Executive Briefing

1

• Executive Briefing

2
What is TeamSTEPPSTM?

• An evidence-based teamwork system
• Designed to improve
• Quality
• Safety
• Efficiency of health care
• Practical and adaptable
• Provides ready-to-use materials for training and
  ongoing teamwork

3
Why Use TeamSTEPPS?

• Goal Produce highly effective medical teams that
  optimize the use of information, people and
  resources to achieve the best clinical outcomes
• Teams of individuals who communicate effectively
  and back each other up dramatically reduce the
  consequences of human error
• Team skills are not innate they must be trained

4
Why Invest in TeamSTEPPS?

• Cost of TeamSTEPPS is minimal compared to savings
• Annual cost is approximately 98,000 lives and
  17-29 billion
• Errors can be reduced by changes to the health
  care system specifically by providing
  interdisciplinary team training
• Reference Kohn LT, Corrigan, JM,
  Donaldson, MS. Eds. To err is human Building a
  safer health system. Washington, DC Committee on
  Quality of Health Care in American, Institute of
  Medicine, National Academy Press, 2000.

5
What Can TeamSTEPPS Do for Us?
Clinical Units in a Medical Center2 After
implementation of SBAR to improve communication
among clinical caregivers Reduced rate of
adverse drug events (from 30 to 18 per 1,000
patient days). Improved medication
reconciliation at patient admission from 72 to
88 and at discharge from 53 to 89.

• Emergency Department1
• After implementation of multiple medical
• team training programs
• Improved observed team behaviors.
• Enhanced staff attitudes toward teamwork.
• Reduced observed clinical errors.

• Morey, JC, Simon, R, Jay GD, et al. Error
  reduction and performance improvement in the
  emergency department through formal teamwork
  training Evaluation results of the MedTeams
  project. Health Serv Res. 371553-1581, 2002
• Haig, K., Sutton S, Whittington, J. SBAR A
  shared mental model for improving communication
  between clinicians. JL Comm J Qual Patient Saf
  32(3)167-75, March 2006.

6
What Can TeamSTEPPS Do for Us?
Labor and Delivery Units1 After implementation of
multiple teamwork strategies and tools - A
50 reduction in the Weighted Adverse Outcome
Score (WAOS). The WAOS describes the adverse
event score per delivery. - A 50 decrease in
the Severity Index, which measures the average
severity of each delivery with an adverse event.

• Intensive Care Units (ICU)2
• After implementation of a Patient Daily Goals
  form to facilitate staff communication
• A 50 decrease in mean ICU length of stay from
  2.2 days to 1.1 days.

• Mann, S, Marcus, R, Sachs, B. Lessons from the
  cockpit How team training can reduce errors on
  LD (Grand Rounds) Contemporary OB/Gyn v51
  i134(8), January 2006.
• Pronovost, P, Berenholtz, S, Dorman, T, Lipsett,
  PA., Simmonds, T, Haraden, C. Improving
  communication in the ICU using daily goals. J Cri
  Care 18(2)71-5, Jun 2003.

7
What Can TeamSTEPPS Do for Us?

• Operating Rooms (OR)
• After implementation of a pre-op brief
• Increased OR communication.1,2
• Increased administration of properly timed
  prophylactic antibiotics prior to incision from
  84 to 95.1
• Increased pre-op deep vein thrombosis prophylaxis
  prior to induction from
• 92 to 100.1
• Error avoidance Pre-op brief revealed seven
  patients (3.3) with previously unidentified
  severe surgical risks surgery cancelled.1
• A 16 reduction in nursing turnover rate.2
• A 19 increase in OR employee satisfaction.2

• Awad, SS, Fagan, SP, Bellows, C., Albo, D, et al.
  Bridging the communication gap in the operating
  room with medical team training. Am J Surg
  190(5) 770-4, Nov 2005.
• Leonard, M,, Graham, S, Bonacum, D. The human
  factor The critical importance of effective
  teamwork and communication in providing safe
  care. Qual Saf Health Care 13 Suppl 1i85-90, Oct
  2004.

8
What Makes TeamSTEPPS Different?

• Evidence-based and field-tested
• Comprehensive
• Customizable
• Easy-to-use teamwork tools and strategies
• Publicly available

9
What Will Our Teams Learn?
10
How Does TeamSTEPPS Work?

• I. Assessment
• Clearly define the need
• II. Planning, Training, and Implementation
• Plan to sustain the effort
• Train individuals
• Implement and test the strategies
• III. Sustainment
• Integrate into daily practice
• Monitor and measure programs

11
What Do We Need to Make This Work?

• Clearly define the need
• Focus on enhancing teamwork and establishing a
  teamwork and safety culture
• Support from senior leadership
• Allocate sufficient resources
• Personnel
• Time
• Resources
• Measure success
• Reward and reinforce teamwork

12
What Does Training Cost?Key to Table Figures

• A Trainer preparation costs - Trainers time x
  trainers hourly rate
• B Travel costs related to any of the train the
  trainer sessions
• C Trainer costs to conduct training -
  Trainers time x trainer hourly rate
• D Trainee costs - Number of staff to be
  trained x (number of training hours) x staff
  hourly rate
• E Other training expenses - Food, senior
  leadership time for kickoff, etc.
• F Trainer costs for ongoing support - Number
  of areas participating X (hours of support) x
  trainer/coach hourly rate
• G Optional cost for staff time discussions -
  As normal course of business
• H Other ongoing support costs
• I, J, K Total - The estimated costs at
  bottom of each column

13
What Does Training Cost?
14
How Do We Start?

• Create a sense of urgency
• Pull together the guiding team
• Formulate a change vision and strategy
• Communicate your vision for understanding and
  buy-in
• Send trainers to one of the TeamSTEPPS National
  Implementation Project Training Resource Centers

15
Training for the Guiding Team

• Training is available until 9/1/09
• Training is available on a first come first
  served basis
• Contact the National Implementation Project for
  TeamSTEPPS and apply
• Complete the readiness assessment
• Submit the statement that indicates they have
  completed the readiness assessment and contact
  info by email tsteppstrainingapps_at_air.org
• For answers to qualification questions, call
• (877)-6STEPPS (678-3777)

16
Backup Slides

• The following slides (16 21) are slides that
  can support the briefing and may be integrated
  into slides 1 14 as appropriate.

17
National Teamwork Initiatives

• Accreditation Council for Graduate Medical
  Education (ACGME) and the Association for
  American Medical Colleges (AAMC) include aspects
  of communication, coordination, and collaboration
  in physician competencies
• National Quality Forum (NQF) included teamwork
  training, skill building and teamwork
  interventions in Safe Practices for Better Health
  Care A Consensus Report (2006 Update)
• The Joint Commission has increasingly included
  elements of teamwork in their National Patient
  Safety Goals and accreditation standards
• Centers for Medicare Medicaid Services (CMS)
  included TeamSTEPPS in the 9th Scope of Work

18
Importance of Communication

• Communication failure has been identified as the
  leading root cause of sentinel events over the
  past 10 years (Joint Commission)
• Communication failure is a primary contributing
  factor in almost 80 of more than 6000 root cause
  analyses of adverse events and close calls (VA
  Center for Patient Safety)

19
What Does it Cost?

• Costs can be modified by obtaining materials and
  having trainers teach themselves
• Based on the National Implementation of
  TeamSTEPPS Project, we estimate that a Change
  Team Member will spent 10 FTE (200 hrs) on this
  effort

20
Resources Available

• TeamSTEPPS resources include
• Three teamwork training curricula
• Course Management Guide
• Multimedia course materials
• TeamSTEPPS Implementation Guide
• Measurement tools
• Web site for updated resources and information
  http//teamstepps.ahrq.gov/