Introduction - K
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Transcript Introduction - K
Strategies and Tools
to Enhance Performance
and Patient Safety
Introduction
Objectives
Describe the TeamSTEPPS training initiative
Explain your organization’s patient safety program
Describe the impact of errors and why they occur
Describe the TeamSTEPPS framework
State the outcomes of the TeamSTEPPS framework
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Introduction
Joint Commission Sentinel
Events
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Introduction
OR Teamwork Climate and Postoperative Sepsis Rates
Length of ICU Stay After Team Training
(per 1000 discharges)
18
2.4
Avg. Length of Stay (days)
16
2.2
14
50
2
1.8
%
Group Mean
12
Re
du
cti
on
AHRQ National Average
10
Low Teamwork
Climate
8
1.6
Mid Teamwork
Climate
6
1.4
4
High Teamwork
Climate
1.2
2
1
June
July
August
Sept
Oct
Nov
Dec
Jan
Feb
March
April
0
May
Teamwork Climate Based on Safety Attitudes Questionnaire
(Sexton, 2006)
Johns Hopkins
(Pronovost, 2003)
Johns Hopkins
Journal of Critical Care Medicine
Adverse Outcomes
Low
High
Indemnity Experience
Pre-Teamwork Training
Post-Teamwork Training
25
20
50%
Reduction
20
50%
Reduction
15
11
10
5
0
(Mann, 2006)
Beth Israel Deaconess Medical Center
Contemporary OB/GYN
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Malpractice Claims, Suits, and Observations
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Introduction
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”
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Introduction
The Components of a
Patient Safety Program
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Introduction
What Comprises Team Performance?
Knowledge
Cognitions
“Think”
Attitudes
Affect
“Feel”
Skills
Behaviors
“Do”
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…team performance is a
science…consequences
of errors are great…
7
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
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
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Introduction
High-Performing Teams
Teams that perform well:
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
Multi-Team System (MTS) for Patient Care
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Leadership
Introduction
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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Introduction
Resource Management
Core Team Leader
Coordinating Team Leader
• Information
• Information
– Patient &
Family
– Plan of care
– Facilities
Administrative
– Facilities
• Time
• Equipment
• Time
• Equipment
• Patient flow
HUMAN
CAPITAL
FOCUS
Team & Your Unit
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• Other
departments
FOCUS
Support Units
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Introduction
Delegation
Method of re-distributing
tasks or assignments
Process includes 4 steps:
Decide what to delegate
Decide to whom to
delegate
Communicate clear
expectations
Request feedback
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Introduction
Promoting & Modeling Teamwork
Effective leaders cultivate desired team
behaviors and skills through:
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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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Introduction
Team Events
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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Introduction
Teamwork Actions
Empower team members to speak freely
and ask questions
Utilize resources efficiently to maximize
team performance
Balance workload within the team
Delegate tasks or assignments, as appropriate
Conduct briefs, huddles, and debriefs
Utilize conflict resolution techniques
(i.e., Two-Challenge rule and DESC script)
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Situation Monitoring
“Attention to detail is one of the most important details ...”
–Author Unknown
Introduction
A Continuous Process
Situation
Monitoring
(Individual Skill)
Situation
Awareness
(Individual
Outcome)
Shared
Mental Model
(Team Outcome)
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Introduction
Components of
Situation Monitoring:
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Introduction
Situation Awareness is…
The state of knowing the current conditions affecting
the team’s work
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Knowing the status
of a particular event
Knowing the status
of the team’s
patients
Understanding the
operational issues
affecting the team
Maintaining
mindfulness
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Introduction
Conditions that Undermine
Situation Awareness (SA)
Failure to—
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Share information with the team
Request information from others
Direct information to specific team members
Include patient or family in communication
Utilize resources fully (e.g., status board,
automation)
Document
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Introduction
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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Introduction
Shared Mental Model?
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Introduction
Teamwork Actions
Conduct team exercises to increase situation monitoring skills
Share information in a timely fashion
Include patient and/or family in communication
Use cross monitoring
Apply the STEP process when monitoring the situation
Foster communication to ensure that all members of the team
have a shared mental model
Share information during briefs, team huddles, debriefs, and
transitions in care
“Teams do not seek consensus; they seek
the best answer.”
–Katzenbach and Smith
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Mutual Support
“A chain is only as strong as its
weakest link.”
–Author Unknown
Introduction
Mutual Support
Mutual support is the essence of teamwork
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Protects team members from work overload
situations that may reduce effectiveness and
increase the risk of error
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Introduction
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.
“In support of patient safety,
it’s expected!”
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Introduction
Characteristics of Effective Feedback
Good Feedback is—
TIMELY
RESPECTFUL
SPECIFIC
DIRECTED toward improvement
Helps prevent the same problem
from occurring in the future
CONSIDERATE
“Feedback is where the learning occurs.”
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Introduction
Advocacy and Assertion
Advocate for the patient
Invoked when team members’
viewpoints don’t coincide with
that of a decision maker
Assert a corrective action in a
firm and respectful manner
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Introduction
Conflict Resolution Options
Information Conflict
(We have different information!)
Personal Conflict
(Hostile and harassing behavior)
Two-Challenge rule
DESC script
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Introduction
Please Use CUS Words
but only when appropriate!
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Introduction
Conflict Resolution
DESC Script
A constructive approach for
managing and resolving conflict
D—Describe the specific situation
E—Express your concerns about the action
S—Suggest other alternatives
C—Consequences should be stated
Ultimately, consensus shall be reached.
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Introduction
Teamwork Actions
Foster a climate supportive of task assistance
Provide timely and constructive feedback
Be assertive and advocate for the patient
Use the Two-Challenge rule, CUS, and DESC
script to resolve conflict
Resolve conflict through collaboration—Create a
“Win-Win-Win” situation
“Those whom we support hold us up in life.”
–Marie von Ebner-Eschenbauch
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Communication
Assumptions
Fatigue
Distractions
HIPAA
Introduction
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
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Offer and request information in an appropriate timeframe
Verify authenticity
Validate or acknowledge information
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Introduction
Call-Out is…
A strategy used to communicate
important or critical information
It informs all team members
simultaneously during
emergency situations
It helps team members
anticipate next steps
…On your unit, what information
would you want called out?
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Introduction
Check-Back is…
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Introduction
Handoff
Optimized Information
Responsibility– Accountability
Uncertainty
Verbal Structure
Checklists
IT Support
Acknowledgement
Great opportunity for
quality and safety
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Teamwork Actions
Communicate with team members in a brief,
clear, and timely format
Seek information from all available sources
Verify and share information
Practice communication tools and strategies daily
(SBAR, call-out, check-back, handoff)
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Introduction
Pulling it All Together
Recognize opportunities to improve patient safety
Assess your current organizational culture and
existing Patient Safety Program components
Identify teamwork improvement action plan by
analyzing data and survey results
Design and implement initiative to improve team-
related competencies among your staff
Integrate TeamSTEPPS into daily practice.
“High-performance teams create a safety net for
your healthcare organization as you promote a
culture of safety."
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