Module 4

LEADING TEAMS
(DRAFT)

SUBSECTIONS
•
•
•

•
•

Types of Team Leaders
Effective Team Leaders
Team Leader Strategies
(Briefs, Huddles, and
Debriefs)
Conflict Resolution
Promoting and Modeling
Teamwork

TIME: 50 minutes
VERSION FOR REVIEW ONLY; NOT FOR DISTRIBUTION

INSTRUCTOR OUTLINE: LEADING TEAMS
Instructor Note: In this module, you will present information
about leading teams. Participants will learn the characteristics of
effective leaders, the importance of role modeling behaviors, and a
leader’s role in conflict resolution. Tools specific to leading teams
will be presented.
The Leading Teams module includes the content provided in the
outline below. More content is available than can be covered in
the time provided; therefore, optional content and activities are
noted. It is strongly recommended that instruction not focus solely
on lecture, but also include exercises, videos, and other activities.
As such, instructors should use the information below to plan how
the module will be taught within the time available.
Content

Page #

1.

Leadership Exercise

2.

Introduction

6- 7

3 mins

3.

Team Leaders

8- 9

4 mins

4.

Defining the Plan and
Assigning Tasks and
Responsibilities

10 - 12

4 mins

5.

Sharing the Plan (Brief)

13 - 14

4 mins

6.

Briefing Exercise

15

15 mins*

7.

Monitoring and Modifying the
Plan (Huddle)

16

2 mins

8.

Reviewing the Team’s
Performance (Debrief)

17 - 19

8 mins

20 - 21

3 mins

22 - 23
24

8 mins*
2 mins

9.

Facilitating Conflict
Resolution and Modeling
Teamwork
10. Team Formation Video
11. Tools and Strategies
Summary

5

Approx. Time
15 mins*

Leading Teams
Slide
MODULE
TIME:
75 minutes

MATERIALS:
• Leadership
Exercise Sheet
• Brief LTC Video
(Brief_LTC.mpg)
• Briefing Exercise
Sheet
• Huddle LTC Video
(Huddle_
LTC.mpg)
• Debrief
Subacute Video
(Debrief_
Subacute.mpg)
• TeamSTEPPS
Success LTC
Video (LTC_
Success_
Complete_
Vignette.mpg)
• TeamSTEPPS
Implementation
Worksheet

12. Applying TeamSTEPPS
25
5 mins
Exercise
*Although all instructional content and activities are recommended to
ensure that participants achieve the learning objectives, these
activities may be considered “optional” if time is constrained.

Continued…

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Leading Teams
Slide

INSTRUCTOR OUTLINE: LEADING TEAMS
(Continued)
Additional Resources: Below are sources of additional
information and videos you may want to use to customize
this module to your participants.
•

TeamSTEPPS for Long-Term Care DVD: The
TeamSTEPPS for Long-Term Care DVD includes
Specialty Scenarios and additional videos that can be
used to customize your instruction.

•

TeamSTEPPS 2.0: Includes videos specific to the use of
the leadership tools and strategies in multiple hospital
settings.
• http://www.ahrq.gov/professionals/education/curriculumtools/teamstepps/instructor/fundamentals/index.html

•

TeamSTEPPS for Office-Based Care Version:
Includes videos specific to the use of the leadership
tools and strategies in the primary care setting.
• http://www.ahrq.gov/professionals/education/curricul
um-tools/teamstepps/primarycare/

•

DoD Patient Safety Program Briefs and Huddles
Toolkit:
• http://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-

Safety/Quality-And-Safety-of-Healthcare/Patient-Safety/PatientSafety-Products-And-Services/Toolkits/Briefs-and-Huddles-Toolkit.
•

DoD Patient Safety Program Debriefs Toolkit:
• http://www.health.mil/Military-Health-Topics/Access-Cost-Quality-andSafety/Quality-And-Safety-of-Healthcare/Patient-Safety/PatientSafety-Products-And-Services/Toolkits/Debriefs-Toolkit.

•

Comprehensive Unit-Based Safety Program
(CUSP) “Implement Teamwork and
Communication”
Module: Includes information on briefs, huddles, and
debriefs and presents a video on briefs.
• http://www.ahrq.gov/professionals/education/curricul
um-tools/cusptoolkit/modules/implement/index.html

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(OPTIONAL) EXERCISE: LEADERSHIP

Leading Teams

DO:
Have participants form groups and provide them with the
instructions below.
SAY:
Within your group, please select a leader and a scribe. You will
have 10 minutes to discuss four questions:
• What characteristics, attitudes, or skills made the leaders that
you have known effective and successful?
• If there was room for improvement, what could they have done
to be more effective?
• Does your group feel that leadership can be learned or taught,
or is it an innate skill?
• What one characteristic is most important to the success of
effective leaders?

Slide

TIME:
15 minutes

MATERIALS:
• Leadership
Exercise Sheet

Your group’s scribe will document your responses, and we will
reconvene as a group to discuss.
DO:
Following the 10 minute group discussion, reconvene the group
and facilitate a discussion by allowing groups to report out on their
responses.

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Leading Teams

OBJECTIVES
SAY:
After completing this module, you will be able to:

Slide

•

Describe how leadership affects team processes and
outcomes;

•

Identify different types of team leaders;

•

Describe the activities involved in successfully leading
teams;

•

Describe the tools for leading teams, including briefs,
huddles, and debriefs; and

•

Apply the tools for leading teams to specific
nursing home scenarios.

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TeamSTEPPS for Long-Term Care | Leading Teams

TEAMSTEPPS TEAMWORK SKILLS

Leading Teams

SAY:
So far, we have covered the following in the TeamSTEPPS
framework:
• Team Structure, which facilitates teamwork by identifying the
individuals among which information must be communicated, a
leader must be clearly designated, and mutual support must
occur.
•

Slide

Communication, which facilitates teamwork by enabling team
members to effectively relay relevant information in a manner
that is known and understood by all.

In this module, we will discuss Leading Teams.
Leadership is the linchpin that holds a teamwork system together.
Usually the physician is identified as the designated team leader;
however, within teams the formal leader may not always be the
one truly leading the team to address the situation at hand.
Therefore, we have titled this module “Leading Teams,” because
any team member may take on the leadership role depending on
the situation and the current team membership.
When leading teams, a climate must be created that allows
teamwork to flourish in support of resident safety and the
delivery of high-quality care. Leading teams involves:
• Establishing a plan of care, identifying roles and responsibilities
of team members, developing norms within the team for
operating, and communicating the plan to all team members.
• Monitoring the plan of care and the surrounding situation to
better anticipate residents’ needs, effectively managing the
resources to meet those needs, and adjusting the plan when
necessary.
• Modeling appropriate behavior and reinforcing and rewarding
appropriate behavior when it is exhibited by team members.

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Leading Teams

TYPES OF TEAM LEADERS
SAY:
Team leaders are well-informed team members who make
decisions and take actions. Team leaders establish the goals of
the team and help maintain its focus. There are two types of
leaders.

Slide

The first type is the designated team leader. For a team to
function successfully, a leader must be designated. This leader
must have the knowledge, skills, and attitudes to achieve the
established goals. In most clinical situations, the physician in
charge is the designated team leader.
The second type is the situational leader. The responsibility of
leading the team may change depending on the flow of the
case. Situational leaders emerge at designated times, such as
during anesthesia induction, and at spontaneous times, such as
the first responder to a code.
In high-performance teams, any member of the team with the
skills to best manage the situation can assume the role of
situational leader. Once the situation has been resolved or the
designated leader is ready to assume control, the situational
leader again assumes the role of team member.

ASK:
•

Who are the designated team leaders in your unit, department, or
work area?

•

Is the role of the designated team leader acknowledged
and understood by team members?

•

Can you describe a case in which someone assumed the
role of the situational team leader?

•

Can the roles of the designated leader and situational leader
be better defined in your unit, department, or work area?

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TeamSTEPPS for Long-Term Care | Leading Teams

EFFECTIVE TEAM LEADERS

Leading Teams

SAY:
When leading teams, both designated and situational team
leaders must have a set of effective skills regardless of the
type of team they are leading or the situation in which they are
leading it. At its core, leading teams involves the following
activities:
•

Identifying a goal and defining a plan to achieve the goal;

•

Assigning tasks and responsibilities;

•

Sharing the plan;

•

Monitoring the plan and progress toward the goal;

•

Modifying the plan and communicating changes to all
team members; and

•

Reviewing the team’s performance.

Slide

It is critical that when leading teams, designated and situational
leaders also:
• Establish “rules of engagement” under which team members
will operate and perform their roles;
• Manage and allocate resources effectively to ensure that
team members have what they need to be successful;
• Provide feedback to team members regarding their assigned
responsibilities and progress toward the team’s goal;
• Facilitate information sharing among team members;
• Encourage team members to assist one another when needed;
• Facilitate conflict resolution; and
• Model effective teamwork.

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Leading Teams

DEFINING THE PLAN
SAY:

Slide

Leading teams involves identifying a goal (or goals) for the team’s
performance and developing and clearly articulating a plan to
achieve the team’s goal. In health care, the team leader (whether
designated or situational) must develop a plan of care for the
resident in order to achieve a specific health outcome—the
identified goal. As part of gathering information needed to develop
the plan, the team leader should seek input from staff to ensure
that the plan makes use of all known information.
Developing a plan of care also involves considering the available
resources with respect to time, people, equipment, and
information relative to the resident’s needs. The goal is to
formulate a plan that makes effective use of the available
resources, while maintaining the highest standards with respect
to resident care and safety.

ASK:
•

How do your team leaders communicate a plan of care to
the care team?

•

Which strategies have been effective and which have not
been effective?

•

How do your team leaders communicate changes to the plan
of care to the care team?

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DEFINING THE PLAN: CASE EXAMPLE

Leading Teams

SAY:
Let’s look at an example.
After attending TeamSTEPPS Master Training, two CNAs at
a nursing home decide that the home needs a more
effective plan for responding to resident emergencies that
occur outside of the home. For example, the nursing home
occasionally holds outdoor picnics, which include most of
the residents and some of their family members, staff from
several departments, and volunteers. When emergencies
have occurred at these events in the past, many people
come running and there is general chaos. In addition,
because these events do not occur within a unit, but involve
residents and staff from multiple units and departments,
staff who may be the first to respond may not know the
resident.

Slide

DISCUSSION:
•

What changes would you recommend to improve
performance in emergencies that occur outside of the unit?

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Leading Teams

ASSIGNING TASKS AND RESPONSIBILITIES
SAY:
When leading teams, it is typically the responsibility of the
designated leader to assign roles and tasks to other team
members. In some cases, a situational leader may also make such
assignments. When leading the team, you should:

Slide

•

Determine the tasks and roles to be assigned
– Consider priorities, work requirements, and availability of
resources

•

Determine which roles must be filled and allocate
tasks appropriately
– Consider the knowledge, experience, skill, availability, and
scope of practice of each member of the team

•

Communicate clear expectations of what team members
need to do
– Communicate the plan, team member roles, and task
responsibilities

•

Request feedback about the plan and about progress toward
achieving the plan’s goals

ASK:
•

How do team leaders assign tasks in your units, once a
plan has been established?

•

What approaches to assigning tasks and responsibilities
are effective and what has not been effective?

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Leading Teams

SHARING THE PLAN
SAY:
Briefs are a strategy for sharing the plan when leading a team.
During a brief, which is sometimes referred to as a team meeting,
the following information should be discussed:
• Team membership and roles—who is on the team and who is
the designated team leader;
• Clinical status of the team’s residents—the current
condition, diagnosis, and status of each resident assigned to
the team;
• The plan of care for each of the team’s residents—what is to be
accomplished, what are the expected outcomes, and who is to
do it; and
• Issues affecting team operations—resources normally available
that may be restricted during the current shift.
Defining clear goals and a plan to achieve those goals is an
important part of the brief as well as establishing clear roles and
expectations for each team member. Successful teams measure
their effectiveness in terms of how well they are performing
against the established plan. The designated team leader usually
conducts the brief, and team members actively participate.

Slide

VIDEO TIME:
0:45 seconds

MATERIALS:
• Brief LTC Video
(Brief_LTC.mpg)

DO:
Play the video by clicking the director icon on the slide.
DISCUSSION:
•

Who is the designated team leader?
– Gayle, the nurse manager. She reviewed the activities
of the day and highlighted the clinical status of one
resident who was found wandering during the night,
which was a change for this resident.

•

Did the team develop a comprehensive plan for Mrs.
Smith?
– Yes. The nurse manager instructs the nursing
assistant in the plan of care for Mrs. Smith. The
nursing assistant is asked to watch Mrs. Smith
and encourage rest periods.

•

Did the team address contingencies?
– Yes, the nurse manager explained that the
resident may be developing an infection and that
staff should encourage fluids.

TeamSTEPPS for Long-Term Care | Leading Teams

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Leading Teams

BRIEFING CHECKLIST TOOL
SAY:

Slide

Similar to a preflight checklist used in aviation, the team leader
should cover the items on this (or a similar) checklist. Conducting
a brief at the beginning of a shift or prior to a case provides an
ideal forum for communicating with other team members about
the goals for each resident and the plan of care to ensure resident
safety.
For example, in the hospital setting, the World Health Organization
(WHO) advocates the use of checklists to promote surgical safety.
They have created the WHO Safe Surgery Checklist. The checklist
identifies three phases of an operation, each corresponding to a
specific period in the normal flow of work: (1) before the induction
of anesthesia (“sign in”), (2) before the incision of the skin (“time
out”), and (3) before the patient leaves the operating room (“sign
out”). In each phase, a checklist coordinator must confirm that the
surgery team has completed the listed tasks before it proceeds with
the next phase.
ASK:
•

Have you participated in a brief? Did the items on this
checklist occur? If not, what was not done?

•

If you were designing a briefing checklist, what items would
you include? When would the briefing occur? Who would be
expected to attend?

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TeamSTEPPS for Long-Term Care | Leading Teams

(OPTIONAL) EXERCISE: BRIEFING

Leading Teams

SAY:
As a TeamSTEPPS Master Trainer, you may choose to
implement briefings as a strategy to improve coordination of care.
You may also choose to develop a checklist as a tool to guide
these briefs. The purpose of this exercise is to develop a
checklist to facilitate briefings in your unit, department, or work
area.

Slide

1. First, break into small groups with others from your unit,
department, or work area.
2. Next, identify when, why, and where briefings might be
conducted. Also note who should lead the brief and who
should participate.

TIME:
15 minutes

3. Then, develop a checklist for guiding the brief.
4. Discuss what outcomes you expect to see as a result
of implementing briefs.
5. At the end of the exercise, you’ll be asked to present
and discuss your plans with the group.

MATERIALS:
• Briefing Exercise
Sheet

DO:
Give participants approximately 10 minutes to work on their
briefing checklists. Then, reconvene the group and ask the small
groups to report on what they developed and their expected
outcomes.

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Leading Teams

MONITORING AND MODIFYING THE PLAN
SAY:

Slide

VIDEO TIME:
0:25 seconds

MATERIALS:
• Huddle LTC
Video (Huddle_
LTC.mpg)

Huddle is a tool for communicating adjustments to a plan of care
that is already in place. When a plan changes as a result of
changes in the resident or team membership, or aspects of the
current plan are not working, a huddle should be convened by
either the designated or situational leader. When leading teams, it
is important that such changes are quickly and effectively
communicated so the team members all know the plan for
providing the best care to the resident.
In addition, information updates within the team should occur as
often as necessary. Many times, the designated team leader (i.e.,
physician) is managing multiple residents simultaneously and is
relying on other team members to provide vital information about
the resident’s status and how the established plan of care is
working. Such important updates can be provided during huddles.

DO:
Play the video by clicking the director icon on the slide.

DISCUSSION:
• What event necessitated the need for the huddle?
– Mrs. Smith did not accept the drinks offered and ate only a
small portion of her breakfast. She is not acting like herself.
• What key information was shared in the huddle?
– Most recent resident history and current status
– Distribution of tasks
– Emergent plan of care

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TeamSTEPPS for Long-Term Care | Leading Teams

REVIEWING THE TEAM’S PERFORMANCE

Leading Teams

SAY:
Research has shown that teams that effectively debrief their own
performance can improve their teamwork in real time. Although it
is often difficult to find time for such reviews in health care,
TeamSTEPPS advocates that after action reviews occur and
that, as new Master Trainers, you try to include opportunities to
debrief critical team events. These events are excellent learning
opportunities for team members and can help sustain the
implementation of TeamSTEPPS.

Slide

Debriefs include:
• Accurate recounting and documentation of key events;
• Analysis of why the event occurred, what worked, and what did
not work;
• Discussion of lessons learned and how the team can alter the
plan for the next time;
• Reinforcement of what went well and how the team can repeat
the behavior or plan the next time; and
• Establishment of a method to formally change the existing plan
to incorporate lessons learned.
Debriefs are most effective when conducted in an environment
where honest mistakes are viewed as learning opportunities.
Debriefs can be a brief (about 3 minutes or less) team event,
typically initiated and facilitated by the team leader. Debriefs are
most useful when they relate to specific team goals or address
particular issues related to recent team actions. Debriefs should
focus on performance improvement. It is important to reinforce
what went well and avoid assigning blame or failure to any
individual regarding what did not go well.

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Leading Teams

DEBRIEF CHECKLIST
SAY:
Here are two guidelines for conducting debriefs:
•

Slide

•

Facilitate the discussion as a leader by asking questions
related to team performance. For example, questions might
include: What did we do well? W hat did not go well that we can
improve?
Recap the situation, background, and key events that occurred.
Similar to the brief, the team leader should cover the items on
this (or a similar) debrief checklist. The team can use this
checklist during a debriefing to ensure that all information is
discussed. The team leader should then summarize lessons
learned and set goals for improvement.

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Leading Teams

DEBRIEF VIDEO
SAY:
Now we will watch the physical therapist lead the debrief
immediately following the situation with Mr. Larkin.
DO:
Play the video by clicking the director icon on the slide.

Slide

VIDEO TIME:
DISCUSSION:
• What were some of the positive effects from this debrief?

0:49 seconds

– Team members provided feedback on other team
members’ actions that were most helpful
– One team member offered a suggestion for future
training to further improve performance
– All team members were encouraged to participate
– It reinforced that teamwork skills produce good
outcomes

MATERIALS:
• Debrief
Subacute Video
(Debrief_
Subacute.mpg)

• Describe the tone set for the debrief.
– Set a positive tone for open communication
– Encouraged feedback
– Facilitated lessons learned
– Reinforced team behaviors and successes with the team

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Leading Teams

FACILITATING CONFLICT RESOLUTION
SAY:

Slide

Next we will turn our attention to a leader’s role in facilitating
conflict resolution. Conflict is inevitable and can be caused by
differences in clinical knowledge, work approaches, values,
opinions, or personality. Resolution of conflict is necessary in the
delivery of safe, quality care. Leadership skill in conflict resolution
can enhance team effectiveness and performance. An effective
team leader does not allow interpersonal or irrelevant issues to
negatively affect the team.

In addition to conflict, other disruptive behaviors can affect the
effectiveness of teams. The Department of Defense (DoD) has
developed the Professional Conduct Toolkit to help address such
behaviors.
For more information, find the Professional Conduct Toolkit at:
http://www.health.mil/Military-Health-Topics/Access-Cost-Quality-andSafety/Quality-And-Safety-of-Healthcare/Patient-Safety/PatientSafety-Products-And-Services/Toolkits/Professional-Conduct-Toolkit
Instructor Note: The Mutual Support module provides
specific strategies for resolving conflict: (1) the Two-Challenge
Rule and (2) DESC script.

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TeamSTEPPS for Long-Term Care | Leading Teams

PROMOTING AND MODELING TEAMWORK

Leading Teams

SAY:
Designated team leaders must model, value, and reinforce
effective team behaviors. This helps team members understand
the performance expectations and cultivate desired team
behaviors within the team. Designated team leaders should:
•

Openly share information;

•

Role model and effectively cue team members to use
prescribed teamwork behaviors and skills;

•

Provide constructive and timely feedback;

•

Facilitate briefs, huddles, and debriefs; and

•

Mitigate conflict within the team.

Slide

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Leading Teams

(OPTIONAL) TEAM FORMATION VIDEO
SAY:
Now that we’ve discussed how to effectively lead teams to
produce positive teamwork outcomes, let’s watch the entire case
of Mrs. Smith under the care of a team that uses effective and
timely leadership strategies, including:
•

Briefs;

•

Huddles;

•

Briefing checklists;

VIDEO TIME:

•

Conflict resolution; and

8:43 minutes

•

Debriefs.

Slide

MATERIALS:
• TeamSTEPPS
Success LTC
Video (LTC_
Success_
Complete_
Vignette.mpg)

DO:
Play the video by clicking the director icon on the slide.

DISCUSSION: Go to next page >

Continued…

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(OPTIONAL) TEAM FORMATION VIDEO
(Continued)
DISCUSSION:

Leading Teams
Slide

• What leadership tools and strategies did Gayle Patel, the nurse
manager, use?
– Briefed team about concerns and current status of residents
– Verbalized the current plan of care
– Conducted a huddle with the nursing assistant due to the
emergent need to address Mrs. Smith’s concerning status
– Conducted debrief to recap events and share lessons
learned
• What leadership tools and strategies did other team members
use?
– Liz James, the nurse supervisor, role modeled the use of
teamwork skills such as SBAR and handoff. She also
indicated that she would speak to Carmen about her
interaction with the recreation therapist.
– Jennifer Anderson, the recreation therapist, used the TwoChallenge Rule and the DESC Script to facilitate conflict
resolution.

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Leading Teams

TOOLS AND STRATEGIES SUMMARY
SAY:

Slide

Team leaders must ensure that information is being shared, all
team members have the resources they need to do their job, the
situation within the work environment is continually monitored, and
appropriate behaviors are modeled and reinforced across the
team.
Tools for leaders to use with their team include the Brief, Huddle,
and Debrief. Use of these tools leads to gaining a shared model
or understanding of a situation or event (i.e., shared mental
model), adaptability, and mutual trust.

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EXERCISE: APPLYING TEAMSTEPPS

Leading Teams

Instructor Note: This slide is intended for the Master
Training course only. The previous slide should be the last one
shown to staff participants at your nursing home.
SAY:
Return to your TeamSTEPPS Implementation Worksheet.
Answer the questions related to Leading Teams as you think
about your identified teamwork issue.
Think about:
• Who is the designated leader on the team your TeamSTEPPS
implementation will target?
• Is your teamwork issue related to this team’s leadership?

Slide

MATERIALS:
• TeamSTEPPS
Implementation
Worksheet

• If so, what is the issue and can any of the tools or strategies
learned in this module be used to address the issue?

DO:
Ask a few individuals to report on any identified leadership issue
and which TeamSTEPPS tools or strategies they might consider
implementing to address the issue.

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