Transcript Customer for Life

PERFORMANCE
Leadership
Situation
Monitoring
Communication
Mutual Support
SKILLS
KNOWLEDGE
ATTITUDES
TeamSTEPPS Overview and Essentials
Sue Sheridan Video
• Spokesperson, World Health Organization’s
World Health Alliance for Patient Safety
Teamwork is all around us…
After Team Training
• 50% reduction in adverse outcomes, based on averaged
scores after they were weighted for severity (Mann, 2006)
• After implementation of a interdisciplinary communication
tools to improve rounds, the average length of ICU stays
were reduced by 50% (Pronovost, 2003)
• Teamwork and communication skills, more than previous
surgical experience, determine how quickly medical
personnel develop expertise in new technology (e.g.,
robotics for minimally invasive cardiac surgery) (Pisano
2001)
Evolution of TeamSTEPPS
• Department of Defense
• Agency for Healthcare
and Quality
• Research
Organizations
• Universities
• Medical and Business
Schools
• Hospitals – Military
and Civilian, Teaching
and Community-Based
• Healthcare
Foundations
• Private Companies
• Subject Matter Experts
in Teamwork, Human
Factors, an Crew
Resource Management
(CRM)
TeamSTEPPS
Team Strategies & Tools to Enhance
Performance & Patient Safety
“Initiative based on evidence derived from team
performance … leveraging more than 25 years of
research in military, aviation, nuclear power, business
and industry…to acquire team competencies”
Patient Safety Movement
JCAHO
National
Patient
Safety
Goals
“To Err is
Human”
IOM
Report
1995
1999
2001
2003
TeamSTEPPS
2004
2005
2006
Medical Team Training
DoD
MedTeams
® ED
Study
Executive
Memo
from
President
Institute for
Healthcare
Improvement
100k lives
Campaign
Patient Safety
and Quality
Improvement
Act of 2005
TeamSTEPPS at Newport Hospital
• The Department of Defense (DoD) and the
Agency for Healthcare Research and Quality
(AHRQ) developed TeamSTEPPS, a teamwork
system which offers a powerful solution to
improving collaboration and communication
within Healthcare
• Newport Hospital implemented TeamSTEPPS in
2007 to support its Culture of Safety
Implementation Plan
• Hospital-wide training
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Overview sessions in September of 2007
Management overview in January of 2008
Champion development in April / May 2008
Ongoing specific skill focus on the 3rd Thursday of
every month
• Hospital-wide phrase for clarity
– “I need clarity”
• Action Planning coordinated by Directors/VPs
– Specific tools and techniques for departments
Your Opportunity
• If I had a “Magic Wand” and could make
changes within my unit or department in the
areas of patient quality and safety…
Why Do Errors Occur – Some Obstacles
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Workload fluctuations
Interruptions
Fatigue
Multi-tasking
Failure to follow up
Poor handoffs
Ineffective communication
Not following protocol
Excessive professional
courtesy
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Halo effect
Passenger syndrome
Hidden agenda
Complacency
High-risk phase
Strength of an idea
Task (target) fixation
Institute of Medicine Report
• Impact of Error
– 44,000 – 98,000 annual deaths occur as a result
of errors
– Medical errors are the leading cause, followed
by surgical mistakes and complications
– More Americans die from medical errors than
from breast cancer, AIDS, or car accidents
– 7% of hospital patients experience a serious
medication error
Cost associated with medical errors is $8
- $29 billion annually.
Team Competency Outcomes
Knowledge
•Shared Mental Model
Attitudes
•Mutual Trust
PERFORMANCE
•Team Orientation
Performance
Leadership
•Adaptability
•Accuracy
•Productivity
Situation
Communication
Monitoring
•Efficiency
•Safety
TeamSTEPPS is an
evidence-based
framework to optimize
performance across
the healthcare delivery
system
Mutual
Support
SKILLS
KNOWLEDGE
ATTITUDES
Key Principles
Team Structure
Delineates fundamentals such as team size, membership, leadership,
composition, identification and distribution
Leadership
Ability to coordinate the activities of team members by ensuring
team actions are understood, changes in information are shared, and
that team members have the necessary resources
Situation Monitoring
Process of actively scanning and assessing situation elements to gain
information, understanding, or maintain awareness to support
functioning of the team
Mutual Support
The ability to anticipate and support other team members' needs
through accurate knowledge about their responsibilities and
workload
Communication
Process by which information is clearly and accurately exchanged
among team members
Multi-Team System For Patient Care
PATIENT
CORE
TEAM
COORDINATING
TEAM
ANCILLARY
SERVICES
ADMINISTRATION
Team Structure
CONTINGENCY
TEAMS
Effective Team Leaders
• Organize the team
• Articulate clear goals
• Make decisions through collective input of
members
• Empower members to speak up and challenge,
when appropriate
• Actively promote and facilitate good teamwork
• Skillful at conflict resolution
Team Events
• Planning
– Brief
• Problem Solving
– Huddle
• Process Improvement
– Debrief
Situation Monitoring
Situation
Awareness
(Individual
Outcome)
Situation monitoring is
the process of
continually scanning
and assessing what’s
going on around you
to maintain situation
awareness.
Situation awareness
is “knowing what is
going on around you.”
Situation
Monitoring
(Individual
Skill)
Shared Mental
Model
(Team
Outcome)
With a shared mental
model, all team
members are “on the
same page.”
Cross Monitoring
• An error reduction strategy that
involves:
– Monitoring actions of other team
members
– Providing a safety net within the
team
– Ensuring mistakes or oversights are
caught quickly and easily
– “Watching each other’s back”
STEP
• A tool for monitoring situations in the
delivery of health care
TATUS OF THE PATIENT
EAM MEMBERS
NVIRONMENT
ROGRESS TOWARD GOAL
I’m SAFE Checklist
I = Illness
M = Medication
S = Stress
A = Alcohol and Drugs
F = Fatigue
E = Eating and Elimination
Task Assistance
• 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
Feedback
• Information provided for the purpose of
improving team performance
Timely – given soon after the target behavior has
occurred
Respectful – focus on behaviors, not personal attributes
Specific – be specific about what behaviors need
correcting
Directed towards improvement – provide directions for
future improvement
Considerate – consider team member’s feelings and
deliver negative information with fairness and respect
Advocacy and Assertion
• Advocate for the patient
– Invoked when team members’ viewpoints don’t
coincide with that of the decision maker
– Assert a corrective action in a firm and
respectful manner
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Make an opening
State the concern
Offer a solution
Obtain an agreement
Two-Challenge Rule
• When an initial assertion is
ignored:
– It is your responsibility to assertively
voice concern at last two times to
ensure it has been heard
– The team member being challenged
must acknowledge
– If the outcome is still not acceptable
• Take a stronger course of action
• Utilize a supervisor or chain of command
Empowers all
team members
to “stop the line”
if they sense or
discover an
essential safety
breach!
CUS
I am
ONCERNED!
I am
NCOMFORTABLE!
This is a
AFETY ISSUE!
DESC Script
• A constructive approach for managing and
resolving conflict
– D – Describe the situation or behavior, provide concrete
data
– E – Express how the situation makes you feel/what
your concerns are
– S – Suggest other alternatives and seek agreement
– C – Consequences should be stated in terms of impact
on established team goals; strive for consensus
SBAR
• A technique for communicating critical
information
– Situation – What is going on?
– Background – What is the background or
context?
– Assessment – What do I think the problem is?
– Recommendation – What would I do to correct
it?
Call Out
• Strategy used to communicate important or
critical information
– Informs all team members simultaneously
during emergent situations
– Helps team members anticipate next steps
– Important to direct responsibility to a specific
individual responsible for carrying out the task
Check Back
• Process of employing closed-loop
communication to ensure that information
conveyed by the sender is understood by the
receiver as intended
– Sender initiates the message
– Receiver accepts the message and provides
feedback
– Sender double-checks to ensure that the
message was received
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
– Shift changes
– Physicians transferring complete responsibility
– Patient transfers
TeamSTEPPS Overview
and Essentials
PERFORMANCE
Leadership
Situation
Monitoring
Communication
Mutual Support
SKILLS
KNOWLEDGE
ATTITUDES