable the teams to perform well by coaching, by providing support, resources and information, and by removing 'rocks' in the way of performance. **IMPORTANT INFORMATION** ------------------------- The performance-driven team will mature over time, as the team learns more about continuous improvement. There will be less errors and problems to deal with and focus will be more on improvements and impactful innovations. This also means that roles and responsibilities will change within the team as time goes by. Ensure that the organogram is always up to date. ### **THE USE OF INTER-TEAM AGREEMENTS** A company's success is dependent on the success of every performance-driven team and the effective interlinking between different performance-driven teams. This can be driven through effective inter-team agreements. In order to draw up inter-team agreements, the following questions can be asked in each team: - Who are our supplier teams and what do we require from them to complete our own process successfully? - Who are our client teams and what do they require from us to complete their process successfully? After these questions have been answered, draw up the inter-team agreements between the team leaders of the two teams. Both team leaders sign off on the inter-team agreements, and this becomes the basis for performance measurement and communication between the two teams. **INTER-TEAM AGREEMENT EXAMPLE:** Process: Distribution of scripts and unit credits between pharmacy and units.  **IMPORTANT INFORMATION** ------------------------- If all performance-driven teams in the company apply the principles of managing the value chain, it establishes a system whereby all teams look to their upstream and downstream processes. Each team simultaneously becomes a supplier and a client to another team and thus all teams manage each other to create synergy in the value chain. The overall output is then a high-performance company. **ACTIVITY 5** -------------- 1. **In relation to your own team, describe what it means to be part of a value chain.** -- -- 2. **For your team, describe your own value creation, by completing the following:** **The inputs to our team are (think of what you receive from your supplier teams):** -- -- **Our process adds the following value to the inputs:** -- -- 3. **In preparation of potentially setting up inter-team agreements, complete the following:** **Who are your supplier teams and what do you require from them?** **SUPPLIER TEAMS** **WHAT IS REQUIRED FROM THEM?** -------------------- --------------------------------- **Who are your client teams and what do they require from you?** **CLIENT TEAMS** **WHAT THEY REQUIRE FROM US** ------------------ ------------------------------- ### **4.3 ESTABLISHING A PERFORMANCE-DRIVEN TEAM ENVIRONMENT** Imagine playing a soccer or rugby game where no one knows the score. The score makes the game interesting to spectators and motivates team members to perform better. It shows exactly how the team is doing and how individual efforts contribute towards success. Similarly, this can be applied to performance targets. Progress against hourly, daily, weekly and monthly targets should be displayed and managed visually. Such visual management should include various measures and targets that reflect the alignment between company and team goals and objectives. #### **THE PHYSICAL TEAM AREA AND VISUAL MANAGEMENT** By now, the performance measures have been set for the team, the organogram, roles and responsibilities are clear and some inter-team agreements have been drawn up. The physical team area will support the visual management of these items. All teams need a physical performance area, equipped with the facilities required, where teams can meet regularly and display relevant information to manage their progress. Such an area supports better teamwork and communication. It is also the place where the team should identify improvement opportunities, do root cause analysis and improvement action planning. **'In a visual workplace everyone will know the who, what, when, where, why and how of an area within five minutes.' -- The Visual Workplace, Productivity Inc.** **GUIDELINES FOR THE TEAM AREA -- IT SHOULD BE:** - Physically attractive, consisting of enough wall space for visual displays - As close as possible to the workplace of team members - As quiet as possible to facilitate communication - Created through involvement of all team members **IMPORTANT INFORMATION** ------------------------- Information is powerful when shared with the team. It is most powerful when the information is not just based on figures handed down by senior management, but when individual team members have responsibility for its implementation and display. If visual communication becomes part of daily operations, major improvements in quality (e.g. of patient safety, clinical outcomes and patient experience outcomes) and operational efficiency (e.g. relating to productivity and cost management) achieved through energised people will result. It is important to remember that visual management is about communication, information sharing and motivation of the team. To measure and display goals and objectives is a typical example of visual management. Visual management of goals and objectives means putting in full view, for all to see and understand at a glance, the following: - Quality and operational efficiency measurements - Performance against targets - Improvement plans that addresses problem areas or opportunities The photographs below show examples of how visual management boards have been set up in a hospital. **EXAMPLE** ----------- The higher the frequency of goals and objectives being tracked, the more the company is enabled to respond to changes. Generally speaking, the closer a team is to the front line, the more likely it is that the goals and objectives can be tracked on a daily basis. Conversely, the further away a team is from the front line, the more likely it is that the team's goals and objectives will only be able to be tracked on a weekly or monthly basis. The principle is: the more real-time the measurement of goals and objectives can be, the better. **IMPORTANT INFORMATION** ------------------------- ### **BEWARE OF MICROMANAGEMENT** Managers should guard against the danger of micromanaging. Team members typically manage processes taking from a few minutes to a few hours, or processes that are repeated frequently during a day, e.g. on an hourly or two- hourly basis, and make decisions as the day progresses. If team members are empowered to make these decisions during the day, their team leaders should not need to make these decisions for them. These managers can thus focus on daily and weekly decisions and planning horizons. If managers are empowered to do this properly, time is freed up to focus on a weekly or monthly planning horizon. Senior managers can then focus on monthly to annual decisions, and so forth. A good litmus test to determine at which level a manager is functioning, is to ask them how long they can be away from their team before they are called upon to make a decision. When senior managers answer 'half a day', it is clear that the company is most probably not able to spend good time focusing on the longer term because everyone from senior management down is caught up in the day-to-day running of the company. **IMPORTANT INFORMATION** ------------------------- **VISUAL DISPLAYS MUST BE:** - Large, bold, simple and easy to read - Visible from a distance -- '3 metres 3 second' rule: a person should be able to look at the visual board from 3 metres away and be able to discern normal from abnormal within 3 seconds. - Meaningful and relevant to the team Focused on only important information **REMEMBER:** - Information should be updated during the day or on a daily basis, depending on the requirement. - Responsibilities for updating information must be shared among team members. - Explain how to read the graphs to the team and check for understanding. - Discuss information daily in the team. - Use information in a positive context (e.g. measure attendance, rather than absenteeism or the number of days since the last clinical event). - Visual displays do not have to be highly technological or electronic. Paper or whiteboards can be even more effective and much less costly. ### **ALIGNING TEAM VALUES WITH COMPANY VALUES** Another important aspect of creating the performance-driven team, is to commit to a common set of values. Shared values are the glue that holds team members together. Values or team norms serve as the rules of the game on how people will work together to achieve the goals and objectives of the team and the company. IMPORTANT INFORMATION --------------------- In Mediclinic Southern Africa we have our five values with certain behaviours associated with each. It is important that our values are visible and known in every unit and that the associated behaviours are known to ensure clarity about the practical ways our values should be lived daily. It is critical that leaders on all levels in the organisation set the example in terms of living our values. **OUR VALUES** ------------------------------------------------------------------------------- -------------------------- **The Mediclinic Group and its employees support the following core values:** **1** PATIENT SAFETY **2** CLIENT FOCUS **3** MUTUAL TRUST AND RESPECT **4** TEAMWORK **5** PERFORMANCE-DRIVEN The Human Resources Department has published a Facilitator Guide for a Mediclinic Culture and Values Workshop on the Leadership Academy Intranet site, which can be helpful to aid a team leader define his/her team's behaviours to reflect the company values. ### **IMPORTANCE OF ACTION PLANNING BASED ON PERFORMANCE MONITORING** Utilising visual display boards to monitor team performance is not sufficient without adding the accompanying action plans to address gaps in performance. Creating a proper action plan enables a team, Team Leader and all other managerial levels to effectively follow up on all allocated actions with the correct people at the right time. The action plan serves as an agreement as to who in the team takes ownership of a specific action and by when it will be completed. **Date** **Issue/Problem** **Action** **Who** **When** **Status** ---------- ------------------- ------------ --------- ---------- ------------ Action plans are also an integral part of the performance-driven team and are displayed on the visual management board. Usually there would be one action plan for each objective that is measured or at least for the objectives with the biggest performance gaps. ### **SOME TIPS TO COMPLETE PROPER ACTION PLANS** - Step 1: Clearly state the end result to be achieved via the action plan. - Step 2: Make a list of actions that would help the team to achieve the stated result. Remember to always start every action sentence with a verb. - Step 3: Evaluate the list of actions; only keep the ones that will really make a difference. - Step 4: Determine the sequence of activities; some activities have to be completed before others. - Step 5: Fill in the planning form and indicate the name (who) of the responsible person, as well as the planned completion date (when). IMPORTANT INFORMATION --------------------- In summary, a company is creating a platform to compete against the world's best when every team functions as a performance-driven team, i.e.: - Sees itself as a performance-driven team - Understands the value created by their team - Has a clear vision and values in support of the overall vision and values of the company - Has an attractive, working team area - Is focused on the continuous improvement of performance through the use of a visual management board and team meetings - Improvements efforts are aligned with the overall goals of the business ACTIVITY 6 ---------- Answer the following questions in preparation of setting up your own performance-driven team visual management board: 1. **What are the benefits of having a visual management board, i.e. displaying goals, objectives, action plans, measurements and actual performance against agreed targets?** -- -- 2. **What characteristics and mind-sets are required in a team for visual management to be effective?** **Characteristics:** -- -- **Mind-sets:** -- -- 3. **Who is responsible for updating actual performance on a visual management board in a team or department?** -- -- 4. **Discuss what must be arranged to create a physical team area that will support good visual management?** **What must be arranged** **Responsible person** **Due date** --------------------------- ------------------------ -------------- 5. **Discuss which behaviours will be reflective of the company values being lived within your team.** -- -- -- -- 6. **With regards to action plans:** **Why is it important for your team to have detailed plans to keep track of actions?** -- -- **What are the consequences for your team if you miss the deadlines on action plans?** -- -- 7. **Design your own visual management board** ### **4.4 LEADER STANDARD WORK TO SUPPORT A CONTINUOUS IMPROVEMENT CULTURE** #### **LEADER STANDARD WORK FOR TEAMS** Continuous improvement in the team is made part of daily work through frequent performance reviews, along with the identification of root causes of sub-optimal performance. This is followed by drawing up improvement action plans to take corrective action. As part of review, it is important to follow up on the completion of action plans. If the results are not sufficient, the process is repeated, but if significant improvement can be seen, the team must apply recognition practices and celebrate their success. IMPORTANT INFORMATION --------------------- Performance in terms of goals and objectives should be evaluated on different levels: - Level 1: Team (e.g. a nursing unit or a hospital reception team) Daily and weekly, by the team and the Team Leader - Level 2: Department - Level 3: Hospital Monthly where the Hospital General Manager meets with the Heads of Departments and quarterly, at a multi-level meeting where senior management meet with all employees to review the results of the business and to plan improvement ### **LEVEL 1: TEAM** The start of a shift meeting is the foundation of the daily review. At the start of every shift, the team and Team Leader conducts a brief and focused meeting. These meetings are often also referred to as 'huddles'. The meeting follows an agenda set by the Team Leader. As the team becomes more comfortable and skilled in conducting meetings, chairmanship of the meeting can be rotated. Team meetings can be used to: - Keep the team focused on the Key Performance Indicators (KPI's). - Review performance measures per KPI and discuss yesterday's performance and today's plan/tactics. - Identify trends or instances indicating suboptimal performance where root cause analysis should be done or where creative thinking is required to solve problems. - Perform root cause analysis and make decisions on how to solve a particular problem today. - Discuss what preventative action to take before a small problem gets out of hand, and what corrective action to take in the future to prevent that problem from occurring again. - Discuss and check progress on previously identified improvement actions. This will typically happen on the level of a Nursing Unit, a theatre complex, a reception team, etc. If the above-mentioned points around continuous improvement are to be combined with an existing meeting where operational issues (e.g. daily staff schedules, absenteeism, equipment failures to be fixed today, etc.) are discussed there should be sufficient focus on the team's performance against targets and improvement action plans. Improvement ideas may be classified as 'just do it', a mini project within the unit or an interdepartmental project that might have to be escalated to a higher level. These meetings are typically held at the team's visual management board. Team meetings may happen in the presence of a Departmental Manager if the team meeting would overlap with a 'Walkabout' or Gemba walk (see glossary) by the hospital leadership on the specific day. ### **MEETING GUIDELINES** Meetings are often criticised for being unproductive, costly, boring and sometimes unnecessary. Here are a few points to consider about your meetings so that they are always productive and time-effective. **Preparation for meetings** To ensure that the full agenda will be covered during a morning meeting, it is essential to prepare for these meetings. The Team Leader must know what must be discussed and what needs to be achieved. To allow individuals an opportunity to prepare for meetings, it is important that team members are notified beforehand for pre-meeting preparation. Define the purpose and agenda of every meeting the agenda typically looks as follows: - Yesterday's performance - Today's plan/tactics (who does what) - Information update and feedback - Problems/issues/risks expected today - Suggestions for improvements - General (birthdays etc.) **Time control** These meetings are typically 10 -- 15 minutes. Meetings should always start and end on time. In order to create a dynamic and focused atmosphere in these morning meetings, they are often held as stand-up meetings. This also contributes to keeping to the 10 -- 15 minutes time framework. Keeping minutes As with any meeting, it is always good practice to keep a record of what was said at the meeting, not all the details, but rather the important information and decisions made. It becomes a written document on decisions made, and it will often assist in eliminating misunderstandings. A good idea is for each person within the meeting to get a chance to take minutes at subsequent meetings, so that it is not always one person's responsibility. The figure below shows an example of a morning meeting minutes template. This template often serves as both the agenda and the minutes in one.  **Post meeting follow-up** After the meeting, the person who has taken the minutes is responsible for recording them in an easy-to-read format (for example, in a book that is kept in the performance-driven team area). The Team Leader is then responsible for checking the progress of each participant against his or her action(s) that needed to be taken, prior to the deadline for each. **PROBLEM-SOLVING GUIDE FOR PERFORMANCE-DRIVEN TEAMS:** +-----------------------------------+-----------------------------------+ | **OBSTACLE** | **POSSIBLE SOLUTION** | +===================================+===================================+ | Team sceptical, actively works | Establish the importance of | | against the concept of team | teamwork by asking questions: 'Is | | meetings | there anybody in this group whose | | | work can affect yours?' | | | | | | OR | | | | | | 'Is there anybody in this group | | | who, if they don't do their job, | | | will affect how others see this | | | group?' Once you get the group to | | | accept that they depend on each | | | other, point out that 70% of | | | people in world-class companies | | | work in teams. | +-----------------------------------+-----------------------------------+ | Lack of participation by | Involve everyone, ask questions, | | individuals in team activities | make suggestions, show that you | | and meetings | value their input and | | | involvement. Listen to them. | | | Demonstrate the benefits of | | | participating in a team, ask for | | | their suggestions, ask them for | | | help in solving problems. | +-----------------------------------+-----------------------------------+ | A dominant individual who is | Try to establish why they are | | negative | negative and deal with their | | | concerns. Address the problem not | | | the person. Focus the team | | | meeting on constructive issues, | | | ask them to make a positive | | | contribution. Make it clear that | | | you value everybody's | | | contribution, and insist on | | | giving everybody a chance to | | | participate. Take them aside and | | | point out the effect of their | | | behaviour on the team. | +-----------------------------------+-----------------------------------+ | Dominant individual who | Listen to them, ask other team | | participates but makes it | members for their input. | | difficult for others to | | | contribute | Make it clear that you value | | | everybody's contribution. Explain | | | how important it is for everybody | | | to participate, that involvement | | | and participation leads to | | | ownership and empowerment and | | | will lead to the team being | | | successful. | +-----------------------------------+-----------------------------------+ | Team too large to hold effective | If a team is larger than 15 | | meetings | people, it becomes difficult to | | | involve all the team members | | | effectively. Discuss this with | | | your immediate manager to find a | | | solution. | +-----------------------------------+-----------------------------------+ | Team members do not all work in | Look at your team and think about | | the same area | whether the way in which your | | | team is organised is the best way | | | of doing the job. Speak to your | | | manager about this and suggest | | | ways of improving the structure. | +-----------------------------------+-----------------------------------+ | Individuals believe that they do | Help them to understand the value | | not need to work in a team | of teamwork and the benefits | | | thereof. | +-----------------------------------+-----------------------------------+ | Team believes there is no time | Demonstrate the improved | | for meetings | performance and productivity, | | | resulting from planning, during | | | team meetings. Explain that if | | | everybody participates in team | | | meetings, then meetings will | | | actually save time, and result in | | | the more effective use of time. | +-----------------------------------+-----------------------------------+ | Lack of support for team meetings | Discuss this with your manager. | | from your manager | Ask for support, point out what | | | you want to achieve in team | | | meetings and demonstrate results. | | | Win your manager over by proving | | | that team meetings do work. | +-----------------------------------+-----------------------------------+ ### ### **LEVEL 2: DEPARTMENTAL** The start of a shift meeting is not enough time to really get the team to focus on longer-term success. The morning meeting is more of an operations meeting, focused on day-to-day performance and improvement activities. However, if a continuous improvement culture and performance-driven teams are to be established, information trends need to be analysed and discussed and weekly and monthly meetings must be held. At least once per month, the team leaders meet with the Department Manager to review: - Performance against targets and completion of action plans - Analysis of trends -- positive or negative -- and the root causes - Achievement of the success of impact projects - New improvement ideas that were raised This will typically happen on the level of a hospital management member with their departmental team (e.g. Nursing Manager with Deputy Nursing Managers and Unit Managers, or Technical Manager with Technicians). If combined with an existing departmental meeting where operational issues are discussed and weekly planning is done, there should be sufficient focus on the department's performance against targets and to progress on improvement action plans. Improvement ideas may be classified as 'just do it', a mini project within the department or an interdepartmental project that might have to be escalated to a hospital management or corporate office level. These meetings should typically also be done at the department's visual management board. ### **LEVEL 3: HOSPITAL** This will typically happen at hospital management level chaired by the Hospital General Manager. It may be held with only the hospital management team present or with all employees present. This is typically a quarterly meeting but can be held more frequently. If held as a hospital management meeting where it is a combined with an existing meeting where operational issues are discussed and monthly planning is done, there should be sufficient focus on the hospital's performance against targets and progress on improvement action plans. ### **LEADER STANDARD WORK FOR INDIVIDUALS** Similar to how teams have standard work, Leader Standard Work for individuals, especially managers, are equally important to build a continuous improvement culture. Leader Standard Work for managers involve a manager drawing up a schedule of the leadership and managerial activities in a typical day, week, month, quarter, semester and year in the relevant role. Apart from normal line management activities such as approving time and attendance data, responding to emails, attending weekly meetings, planning staff for the upcoming shift etc. it is important that continuous improvement activities become part of the daily, weekly and monthly rhythm of a manager. Such activities may include daily team huddles, weekly discussion of new ideas, bi-weekly 'Gemba walks', monthly recognition practices, etc. EXAMPLE **ACTIVITY 7** -------------- 1. -- -- 2. **Draw up an example of Leader Standard Work for yourself that shows the main tasks on a daily, weekly and monthly basis.** **LEADER STANDARD WORK DOCUMENT** ----------------------------------- **DEPARTMENT/UNIT:** **DAILY** WEEKLY MONTHLY