Improvement work thrives with a team. People involved in parts of the process or system that you are trying to improve will bring diverse perspectives and expertise to fuel more effective ideas for change that are more likely to be sustained while building will to make improvements.

Improvement teams vary in size and composition. Each organization forms teams to suit its own needs and the needs of the specific improvement effort.

First, review the purpose of the improvement initiative (you may or may not have a specific aim, yet, when you pull the team together).

Second, consider the system that relates to that purpose: What are the boundaries of the system that will be affected by the improvement efforts?

Third, ensure that the team includes members who are familiar with all the different parts of the process — leaders, managers, and administrators as well as those who work in the process, including physicians, pharmacists, nurses, point-of-care staff, and other subject matter experts.

Consider which “customers” or individuals with lived and living experience are most likely to benefit from the improvement and engage them as members of the team. 

When forming an improvement team, it is vital to apply an equity lens. Some questions to ask with an equity lens include the following:

• Who is invited to contribute input to the improvement effort to identify the desired outcome, measures, and change ideas?
• Whose expertise is valued? The people who are most affected by the improvement opportunity need to be represented in the team that is designing the work and ideally throughout the lifespan of the improvement effort.
• Are people who are engaged in different parts of the process represented? Who is missing?

Finally, each team needs an executive sponsor who takes responsibility for aligning the project to the organizational strategy, relieving bottlenecks, allocating resources, and supporting the improvement opportunity.

Team Roles

Effective teams include members representing different knowledge and experience of the system: system leadership, technical/subject matter expertise, day-to-day leader or process owner, and user/customer experience. 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 areas should be represented on the team to successfully drive improvement.

Experience in the Process/System

Include team members who have knowledge of the process or system that is being improved and who represent a range of perspectives (e.g., patients, providers). Think about the end user and co-design with those individuals instead of for them. The team also needs someone with enough authority in the organization to test and implement a change and who understands both the clinical implications of proposed changes and the consequences such a change might have in other parts of the system.

Day‐to‐Day Leader or Process Owner

The process owner is usually the day-to-day improvement team leader. 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. After the improvement project ends, the process owner continues to be involved in implementing and maintaining the improvement.

Experience with Improvement Methods

At least one team member should have experience with improvement methods, such as through participating in past quality improvement (QI) initiatives or through formal QI training. A team member with improvement methods expertise 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.

Technical/Clinical/Subject Matter Expertise

Subject matter experts have expertise in areas relevant to the improvement project. They may not be able to attend all team meetings (in health care, this is especially true for busy clinicians), but should be consulted and engaged to the extent they are willing and able.

Project Sponsor (System Leader)

In addition to the working members listed above, a successful improvement team needs a sponsor, someone with executive authority who can provide liaison with other areas of the organization, serve as a link to senior management and the strategic aims of the organization, provide resources and overcome barriers on behalf of the team, and provide accountability for the team members. The sponsor is not a day-to-day participant in team meetings and testing, but needs to review the team's progress on a regular basis.

Example Team: Improving Care in Office Practices

Aim: We will improve care for all patients with chronic illness by making improvements in our clinic such that measures of patient experience (specifically percent reporting they are listened to and treated with respect) for patients who self-define as Black, Indigenous, or people of color increases from 25% to 75% within 18 months.

Team:

• Technical Expert: ____, MD, Physician at downtown primary care clinic
• Day-to-Day Leader: ____, RN, Manager of downtown primary care clinic
• Team Members:
  • Patient educator
  • Medical assistant
  • Clerk/scheduler  
  • Quality expert
  • Two to five patients who self-define as Black, Indigenous, or people of color and their family members
• Sponsor: ______, MD, Medical Director for primary care practices