Transcript CLED41365 TS Unit Secretary

Strategies and Tools
for 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”
.
TeamSTEPPS
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Weathering a disaster is not a
matter of luck
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It’s a team process
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Sue Sheridan Video
Play Video
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Objectives
 Understand the role of communication in
patient safety
 Acknowledge that conflict creates significant
risk for patients
 Gain a basic understanding of TeamSTEPPS
tools and incorporate into patient care
 Support co-workers in utilizing TeamSTEPPS
tools to enhance patient safety
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INEFFECTIVE
COMMUNICATION
Impact?
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Joint Commission Sentinel Events
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How Health Care Systems have
measured success with TeamSTEPPS:
– Length of Stay
– Reduction in sentinel events
– Quality Patient Indicators- Culture of safety
– Staff retention
– Event reporting (STARS)
– Staff satisfaction
– Patient satisfaction
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Length of ICU Stay After
Team
Training
Length
of ICU Stay
After Team Training
Avg. Length of Stay (days)
2.4
2.2
2
1.8
1.6
1.4
1.2
1
June
July
August
Sept
Oct
Nov
Dec
Jan
Feb
March
April
May
(Pronovost, 2003)
Johns Hopkins
Journal of Critical Care Medicine
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OR Teamwork Climate and
Postoperative Sepsis Rates
OR Teamwork Climate and Postoperative Sepsis Rates
(per 1000 discharges)
(per 1000 discharges)
18
16
14
12
Group Mean
AHRQ National Average
10
8
Low Teamwork
Climate
6
Mid Teamwork
Climate
4
High Teamwork
Climate
2
0
Teamwork Climate Based on Safety Attitudes Questionnaire
Low

High
(Sexton, 2006)
Johns Hopkins
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Adverse Outcomes
(Mann, 2006)
Beth Israel Deaconess Medical Center
Contemporary OB/GYN
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If you had the tools to cure a
critical illness, wouldn’t you
use them?
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What Defines a Team?
Two or more people who
interact dynamically,
interdependently, and
adaptively toward a
common and valued
goal, have specific roles
or functions, and have a
time-limited membership
“Individual commitment to a group effort—that is what
makes a team work, a company work, a society work, a
civilization work.”
–Vince Lombardi
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Team Structure
The ratio of We’s to I’s is the best
indicator of the development of a
team.
–Lewis B. Ergen
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High-Performing Teams
Teams that perform well:
– Have clear, valued, and shared vision
– Engage in a regular discipline of feedback
• Briefs, huddles, debriefs
– Manage and optimize performance outcomes
• Hold each other accountable
• Give feedback and share information
(Salas et al. 2004)
“The trick is understanding that only a special type of
teamwork and camaraderie can catch in time the types
of medical errors a hospital will always generate.”
(Nance, 2009)
“Why Hospitals Should Fly”
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Barriers to Team Performance
• Lack of information
sharing
• Hierarchy
• Defensiveness
• Conflict
• Distractions
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•
•
•
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Fatigue
Workload
Lack of role clarity
Lack of coordination
and follow-up
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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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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Eight Steps of Change
•
•
•
•
•
•
•
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Create sense of urgency
Build the guiding team
Develop a change vision and strategy
Understanding and buy-in
Empower others
Short term wins
Don’t let up – Be relentless
Create a new culture
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Leadership
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Team Leader
Two types of leaders:
– Designated – The person assigned to lead
and organize a designated core team,
establish clear goals, and facilitate open
communication and teamwork among team
members
– Situational – Any team member who has
the skills to manage the situation-at-hand
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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
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Promoting & Modeling Teamwork
Effective leaders cultivate desired
team behaviors and skills through:
– Open sharing of information
– Role modeling and effectively cueing team
members to employ prescribed teamwork
behaviors and skills
– Constructive and timely feedback
– Facilitation of briefs, huddles, debriefs, and
conflict resolution
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Communication
Assumptions
Fatigue
Distractions
HIPAA
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Communication and Conflict
Resolution Techniques
• Communication is a skill
• Communication starts with active
listening
• Conflict resolution is a higher level skill
built on effective communication and
active listening plus….
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Communication 101
DEPERSONALIZE: The more
inappropriate communication is, the less
you have to own it!!!!”
“No one can make me feel inferior without
my consent” Eleanor Roosevelt
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Communication 101
• Being able to depersonalize
inappropriate communication and/or
behavior allows us to effectively begin
the process of conflict resolution
• When we do not feel diminished or
upset we can focus on the goal
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Communication 101
Two goals of any conversation
including conflict resolution:
• Good working relationships with coworkers
• Safe and optimal patient care
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Conflict resolution 101
• Make positive assumptions
• Keep goal of communication in mind
• If you meet with resistance…”I don’t know
what you’re talking about”, “whatever”..,”
you’re crazy”, don’t respond to the words,
respond to the feelings and keep focused on
goal, “You’re getting upset, that’s not my
intent”.
• Repeat goal of conversation
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Communication Breakdown
Reasons for communication breakdown
between nurse and physician
• Disagreement over discharge orders
• Disagreement over treatment plan
• Misunderstanding the other’s rationale for
action or for delay in meds or treatments
Focus on:
• Patient safety, danger or harm to patient
• Ethical considerations
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Delegation
• Process includes 4
steps:
– Decide what to
delegate
– Decide to whom to
delegate
– Communicate
clear expectations
– Request feedback
Why is it such a problem?
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Standards of
Effective Communication
• Complete
– Communicate all relevant information
• Clear
– Convey information that is plainly understood
• Brief
– Communicate the information in a concise manner
• Timely
– Offer and request information in an appropriate timeframe
– Verify authenticity
– Validate or acknowledge information
• Respectful
– Critical aspect of effective delegation
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TeamSTEPPS Tools for Effective
Communication
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Tools for Conflict Resolution
DESC
CUS
I am Concerned!
I am Uncomfortable!
D escribe the situation
E xpress concerns
S uggest alternatives
C onsequences of actions
This is a Safety issue!
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SBAR provides…
• A framework for team members to effectively
communicate information to one another
• Communicate the following information:
– Situation - What is going on with the patient?
– Background - What is the clinical background or
context?
– Assessment - What do I think the problem is?
– Recommendation - What would I recommend?
Remember to introduce yourself . . .
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SBAR Video
Play Video
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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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Handoff
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Optimized Information
Responsibility– Accountability
ELIMINATE Uncertainty
Verbal Structure
Checklists
Acknowledgement of Understanding,
Feedback
Great opportunity for
quality and safety
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Additional TeamSTEPPS Team
Communication Tools
• Briefs – planning
• Huddles – problem solving
• Debriefs – process improvement
Leaders are responsible to assemble the team
and facilitate team events
But remember…
Anyone can request a brief, huddle, or debrief
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Briefs
Planning
– Form the team
– Clarify team roles
and responsibilities
– Establish goals
(shift, patient,unit)
– Engage team in short
and long-term
planning
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Briefing Checklist
TOPIC
Who is on team?
All members understand
and agree upon goals?
Roles and responsibilities
understood?
Plan of care?
Staff availability?
Workload?
Available resources?
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Brief Video
Play Video
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Huddle
Problem solving
– Hold ad hoc, “touchbase”
meetings to regain
situation awareness
– Discuss critical issues
and emerging events
– Anticipate outcomes
and likely
contingencies
– Assign resources
– Express concerns
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Huddle Video
Play Video
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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
TOPIC
Communication clear?
Roles and responsibilities
understood?
Situation awareness
maintained?
Workload distribution?
Did we ask for or offer
assistance?
Were errors made or
avoided?
What went well, what
should change, what
can improve?
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Debrief Video
Play Video
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The primary role of all Healthcare
providers is patient advocacy
• Effective communication and
conflict resolution are essential
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ER Video
Carter preps for surgery
Play Video
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“When each member
accepts full responsibility and
strives for excellence…trust
and performance increase
exponentially…the team is
ready to take off.”
- Scott ‘Yogi’ Beare
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Kaleida Health Patient Safety
Initiative 2010
• Educate staff on TeamSTEPPS tools*
– Brief
– Debrief
– Huddle
– Handoff
– Situation monitoring
*Orientation, Preceptor Workshop, PICU at
WCHOB
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Using TeamSTEPPS tools
will impact patient safety
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This is
urgent…
This is
personal.
Play Video
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