Transcript newbref

Introduction
TeamSTEPPS 101
Karen Frush, BSN, MD
Charles Murphy, MD
Margaret Sturdivant, RN, MSN
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2014 National TeamSTEPPS Conference:
TeamSTEPPS 101
Presenters:
Karen Frush, BSN, MD
Charles Murphy, MD
Margaret Sturdivant, RN, MSN
Duke University Health System,
Patient Safety Office
Team Strategies and Tools
to Enhance Performance
and Patient Safety
Introduction
Objectives
 Describe the TeamSTEPPS training initiative
 Describe the impact of errors and why they occur
 Describe the TeamSTEPPS framework
 Describe the key tools and strategies used
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Introduction
Sue Sheridan Video
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Introduction
Jesica Santillan
 17 yr old young woman
with complex congenital
heart disease
 Followed in our clinics with
progressive disease;
transplant candidate
 Worst nightmare:
“botched” heart- lung
transplant
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Introduction
Barriers to Team Performance
 Inconsistency in team
membership
 Lack of coordination
 Lack of time
and followup
 Lack of information sharing
 Distractions
 Hierarchy
 Fatigue
 Defensiveness
 Workload
 Conventional thinking
 Misinterpretation of
 Varying communication
cues
 Lack of role clarity
styles
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 Conflict
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Introduction
Team Strategies & Tools to Enhance Performance
& Patient Safety

Based on more than 30 years of research and evidence

Team training programs have been shown to improve attitudes,
increase knowledge, and improve behavioral skills

Salas, et al. (2008) meta-analysis provided evidence that team
training had a moderate, positive effect on team outcomes
(ρ = .38)
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Introduction
What Makes Up Team Performance?
Knowledge
Cognitions
“Think”
Attitudes
Affect
“Feel”
Skills
Behaviors
“Do”
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Introduction
Outcomes of Team Competencies
 Knowledge
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Shared Mental Model
 Attitudes
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Mutual Trust
Team Orientation
 Performance
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Adaptability
Accuracy
Productivity
Efficiency
Safety
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Introduction
Evidence That TeamSTEPPS
Works
 Capella, et al. (2010)
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 Thomas & Galla (2013)
Trauma resuscitation team
implementation
Pre- and post-TeamSTEPPS
training results:
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Team performance improved
across all teamwork skills:
Leadership, Situation
Monitoring, Mutual Support,
Communication
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Significantly decreased times
from arrival to CT scanner,
endotracheal intubation, and
operating room
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Systemwide implementation
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Pre- and post-TeamSTEPPS
training results:
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Significant improvement
in HSOPS scores on Feedback
and Communication About
Error, Frequency of Events
Reported, Hospital Handoffs and
Transitions, and Teamwork
Across Units
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Incremental changes evident
through reduction of
nosocomial infections, falls,
birth trauma, and other incidents
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Team Structure
NEXT:
The ratio of We’s to I’s is the
best indicator of the
development of a team.
–Lewis B. Ergen
Introduction
Team
Structure
‘Team of Experts’ ≠ ‘Expert Team’
‘Expert Team’
‘Team of Experts’
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Introduction
Team
Structure
High-Performing Teams
Teams that perform well:
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Hold shared mental models
Have clear roles and responsibilities
Have clear, valued, and shared vision
Optimize resources
Have strong team leadership
Engage in a regular discipline of feedback
Develop a strong sense of collective trust and confidence
Create mechanisms to cooperate and coordinate
Manage and optimize performance outcomes
(Salas et al. 2004)
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Introduction
Team
Structure
Partnering With the Patient
Strategies for involving patients in their care
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Include patients in bedside rounds
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Conduct handoffs at the patient’s bedside
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Provide patients with tools for communicating with
their care team
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Involve patients in key committees
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Actively enlist patient participation
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Introduction
Team
Structure
Clinical Team Responsibilities
Embrace patients and their families as valuable
and contributing partners in patient care
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Listen to patients and their families
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Assess patients’ preference regarding involvement
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Ask patients about their concerns
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Speak to them in lay terms
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Allow time for patients and families to ask questions
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Ask for their feedback
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Give them access to relevant information
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Encourage patients and their families to proactively
participate in patient care
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Introduction
Team
Structure
Patient and Family Responsibilities
 Provide accurate patient information
 Comply with the prescribed plan of care (e.g.,
schedule and attend appointments as directed)
 Ask questions and/or voice any concerns regarding
the plan of care
 Monitor and report changes in the patient’s condition
 Manage family members
 Follow instructions of the clinical team
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Communication
Assumptions
Fatigue
Distractions
HIPAA
Introduction
Communication
Communication
 Effective
communication
skills are vital for
patient safety
 Enables team
members to
effectively relay
information
 The mode by
which most
TeamSTEPPS
strategies and
tools are
executed
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Introduction
Communication
Importance of Communication
 Joint Commission data continues to demonstrate
the importance of communication in patient
safety
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1995 - 2005: Ineffective communication
identified as root cause for nearly 66 percent
of all reported sentinel events*
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2010 - 2013: Ineffective communication
among top 3 root causes of sentinel events
reported**
* (JC Root Causes and Percentages for Sentinel Events (All
Categories) January 1995−December 2005)
** (JC Sentinel Event Data (Root Causes by Event Type) 20042012)
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Introduction
Communication
Brief
Clear
Timely
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Introduction
Communication
Information Exchange Strategies
 Situation – Background – Assessment –
Recommendation (SBAR)
 Call-Out
 Check-Back
 Handoffs
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Introduction
Communication
SBAR Provides…
A framework for team members to effectively
communicate information to one another
Communicate the following information:
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Situation―What is going on with the patient?
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Background―What is the clinical background or
context?
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Assessment―What do I think the problem is?
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Recommendation―What would I recommend?
Remember to introduce yourself…
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Introduction
Communication
Call-Out is…
A strategy used to communicate
important or critical information
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It informs all team members
simultaneously during
emergency situations
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It helps team members
anticipate next steps
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Introduction
Communication
Check-Back is…
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Introduction
Communication
Handoff is…
 The transfer of information during transitions in care
across the continuum
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Includes an opportunity to ask questions, clarify, and
confirm
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Introduction
Communication
“I PASS THE BATON”
Introduction:
Introduce yourself and your role/job (include patient)
Patient:
Identifiers, age, sex, location
Assessment:
Present chief complaint, vital signs, symptoms, and
diagnosis
Situation:
Current status/circumstances, including code status,
level of uncertainty, recent changes, and response to treatment
Safety:
Critical lab values/reports, socioeconomic factors, allergies, and alerts
(falls, isolation, etc.)
THE
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Background:
Comorbidities, previous episodes, current medications, and family history
Actions:
What actions were taken or are required? Provide brief rationale
Timing:
Level of urgency and explicit timing and prioritization of actions
Ownership:
Who is responsible (nurse/doctor/team)?
Include patient/family responsibilities
Next:
What will happen next? Anticipated changes?
What is the plan? Are there contingency plans?
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Introduction
Communication
Other Example Handoff Tools
 ANTICipate
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Administrative Data; New clinical information; Tasks
to be performed; Illness severity; Contingency plans
for changes
 I PASS
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Illness severity; Patient Summary; Action list for the
new team; Situation awareness and contingency
plans; Synthesis and “read back” of the information
 SHARQ
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Situation; History; Assessment;
Recommendations/Result; Questions
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Leading Teams
“Effective team leaders create an environment
and tone for people to flourish.”
Karen Frush, MD
Duke University Health System
Introduction
Leading
Teams
Leadership
 Holds a teamwork
system together
 Ensures a plan is
conveyed,
reviewed, and
updated
 Facilitated through
communication,
continuous
monitoring of the
situation, and
fostering of an
environment of
mutual support
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Introduction
Leading
Teams
Types of Team Leaders
 Designated – The person assigned to lead
and organize a 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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Introduction
Leading
Teams
Effective Team Leaders
 Define, assign, share, monitor, and modify a plan
 Review the team’s performance
 Establish “rules of engagement”
 Manage and allocate resources effectively
 Provide feedback regarding assigned responsibilities
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and progress toward the goal
Facilitate information sharing
Encourage team members to assist one another
Facilitate conflict resolution
Model effective teamwork
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Introduction
Leading
Teams
Defining the Plan
 When developing a plan, team leaders should
consider:
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Time – How much time is available to complete all the
necessary tasks and activities?
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People – Do the available staff have the necessary
knowledge and skills to perform their roles?
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Equipment – Is the necessary equipment available and
working?
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Information – Has all of the necessary information been
collected and reviewed?
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Introduction
Leading
Teams
Sharing the Plan:
Briefs
 A team briefing is an
effective strategy for
sharing the plan
 Briefs should help:
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Form the team
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Designate team roles and
responsibilities
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Establish climate and
goals
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Engage team in shortand long-term planning
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Introduction
Leading
Teams
Monitoring & Modifying the Plan:
Huddle
Problem Solving
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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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Introduction
Leading
Teams
Reviewing the Team’s Performance:
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
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An accurate recounting of key events
Analysis of why the event occurred
Discussion of lessons learned and reinforcement of
successes
Revised plan to incorporate lessons learned
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Introduction
Leading
Teams
Promoting & Modeling Teamwork
Effective leaders cultivate desired team
behaviors and skills through:
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Open sharing of information
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Role modeling and effective cuing of team
members to use prescribed teamwork behaviors
and skills
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Constructive and timely feedback
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Facilitation of briefs, huddles, debriefs, and
conflict resolution
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Mitigation of conflict within the team
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Situation Monitoring
Introduction
Situation
Monitoring
Situation
Monitoring
 Ensures new or
changing
information is
identified for
communication
and decisionmaking
 Leads to
effective support
of fellow team
members
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Introduction
Situation
Monitoring
A Continuous Process
Situation
Monitoring
(Individual Skill)
Situation
Awareness
(Individual
Outcome)
Shared
Mental Model
(Team Outcome)
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Introduction
Situation
Monitoring
Situation Awareness is…
The state of knowing the current conditions affecting
one’s work.
Includes knowing…
 Status of the patient
 Status of other team
members
 Environmental
conditions
 Current progress
toward the goal
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Introduction
Situation
Monitoring
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
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Introduction
Situation
Monitoring
Shared Mental Model?
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Introduction
Situation
Monitoring
When and How to Share?
When:
How:
 Briefs
 SBAR
 Huddles
 Call-outs
 Debriefs
 Check-backs
 Transitions in Care
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Introduction
Situation
Monitoring
What Do You See?
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Introduction
Situation
Monitoring
How Shared Mental Models
Help Teams
 Lead to mutual understanding of situation
 Lead to more effective communication
 Enable back-up behaviors
 Help ensure understanding of each other’s roles
and how they interplay
 Enable better prediction and anticipation of team
needs
 Create commonality of effort and purpose
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Mutual Support
Introduction
Mutual
Support
Mutual Support
 Dependent upon
information
gathered through
situation
monitoring
 Moderated by the
communication of
information
 Enhanced by
leaders who
encourage and
role model mutual
support behaviors
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Introduction
Mutual
Support
Mutual Support
Mutual support involves members:
1. Assisting each other
2. Providing and receiving feedback
3. Exerting assertive and advocacy behaviors when
patient safety is threatened
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Introduction
Mutual
Support
Task Assistance
Team members foster a climate in which it
is expected that assistance will be actively
sought and offered as a method for reducing
the occurrence of error.
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Introduction
Mutual
Support
What Is Feedback?
Feedback is information provided for the
purpose of improving team performance
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Introduction
Mutual
Support
Characteristics of Effective Feedback
Effective feedback is—
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Timely
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Respectful
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Specific
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Directed toward improvement
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Helps prevent the same problem
from occurring in the future
Considerate
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Introduction
Mutual
Support
Please Use CUS Words
but only when appropriate!
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Introduction
Mutual
Support
Barriers to Team Effectiveness
BARRIERS
 Inconsistency in Team
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Membership
Lack of Time
Lack of Information Sharing
Hierarchy
Defensiveness
Conventional Thinking
Complacency
Varying Communication Styles
Conflict
Lack of Coordination and
Follow-Up with Co-Workers
Distractions
Fatigue
Workload
Misinterpretation of Cues
Lack of Role Clarity
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TOOLS and
STRATEGIES
Brief
Huddle
Debrief
STEP
Cross Monitoring
Feedback
Advocacy and Assertion
Two-Challenge Rule
CUS
DESC Script
Collaboration
SBAR
Call-Out
Check-Back
Handoff
TEAMSTEPPS 05.2
OUTCOMES
 Shared Mental Model
 Adaptability
 Team Orientation
 Mutual Trust
 Team Performance
 Patient Safety!!
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Summary
Pulling it All Together
“The truth of the matter is that you
always know the right thing to do. The
hard part is doing it.”
–Norman Schwarzkopf
®