TeamSTEPPS

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• TeamSTEPPS

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(No Transcript)
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Objectives

• Describe what TeamSTEPPS can offer your MTF
• Identify critical success factors to implement
  and sustain TeamSTEPPS as an actionable
  organization improvement
• Adopt team-related tools and strategies that can
  be integrated into daily practice
• Identify your role to 'make it happen'

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What happens when Communication fails?
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What happens when Communication fails?
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Teamwork Targets Root Causes
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Teamwork Is All Around Us
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Evidence-Based

• Growing body of scientific literature indicates
  that medical teamwork can improve
• Quality of clinical processes
• Adherence to clinical guidelines/standards of
  care
• Patient safety and error-avoidance
• Patient outcomes in variety of clinical settings
  with diverse patient populations
• Cost-effectiveness of healthcare delivery

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Settings Populations
Settings
Patients

• Surgical Services
• Medical Inpatient Wards
• Intensive Care Units
• Labor and Delivery
• Emergency Department
• Ambulatory Care
• Nursing Homes
• Community-based

• Surgical
• Medical
• Critically ill
• Neonates
• Obstetric
• Acutely ill
• Chronically ill
• Frail geriatric
• Healthy geriatric

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Five Ways TeamSTEPPS Transforms Culture

• Establishes names for behaviors and a common
  language for talking about communication
  failures
• Bridges the professional divide and levels the
  hierarchy
• Provides actions to practice
• Increasing mindfulness
• Enlists the patient as a valued team member

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Teams that perform well

• Hold shared mental models
• Have clear roles and responsibilities
• Have a clear, valued, and shared vision
• Optimize resources
• Have strong team leadership

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Teams that perform well

• Engage in a cycle of feedback
• Develop a strong sense of collective--trust,
  teamness and confidence
• Create mechanisms to cooperate and coordinate
  (interaction)
• Manage and optimize performance outcomes

• Salas, funded by Army Research Institute 2004

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Team Work Video
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Discussion

• Did the team members communicate essential
  information?
• Did the team demonstrate mutual respect toward
  one another?
• Did the team address issues and concerns?
• What were the barriers to team performance?
• How could the team have partnered better?

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Outcomes of Team Performance

• Knowledge
• Shared Mental Model
• Attitudes
• Mutual Trust
• Team Orientation
• Performance
• Adaptability
• Accuracy
• Productivity
• Efficiency
• Safety

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TeamSTEPPS Key Principles

• Team Structure Whos on my team?
• Leadership Team coordination
• Situational Leaders
• Situation Monitoring Keep an eye on your
  teammates
• Mutual Support Offer and receive help when
  needed
• Communication Share information

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TeamSTEPPS Multi-Team Structure
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TeamSTEPPS Leadership

• Organize the team
• Articulate clear goals
• Make decisions collective input from the team
• Empower members to speak up
• Promoterole model good teamwork
• Encourage feedback re team performance
• Develop teams ability handle conflict

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TeamSTEPPS Team Events

• Planning
• Brief a short session prior to start to form
  team establish roles
• Problem solving
• Huddle Ad hoc team meeting to share info and
  adjust plans
• Process improvement
• Debrief After action review to provide feedback
  improve team performance

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Briefs

• Planning
• Form the team
• Designate team roles and responsibilities
• Establish climate and goals
• Engage team in short and long-term planning

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Briefs
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Briefing Checklist
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Huddle

• Problem solving
• Hold ad hoc, touch-base meetings to regain
  situation awareness
• Discuss critical issues and emerging events
• Anticipate outcomes and likely contingencies
• Assign resources
• Express concerns

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Debrief

• Process Improvement..
• Brief, informal information exchange and feedback
  sessions
• Occur after an event or shift
• Designed to improve teamwork skills
• Designed to improve outcomes
• An accurate reconstruction of key events
• Analysis of why the event occurred
• What should be done differently next time

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Debrief Checklist
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Debrief Video
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Debrief Video
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What are Effective Situation Monitoring Skills
and Tools?

• Situation Monitoring
• Cross Monitoring
• STEP
• IM SAFE Checklist
• Maintaining a Shared Mental Model

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Situation Monitoring

• Process of actively scanning behaviors and
  actions to assess elements of the situation or
  environment
• Fosters mutual respect and team accountability
• Provides safety net for team and patient
• Includes cross monitoring

Remember, engage the patient whenever possible.
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Cross Monitoring is

• Process of monitoring the actions of other team
  members for the purpose of sharing the workload
  and reducing or avoiding errors
• Mechanism to help maintain accurate situation
  awareness
• Way of watching each others back
• Ability of team members to monitor each others
  task execution and give feedback during task
  execution

Mutual performance monitoring has been shown to
be an important team competency. (McIntyre and
Salas 1995)
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A Shared Mental Model is

• The perception of, understanding of, or knowledge
  about a situation or process that is shared among
  team members through communication.

Teams that perform well hold shared mental
models. (Rouse, Cannon-Bowers, and Salas 1992)
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Shared Mental Model?
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How Shared Mental Models Help Teams

• Help ensure that teams know what to expect, so if
  necessary, can regroup to get on the same page
• Foster communication to ensure care is
  synchronized
• Ensure that everyone on the team has a picture of
  what it should look like
• Enable team members to predict and anticipate
  better
• Create commonality of effort and purpose

Shared mental models help teams avoid errors
that place patients at risk.
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Practical Exercise
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What are Mutual Support Skills Tools?

• Mutual Support
• Task Assistance
• Advocacy and Assertion
• Feedback
• Conflict Resolution
• Two-Challenge Rule
• CUS Words
• DESC Script
• Collaboration

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Task Assistance

• A form of mutual support
• Team members protect each other from work
  overload situations
• Effective teams place all offers and requests for
  assistance in the context of patient safety
• Team members foster a climate where it is
  expected that assistance will be actively sought
  and offered

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Advocacy and Assertion

• Advocate for the patient
• Invoked when team members viewpoints dont
  coincide with that of a decision maker
• Assert a corrective action in a firm and
  respectful manner

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Conflict Resolution Options

• Personal Conflict
• (Hostile and harassing behavior)
• DESC script

• Information Conflict
• (We have different information!)
• Two-Challenge rule

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Two-Challenge Rule

• Invoked when an initial assertion is ignored
• It is your responsibility to assertively voice
  your concern at least two times to ensure that it
  has been heard
• The member being challenged must acknowledge
• If the outcome is still not acceptable
• Take a stronger course of action
• Use supervisor or chain of command

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Conflict ResolutionDESC Script

• A constructive approach for managing and
  resolving conflict
• DDescribe the specific situation
• EExpress your concerns about the action
• SSuggest other alternatives
• CConsequences should be stated
• Ultimately, consensus shall be reached.

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Collaboration

• Achieves a mutually satisfying solution resulting
  in the best outcome
• All Win! Patient Care Team (team members, the
  team, and the patient)
• Includes commitment to a common mission
• Meet goals without compromising relationships
• True collaboration is a process, not an event.

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What are Effective Communication Skills and Tools?

• SBAR
• Situation
• Background
• Assessment
• Recommendation
• Call-Out
• Check-Back
• Handoff

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SBAR

• Structured Communication Tool for Briefing
• S Situation
• B Background
• A Assessment
• R Recommendation

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Check Back
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Check Back
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Handoff

• The transfer of information (along with authority
  and responsibility) during transitions in care
  across the continuum to include an opportunity
  to ask questions, clarify and confirm

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Good team video
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Good team video
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Carl R. Darnall Army Medical Center Experience

• Site Readiness Assessment and Executive Brief
• Why change? Sentinel Events/Communication
• Teams in high risk areas OB, OR, ED
• Training
• Train-the-trainer-instructor selection
• Integration and Implementation
• Focused Unit Training Tools
• Sustainment and Evaluation
• Impact on Clinical Outcomes
• Behavior/Attitude Change

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Training

• Unit leaders involved with planning/scheduling
• Sessions to accommodate shifts
• Multidisciplinary group sessions
• Physician, nurse, and other facilitators
• Interactive session with hands-on tools
• Feedback allowed for further development
• Focused training for action at unit levels
• Focused on tools/techniques to address units
  issues

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Focused Unit Training Tools

• SBAR-facility-wide communication tool
• Handoff- shift change, transfers
• Huddles, Briefs and Debriefs
• White Board Briefs
• Stop the line/Two Challenge Rule
• Publish, advertise, celebrate successes

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Integration and Implementation

• Integrate information into Joint Performance
  Improvement Council meetings
• Leadership role models
• Multi-disciplinary (internal) coaches
• Make up classes-include more staff
• Must partner with the patient and family

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Sustainment and Evaluation

• Immediate feedback of training session
• Executive sponsors synopsis of issues/goals
• Change of Knowledge
• Change in Attitude- Survey
• Change in Behavior- Observations
• Process or Practice Changes
• Impact on Clinical Outcomes

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Where are we now?

• Trained 23 Instructors in Mar 07
• Trained 98 (150 staff) in NICU, LD, MBU, Peds,
  WHC
• Trained 99 (200 staff) in OR, Anesthesia, PACU,
  SDS
• ED training next quarter
• Coach and mentor behaviors over time
• Gather and use data to modify, retrain or refresh
  behaviors

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ED TeamSTEPPS Naval Medical Center Portsmouth

• The ED is a High Risk, high volume, fast-paced
  environment where teamwork is essential
• Implementation of TeamSTEPPS will improve
  communication, teamwork and efficiency, and
  decrease risk
• TeamSTEPPS can provide a common language and
  procedures for acute care in the field where
  personnel from different units must come together
  and form teams very quickly

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NMCP ED Implementation

• Command and ED leadership are aware and very
  supportive
• Key personnel have been trained as trainers
  including select
• Nurse managers
• Physicians
• Corpsmen
• Clerks

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NMCP ED Implementation

• Pre-implementation data will be collected to
  measure the impact of the TeamSTEPPS
  implementation
• Training for all ED personnel will follow in the
  next few weeks
• TeamSTEPPS procedures will become the norm
• Post-implementation data will be collected for
  comparison
• Continuous feedback will allow us to further
  refine our procedures

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TeamSTEPPS Training Tools

• SBAR-facility-wide communication tool
• Briefs Handoffs - Shift Change, White Board
  Rounds Transfers
• Huddles as needed
• Debriefs End of shift or after significant
  events
• Call-outs Check Backs resuscitations All
  Verbal Orders
• Advocacy and Assertion
• Two Challenge Rule DESC Script
• Publish, advertise, celebrate successes

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TeamSTEPPS Training Goals

• Shared Mental Model
• Task Assistance
• Cross monitoring
• Situation Awareness
• Two way communication

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Why Teamwork?

• Reduce clinical errors
• Improve patient outcomes
• Improve process outcomes
• Enhance patient satisfaction
• Staff satisfaction and morale
• Reduce malpractice claims

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TeamSTEPPS

• Grounded in team performance research
• Applies teamwork principles and strategies that
  are teachable and learnable
• Field tested
• Comprehensive
• Customizable
• Evaluation Tools
• Ready-to-use
• Available to your organization

Recipient of 2007 Scott Myers Award for Applied
Research in the Workplace (SIOP)
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Resources Available

• Order materials at
• www.ahrq.gov/qual/teamstepps/
• To preview materials and check for updates
• www.dodpatientsafety.usuhs.mil/teamstepps