Transcript Slide - community360.net

Teamwork Across Units
Armstrong Institute for Patient Safety and Quality
Presented by: Jill A. Marsteller
© The Johns Hopkins University and The Johns
Hopkins Health System Corporation, 2011
Motivation
• Feeling that “I’m done” when the patient leaves my
area (must turn to next patient)(out of sight, out of
mind)
• Lack of understanding across and between clinical
areas/units (what, how, why, who)
• In-group and out-group (Halo and Horns effects)
• Cross-unit communications may lack explicit tools,
vehicles for communication
• Leads to duplication; missed items; failure to
interact; low inter-unit respect/ collegiality
Motivation
• Interactions among units can be strained
• CUSP is challenging to implement, units can
support each other
• Some issues differ across units and others are
common
• Consolidating effort in QI/PS may lead to better
results (fragmented efforts less payoff)
Elizabeth Dayton et al., Joint Commission Journal, Jan. 2007
Figure 2: Stages of communication, common problems and
solutions
Problems:
Stage 1:
Decide
on
message
Groupthink,
tunnel
vision, low
input
Problems:
Stage 2:
Encode
Ambiguous
language
Solutions:
Solutions:
Psychological safety,
pause points,
diversity, situational
awareness
Structured
communication
tools such as SBAR
Problems:
Stage3:
Decode
Fatigue,
distraction,
noise, closed
culture
Problems:
Stage 4:
Negotiate
Failure to
speak up,
bullying,
judging
Problems:
Stage 5:
Escalate
Failure to
seek
mediation
Solutions:
Solutions:
Solutions: Set up
Read back
Assertive
communication, role
playing
clear chain of
command and
expectations for use
Aim For Cross-Unit Teamwork
• To facilitate and improve teamwork,
communication, and coordination of quality
improvement and patient safety activities
across the CUSP teams working in the three
clinical areas/units.
Goals
• Thinking about keeping patients safe during
entire episode of inpatient care
• Increased cross-unit interactions would
encourage shared goals and problem-solving
with respect to quality and safety issues/
initiatives across units within a hospital
• Improved understanding and interactions
across units within a hospital
Conceptual Supports
• Improvement of relationships due to:
–
–
–
–
Work on common topics
Increased exposure to problems/ successes of other units
Shared problem-solving
Creation of a super-ordinate identity
• Faster/ greater improvement in QI/PS issues due
to:
– Increased availability of information/ ideas
– Benefits of multiple perspectives
– Coordinated approach across units with common issues
Interventions
• Meetings of an All-unit CUSP team
• Sharing local safety assessment and LFD results
• Joint LFD investigations of common safety issues
• Joint designation/development of new QI initiatives
• Cross-unit Shadowing
Cross-unit Shadowing
• What happened during the shadowing exercise that
involved multiple practice domains?
• Were any health care providers difficult to approach? Did
one provider get approached more often for patient
issues?
• Did you observe any errors in transcription, interpretation,
delivery of orders/ other processes?
• Were patient problems identified quickly? Were they
handled as you would have handled them? Why/ why not?
What obstacles were faced?
• Any suggestions for the shadowed unit to consider?
The hard question
• What could my unit/area do to help care go
more smoothly in the shadowed unit?
Outcomes/Results
• We hypothesize that providers will note
increased frequency of communication and
better problem-solving interactions, higher
ratings of shared goals, knowledge, and
mutual respect across units at time 2
compared to time 1
• Shared QI programs/ strategies will be
observed at time 2 that were not present at
time 1