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Chapters 14, 15, 16, and 17 deal with action for improvement of team performance. Chapter 14 covers training, and Chapter 15 examines team building. This chapter provides an account of process improvement, beginning with how it fits within the larger category of performance improvement. Chapter 17 deals with troubleshooting.

The phrase performance improvement refers to a cycle of management activities that consists of measuring performance, identifying areas for improvement, settings goals for improvement, taking a variety of actions aimed at achieving the goals, and measuring performance again—followed by identifying new areas for improvement, setting goals again, and so on in unending repetitions of the cycle.

The first step in the cycle is to measure performance. The measurement of performance in a team should include assessment of the team's success in achieving its goals as well as assessment of the quality of its teamwork. Chapter 13 deals with evaluation of team performance and emphasizes the measurement of teamwork quality, in keeping with the topic of this book. The details of measuring how well teams perform in achieving their goals is outside the scope of this book, but the general nature of this measurement can be stated briefly. For a clinical team, measuring goal attainment consists of measuring how well the team succeeds in achieving the Institute of Medicine's 6 aims discussed in Chapter 6. For example, a clinical team will want to know the quality of its clinical outcomes such as the quality of obstetrical outcomes in the Labor and Delivery Unit described in Chapter 13. For management teams, the goals vary widely from team to team, and measuring goal attainment varies accordingly. To take one example, a hospital finance team will want to know how well the hospital is performing on various financial indicators, including the hospital's debt-to-equity ratio and its cash-on-hand. Considering teams of all kinds, the list of appropriate performance measurement topics includes many widely varying topics: patient satisfaction, waiting times, postsurgical infection rates, costs for common procedures (for example, total hip replacement), rates of revenue growth and operating margin growth, and so on. One of the topics on the list is the quality of teamwork.

After measurement of performance has revealed areas for improvement, the next step in the cycle is to take action for improvement. The list of potential actions consists of a broad and diverse array: coaching, training, team building, process improvement, culture change, and many other management actions. Coaching is explained in Chapters 8 and 12. Training and team building are covered in the previous 2 chapters. Chapter 18 covers creating a team-based organizational culture and using compensation systems to foster organizational alignment. The list of possibilities is long. Some actions can be very simple and straightforward. For example, if a hospital supplier can no longer consistently meet its delivery schedule, a change to a more reliable supplier will improve performance.

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