Transcript Presentation Title - TeamSTEPPS National Implementation

Spreading and Sustaining
TeamSTEPPS
Madeline Fricke, MPS, RN
Denise Mazzapica, MSN, RN-BC
Barbara Olson, MS, RN, CPPS
Vanessa Peters, RN, BS, MHS
Using TeamSTEPPS to
Improve Care Across a
Large Healthcare
Organization:
LifePoint Hospitals’
Journey
Barbara Olson, MS, RN, CPPS
Senior Patient Safety Officer
LifePoint Hospitals
Vanessa Peters, RN, BS, MHS
Interim Chief Nursing Officer
River Parishes Hospital
LaPlace, LA
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TeamSTEPPS in the Improvement Journey
BACKGROUND BRIEFING: LIFEPOINT
HOSPITALS AND THE LIFEPOINT HEN
LifePoint Hospitals
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61 hospitals in 20 states
>32,000 employees &
3400 physician
relationships
a CMS-designated
Partnership for Patients’
Hospital Engagement
Network (HEN)
HEN Imperatives: Sustainable Prevention of Harm &
Improvement of Care Transitions
• Since December 2011, we’ve used interdisciplinary teams
and processes to:
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harvest data
make harms visible
provide evidence-based solutions
support local learning
foster peer-support
measure & improve culture
engage patients and family members
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LifePoint’s Gains: Improving Culture & Preventing
Harm
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All cause harm aggregate: CLABSI; c. diff; Hospital acquired pneumonia; HAUTI; Post-op infection; Pressure ulcers (all stages); Falls (with and without
injury); VTE
LifePoint’s Gains: Improving Culture & Preventing
Harm
The Team of Regional Patient Safety Officers
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The Hospital Support Center Team of Subject
Matter Experts
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Transforming Care is Iterative Work!
Safety Attitude
Questionnaire (SAQ)
(1Q12)
• Baseline assessment
• Introduction of “culture” as a
measurable, improvable
attribute of workplaces
Hospital debriefings
(2Q12 – 3Q12)
• Validation process
• 52 hospitals and 758 individual work
settings
Outcome: Need to Improve Communication
Norms & Problem-Solving Skills
5 Foundational Tools
• Briefs
• Debriefs
• Huddles
• Learning Boards
• Executive Patient Safety Rounds
Transforming Care is Iterative Work!
Safety Attitude
Questionnaire (SAQ)
(1Q12)
• Baseline assessment
• Introduction of “culture” as a
measurable, improvable
attribute of workplaces
Collaborative Learning
(3Q12)
● Peer-to-peer interaction facilitated by
a subject matter expert
● Focused on specific harm
Hospital debriefings
(2Q12 – 3Q12)
• Validation process
• 52 hospitals and 758 individual work
settings
TeamSTEPPS: Teaching & Modeling Behaviors
• Leadership development
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TeamSTEPPS: Modeling Specific Behaviors
• Every Collaborative
learning session, every
time:
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TeamSTEPPS: Defining Specific Safety Behaviors
• Safe Surgery: Preventing
retained surgical items
• Falls Prevention: Learning in
the aftermath of close calls &
actual falls
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TeamSTEPPS: Defining Specific Safety Behaviors
• CLABSI Prevention: The
importance of detecting and
correcting mission-critical
variations.
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Transforming Care is Iterative Work!
Collaborative Learning
(3Q12 to present)
• Peer-to-peer interaction
facilitated by a subject
matter expert
• Focused on specific harm
Monthly Coaching Calls
(3Q13 to present)
• Developmental milestones for adoption of
foundational TeamSTEPPS skills introduced
• Peer-to-peer interaction facilitated by a
Regional Patient Safety Officer
• Check understanding & provide clarity
Briefs & Huddles
Proactive!
Contingency!
Debriefs
Learning!
TeamSTEPPS in the Improvement Journey
BRIGHT SPOT EXEMPLARS
TeamSTEPPS at Logan Regional Medical Center
Kaizen to
Improve A2MSE
• Immediate bedding
• Team communication
• Role standardization
(Aug. 2013)
TeamSTEPPS
training
(Oct. 2013)
• Briefs, Debriefs, Huddles
• Mutual Respect
• Escalation: Speaking Up & CUS
Logan Regional TeamSTEPPS training as a
countermeasure for communication deficits
TeamSTEPPS to Improve Bedside Shift Report at
Wythe County Hospital
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TeamSTEPPS in the Improvement Journey
ONE HOSPITAL’S STORY
River Parishes Hospital
River Parishes Hospital is an
acute-care facility offering a variety
of services ranging from family
medicine to vascular surgery.
Our full-service, 24-hour
Emergency Room serves
greater than 20,000
visitors annually. Our primary
service area includes St. John, St.
Charles and St. James Parishes,
encompassing a population
of 80,000 people.
River Parishes Hospital
All-cause, non-OB harms: c. diff; CLABSI; HAP; HAUTI; Post-Op Infection; PrU;
Falls; VTE
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River Parishes Hospital: Aggregate SAQ Data
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River Parishes: Culture at the Unit level
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Benefitting from TeamSTEPPS at River Parishes
• Event Learning
– Using TeamSTEPPS communication tools to simulate
(“re-play”) a close call event
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Benefitting from TeamSTEPPS at River Parishes
• Event Learning
– Debriefing the
simulation
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Benefitting from TeamSTEPPS at River Parishes
• Shift briefing in
Environmental Services
– Empowering employees
in all units
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Benefitting from TeamSTEPPS at River Parishes
• Shift briefing in
Environmental Services
– Empowering employees
in all units
– Resolving threats
– Sharing benefits with
other LifePoint
hospitals in the
Medication Safety
Collaborative
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Benefitting from TeamSTEPPS at River Parishes
• Shift Debriefings in the OR
– A time when staff members identify and solve threats to
safety & operations proactively. Here’s an example:
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Thank You!
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UTILIZATION OF A
SELF-DIRECTED WORK TEAM
TO SUSTAIN TEAMSTEPPS
Denise Mazzapica, MSN, RN-BC
Madeline Fricke, MPS, RN
Jayne O’Leary, MSN, RN
Myrta Rabinowitz, PhD, RN-BC
OBJECTIVES
• Define a self-directed work team
(SDWT)
• Describe how the North Shore LIJ
Institute for Nursing SDWT model
was used to sustain
TeamSTEPPS
• Apply this sustainment model to
learner’s organization
LET’S TALK
TEAMSTEPPS
ASSESSMENT IS A
CHALLENGE
PLANNING, TRAINING AND
IMPLEMENTATION ARE HARD
WORK….
HOW IS SUSTAINMENT
WORKING OUT FOR
YOU???
TeamSTEPPS
Flavor of the Month?
What does it take to be
Vanilla?
TeamSTEPPS is who we
are...
and this is how
we did it!
Self-Directed Work Team (SDW
A highly trained group of
employees, fully
responsible for turning out a
Osborn & Moran 1990
well-defined segment
of
work.
“Rarely
does a single person have
enough knowledge or experience
to understand everything that goes
on in a process.
Therefore, major gains in quality
and productivity most often result
from teams – groups of people,
Scholtes, 1988
their skills, talents and
knowledge.”
Creating a Self-Directed
Work Team
The
Leadership
Selects the team
Provides training
Set goals/ expectations
Supervises from a
distance
Fisher, 2000; Gustavson & Liff, 2014; Torres
The Team
Diverse Experience
Multiple skills
Semi autonomy
Share
Fisher, 2000; Gustavson & Liff, 2014;
Spiegel,1990
The Benefi
Increased Productivity
Improved Outcomes
Increased Morale
Fisher, 2000; Gustavson & Liff, 2014; Spiegel, 1990
How It Works
Plan
Improv
e
Goals
Control
Impleme
nt
North Shore LIJ
Story
IFN MANAGERS
Denise
Mazzap
ica
Jayne
O’Lear
y
Madeli
ne
Fricke
The NSLIJHS Self-Directed
Work Team
The IFN Managers
Myrta
Rabino
witz
Home
Care
Education
Critical
Care
Med - Surg
FIRST STEPS
Relationships
Trust
Partnership
TeamSTEPPS
Assess
Coach
Transform
Collaborative Care
Councils
Educate
Facilitate
Coach
Sustainment
Begin with the End in Mind
Torres, Covey 1984, 2004
Teamwork must become the
way things are done in the
daily work flow King & Harden, 2013
OUTCOMES
• Improved Patient Experience Scores
• Decreased Turnover Rates
NSLIJHS – 2012 One of the 100 Great
Places to Work
• Reduced infection rates, falls, lowered
incidence of patient harm
• AHRQ’s Hospital Survey on Patient Safety
Culture
2009: System results lower in 9 dimensions
2011: System results higher in 7
dimensions
Thomas & Galla, 2013
NEXT STEPS
BUILDING THE BENCH
INFRASTRUCTURE
System SDWT
Site
Coordinator
System SDWT
Site SDWT
Utilizing a Self-Directed Work
Team
at a Pilot Site
SDWT
develops plan
SDWT selects
and trains
Coaches
Plan
Staff
Engagement
Coaches roll
out plan
Improv
e
SDWT collects
data
Goals
SDWT
modifies plan
Control
Engage
CCC’s
Impleme
nt
Project:
SDWT to Sustain Team STEPPS
Project Sponsor:
Amy Loeb
Project Manager:
Madeline Fricke
Goal Category:
Patient Safety
Goal Alignment
Aligns to HH/ System Goals
Project Status
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Status Comments
Roadblocks:
Project Scope:
Resource Requirements:
• Provide Master Training for the SDWT
• Provide Master Training to a selected group (the Coaches)
approximately 50 cross-disciplinary professionals.
• Select measure of success while providing Master Training for
the SDWT/Coaches
• Out of Scope: Strengthen Collaborative Care Council
• Quality Metric Selection related to TS Assumptions:
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Project Description:
Important Milestones:
Date
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Select the SDWT
Determine the training curriculum
Facilitate a 2-day Master Training Session
Select metrics for measure of success
Review metrics and implement modifications
Engage CCC’s
SDWT: 8 members in key roles
Bi-weekly meetings with defined deliverables
Secretarial support for invitations/catering/venue
Budget for catering/education time
Support from Stakeholders: Executive team, the SDWT,
Institute for Nursing
Select SDWT
Master Training for SK and RS
Finalize Coach Invitees
Secure venue (Dolan Center)
Secure budget for catering
Craft and send invitation to the Coaches
Select measure of success
Develop and solidify the curriculum
Practice the presentation
completed
4/21/14
4/21/14
4/21/14
4/28/14
5/12/14
6/2/14
6/16/14
6/2/14
REFERENCES
Fisher, K. (2000). Leading Self-Directed Work Teams. New York, NY: McGrawHill.
Gustavson, P. & Liff, S. (2014). A Team of Leaders. New York, NY: American
Management Association.
Orsburn, J., & Moran, L. (2000). The New Self-Directed Work Teams. New
York, NY:
McGraw-Hill.
Salas, E., Frush, K., Baker, D., Battles, J., King, H., & Wears, R. (2013).
Improving Patient
Safety Through Teamwork and Team Training. New York, NY: Oxford
University Press.
Thomas, L. & Galla, C. (2013). Building a culture of safety through team training
and
engagement. BMJ Quality and Safety 22:425-434.
Torres, C. & Spiegel, J. (1990). Self-Directed Work Teams: A Primer. San
Diego, CA: Pfeiffer
& Company.