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The Healthcare Team Fitness Test

A healthcare organization that supports effective teamwork can improve the quality of patient care and patient safety, create a better staff experience, and reduce workload issues that cause burnout and turnover among healthcare professionals.

The Healthcare Team Fitness Test (HTFT) helps to improve team performance and the quality of patient care by measuring the 7 critical characteristics of high performing healthcare teams, and by providing teams and leaders with a process for identifying their teams' growth opportunities, for recognizing their strengths, and for taking action to improve performance.

Cohesiveness Healthy Climate Open Communication Change Compatibility
Shared Leadership Team Members Contribution Shared Learning

The HTFT is based on close to 25 years of research in team performance in the private and public sectors. More recently, between 2004 and 2008 we conducted two research projects for the purpose of gaining a greater understanding of what constitutes a patient safety culture, high performance healthcare teams, and effective communication between healthcare workers. 18 Canadian healthcare facilities participated in the research. We conducted an extensive literature review along with16 inter-professional focus groups, 53 interviews with physicians, nurses, administrators and midwives, and 4 different surveys (329 surveys were returned).

Based on this research we developed two assessments for the Society of Obstetricians and Gynaecologists of Canada: The Culture Assessment Survey that measures the behaviours and practices essential to a patient safety culture (now being used in over 200 healthcare facilities in Canada and in the United States), and the Healthcare Communication Effectiveness Survey. The outcomes of both projects, along with the work we have conducted with teams and leaders for the past 25 years, supported our identification of the behaviours and practices most essential for a healthcare team to work to its fullest potential and led to the development of the Healthcare Team Fitness Test.

Why the HTFT is Key to Improving Team Performance

Like individuals, each team is unique. Each has its own fitness profile, depending upon the strengths and mix of critical team characteristics. Teams must regularly check their fitness level, recognize areas that need developing, and put themselves through the appropriate development to achieve the desired level of fitness.

In order for a team to become even better than it is, the goals to be achieved must be clearly understood. Team members usually have ideas as to what could be better in their team. Few, however, have specific knowledge of what is required for high performance teamwork. Therefore, even when a team is consciously trying to improve, critical aspects that may be blocking team performance are often overlooked. The HTFT ensures that leaders and team members understand what creates high performance teamwork and focuses the team's attention on the areas that will bring the greatest return. When the HTFT is used consistently across the healthcare facility as a model for team effectiveness the behaviours and practices most essential to effective teamwork and inter-professional collaboration will be more regularly demonstrated and over time will become ingrained in the culture.

The Seven Elements of High Performing Healthcare Teams

The HTFT measures each of the following seven critical elements of high performing healthcare teams:

  1. Cohesiveness

    Cohesiveness refers to the degree to which the team pulls together in the same direction. Cohesiveness requires agreement and commitment to what the team is in place to achieve (mandate, goals, and objectives), as well as how it will achieve them (values, priorities, and procedures).

    Sample of items that measure this element:

    • Our actions demonstrate that we are all working towards the same team goals and objectives.
    • Roles and responsibilities are clearly defined and accepted by all team members.
    • We overcome individual differences to pull together in the best interest of the patient.
  2. Healthy Climate

    Healthy Climate refers to how members feel about the way the team functions, including their level of comfort with team norms of behaviour. If the climate is not positive, honesty and openness are lacking and team members may not fully trust and respect one another.

    Sample of items that measure this element:

    • There is a feeling of openness and trust in our team.
    • Each member of our team is treated with equal respect.
    • I feel good about being a member of this team.
  3. Open Communication

    Poor communication within healthcare organizations is cited as a major contributing factor in patient safety incidents. The degree of open communication is reflected by a team's ability to communicate clearly, accurately, and respectfully, with the freedom to express opinions and to ask questions.

    Sample of items that measure this element:

    • We communicate with each other in a respectful manner at all times.
    • I am able to communicate my point of view without fear of reprisal.
    • I feel free to question the decisions of others regardless of their level of authority.
  4. Team Members' Contribution

    Team members' contribution measures the degree to which team members individually contribute to the team's by fulfilling their team responsibilities. Examples include keeping one another informed, sharing the load, and actively participating by looking for opportunities to improve the team's ability to provide quality patient care by sharing ideas and concerns.

    Sample of items that measure this element:

    • Team members look for opportunities to improve care practice/service delivery.
    • Team members focus on what is best for the team and the patient rather than themselves.
    • Team members recognize when others require assistance and proactively offer help whenever possible.
  5. Shared Learning

    Learning is at the heart of a culture focused on team performance and patient safety. This element measures the degree to which the team actively reflects on experiences, shares knowledge and provides feedback in a blame free, 'what can we learn from this' manner so that learning becomes part of the team's regular day-to-day practice.

    Sample of items that measure this element:

    • We take the initiative to share knowledge and experiences with one another, including sharing learning from mistakes.
    • We take time to reflect on, and discuss, how to improve our care practice/service delivery and team effectiveness.
    • We approach the discussion of errors in a blame free, "What can we learn from this?" manner.
  6. Shared Leadership

    Shared leadership requires that each team member is appropriately self directed, involved in the decision making process and is an equal member of the team in that their input is both valued and respected.

    Sample of items that measure this element:

    • I am empowered to make decisions within my own area(s) of expertise.
    • Input from team members is used whenever possible.
    • Team members take the initiative to solve issues on their own whenever possible rather than passing them on to our leader.
  7. Change Compatibility

    The team that thrives in healthcare today must be able to maintain high performance in an environment of accelerated and constant change. Change compatibility requires:

    • Receptivity to change.
    • Adaptability to change.
    • Effective evaluation of opportunities for change.

    Sample of items that measure this element:

    • Our team is open to new ideas.
    • We take a positive attitude toward change with which we may not agree but over which we have no control.
    • We are able to manage the volume of change without it impacting the quality of patient care.