NURS 732 Week 3 Reflective Exercise on Leadership and Teambuilding in CQI Example

Reflective Exercise: Talking Less in My Own Meetings, Leading and Building an Interprofessional Improvement Team Through Its Storming Stage

Introduction

Six weeks after our clinic's hypertension improvement team first met, I read the notes from our early meetings and counted who had spoken. I had made more than half of all the comments. Our two medical assistants, who room every patient and take every blood pressure, had spoken a total of four times across three meetings. I had thought of myself as a collaborative leader. The notes suggested otherwise. This paper reflects on leading that team through its first six months, using the reflective cycle Gibbs (1988) described to move from description to an action plan, and drawing on theories of team development, psychological safety and interprofessional competence to understand what happened.

Description

Our federally qualified health center formed the team to improve blood pressure control, which had been stuck at 58% of adults with hypertension for three years. The medical director asked me, as a family nurse practitioner completing a DNP, to lead it. Its members were a pair of medical assistants, a pair of registered nurses, our pharmacist, the community health worker, two of our physicians, a second nurse practitioner and, starting in month four, a patient advisor. We met every two weeks for an hour in the conference room after clinic.

The first meetings went smoothly on the surface. I presented the data, explained the evidence on team-based care and proposed a plan: standardize blood pressure measurement, start a cuff-lending program and add pharmacist visits for patients above 160/100. People agreed. Little happened between meetings. In the fourth meeting, a physician said that medical assistants were rushing blood pressure measurements, and a medical assistant replied, with an edge in her voice, that the physicians' schedules gave them seven minutes to room each patient. The room went silent, and I moved to the next agenda item.

Feelings

At the time, I felt embarrassed and anxious. I disliked conflict, and I worried that the team would fall apart. I also felt a quiet resentment that the plan I had prepared so carefully was not being carried out. Looking back, I recognize that I treated the team's agreement in early meetings as commitment, when it was mostly politeness. I also felt protective of the medical assistant and frustrated with the physician, but I said nothing, which left both of them unsupported.

Evaluation

Some things went well. The team had the right members, a clear aim and good data, and the members respected one another outside meetings. The cuff-lending idea, once the patient advisor reshaped it, became the team's most successful change. But much went badly. My plan was mine, not the team's, so no one felt responsible for it. The medical assistants, who knew most about measurement, were silent until frustration forced them to speak. And when conflict finally surfaced, I avoided it, which taught the team that hard truths would not be discussed.

Analysis

Stages of Team Development

Tuckman (1965) described small groups as moving through stages of forming, in which members orient to the task and test what behavior is acceptable; storming, in which conflict and resistance emerge; norming, in which cohesion and shared norms develop; and performing, in which the group's energy goes into the task. Our first three meetings were classic forming: polite, dependent on the leader and short on real engagement. The exchange between the physician and the medical assistant was the beginning of storming. My mistake was treating storming as a failure to be smoothed over rather than a necessary stage to be worked through. By moving to the next agenda item, I kept the team in limbo, neither forming nor norming.

Psychological Safety

Edmondson (1999) defined psychological safety as a belief, held in common by a team, that taking an interpersonal risk in front of colleagues will not bring humiliation or penalty, and her study of manufacturing teams linked it to behaviors through which teams learn, such as raising problems, asking colleagues for help and talking openly about mistakes, which in turn went with better performance. Our medical assistants' silence suggests they did not feel safe raising problems in front of physicians and nurse practitioners. The conflict over rooming time was not only a disagreement about minutes; it was a test of whether a medical assistant could challenge a physician in our meetings. My silence answered that test badly. In the two weeks that followed, the medical assistant who had spoken did not raise anything else, and her colleague told me privately that they had decided it was safer to keep problems to themselves. Edmondson's work suggests that this kind of retreat is exactly how teams stop learning, and that leaders shape the climate through how they respond to the first person who takes a risk.

Interprofessional Competencies and Improvement

Of the four competency areas the Interprofessional Education Collaborative (2023) sets out, the two concerned with understanding one another's roles and with communicating across professions were where our team was weakest. No one had defined who owned blood pressure follow-up, and the hierarchy in the conference room meant that the people closest to the process spoke least. Sollecito and Johnson (2013) emphasize that continuous quality improvement relies on the knowledge of those who do the work and on leaders who build systems that draw out that knowledge. Evidence suggests this matters for outcomes: Halcomb et al. (2026), pooling a dozen systematic reviews, report that primary care teams managing hypertension generally lowered blood pressure, with stronger results where teams combined more components. A team whose members do not speak cannot use its components.

What Changed

After reading the meeting notes, I asked the team whether we could try something different. We replaced two biweekly meetings with a ten-minute daily huddle at the start of clinic, standing at the medical assistants' station, using a short checklist: yesterday's high blood pressure readings, who needs a follow-up call, any equipment problems and one improvement idea. The medical assistants led the huddle on alternate days. At first the huddles were awkward; on the third day, no one offered an improvement idea, and I had to resist filling the silence. On the fifth day, one of the medical assistants mentioned that the large adult cuffs were kept in a cabinet in the back hallway, so staff used the regular cuff on patients who needed the larger size rather than walk to get one. It was a problem none of the providers had known about, and the fix, a large cuff hung in every exam room, cost less than two hundred dollars. A comparative case study of evidence-based quality improvement in two Veterans Affairs medical centers found that structured daily huddles with a checklist and a protocol clarifying roles were perceived to improve team structure, communication, role clarity, staff voice and accountability (Ovsepyan et al., 2023). Our experience was similar. Within a month, the medical assistants were raising problems daily, and one of them proposed a rooming change, a five-minute seated rest before the reading, which the physicians accepted after seeing the data. The huddle did not make the medical assistants more knowledgeable; it made their knowledge audible.

Conclusion of the Reflection

Leading the team again, I would change three habits. First, I would bring the problem and the data to the first meeting, not a plan, and let the team design the changes. Second, I would expect and welcome storming, and when conflict surfaced, I would name it and ask both sides to describe the problem from their position. Third, I would choose meeting structures that place frontline staff at the center, such as huddles at their station, rather than meetings in a conference room where hierarchy is built into the seating.

Action Plan

Christian Worldview

Jesus washed his disciples' feet and told them that he had given them an example, that they also should do as he had done (English Standard Version Bible, 2001/2016, John 13:14-15). The act reversed the expected order of honor. In an improvement team, servant leadership means arranging the work so that those with the least formal authority are heard first, and accepting that the leader's plan may be set aside for a better one from someone else. It also means having the courage to address conflict honestly, since peace that avoids truth is not the peace Scripture commends.

Conclusion

Reflecting on six months of leading an improvement team showed me that my early leadership produced agreement without commitment and silence instead of learning. Tuckman's stages explained why the team stalled, Edmondson's psychological safety explained why the medical assistants were quiet, and the IPEC competencies identified the gaps in roles and communication. A simple structural change, a daily huddle led in rotation, gave the team a voice, and the action plan commits me to leading future teams by speaking less and listening first.

References

Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350-383. https://doi.org/10.2307/2666999

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Further Education Unit, Oxford Polytechnic.

Halcomb, E., Kuzmins, K., de Tourettes, E., & Stephen, C. (2026). Team-based hypertension management in primary care: A synthesis of systematic reviews. Heart, Lung and Circulation. Advance online publication. https://doi.org/10.1016/j.hlc.2026.05.020

Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. Interprofessional Education Collaborative.

Ovsepyan, H., Chuang, E., Brunner, J., Hamilton, A. B., Needleman, J., Heilemann, M., Canelo, I., & Yano, E. M. (2023). Improving primary care team functioning through evidence based quality improvement: A comparative case study. Healthcare, 11(2), Article 100691. https://doi.org/10.1016/j.hjdsi.2023.100691

Sollecito, W. A., & Johnson, J. K. (Eds.). (2013). McLaughlin and Kaluzny's continuous quality improvement in health care (4th ed.). Jones & Bartlett Learning.

Tuckman, B. W. (1965). Developmental sequence in small groups. Psychological Bulletin, 63(6), 384-399. https://doi.org/10.1037/h0022100