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Strategies and Tools to Enhance Performance and Patient Safety.

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Presentation on theme: "Strategies and Tools to Enhance Performance and Patient Safety."— Presentation transcript:

1 Strategies and Tools to Enhance Performance and Patient Safety

2 2 “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” Team Strategies & Tools to Enhance Performance & Patient Safety

3 3 (Mann, 2006) Beth Israel Deaconess Medical Center Contemporary OB/GYN (Sexton, 2006) Johns Hopkins (Pronovost, 2003) Johns Hopkins Journal of Critical Care Medicine

4 4 Why Do Errors Occur—Some Obstacles Workload fluctuations Interruptions Fatigue Multi-tasking Failure to follow up Poor handoffs Ineffective communication Not following protocol Excessive professional courtesy Halo effect Passenger syndrome Hidden agenda Complacency High-risk phase Strength of an idea Task (target) fixation

5 5 JCAHO Sentinel Events

6 6 What Comprises Team Performance? Knowledge Cognitions “Think” …team performance is a science…consequences of errors are great… Attitudes Affect “Feel” Skills Behaviors “Do”

7 7 Outcomes of Team Competencies Knowledge – Shared Mental Model Attitudes – Mutual Trust – Team Orientation Performance – Adaptability – Accuracy – Productivity – Efficiency – Safety

8 8 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)

9 9 Barriers to Team Performance Inconsistency in team membership Lack of time Lack of information sharing Hierarchy Defensiveness Conventional thinking Varying communication styles Conflict Lack of coordination and follow-up Distractions Fatigue Workload Misinterpretation of cues Lack of role clarity

10 10 Multi-Team System (MTS) for Patient Care

11 11 Team Failure Video

12 12 Are better able to predict the needs of other team members Provide quality information and feedback Engage in higher level decision-making Manage conflict skillfully Understand their roles and responsibilities Reduce stress on the team as a whole through better performance “Achieve a mutual goal through interdependent and adaptive actions” Effective Team Members

13 13 TeamSTEPPS Leadership

14 14 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 Effective Team Leaders

15 15 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 Promoting & Modeling Teamwork

16 16 Briefs Planning Form the team Designate team roles and responsibilities Establish climate and goals Engage team in short and long-term planning

17 17 Huddle Problem solving 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

18 18 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

19 19 Facilitating Conflict Resolution Effective leaders facilitate conflict resolution techniques through invoking: Two-Challenge rule DESC script Effective leaders also assist by: Helping team members master conflict resolution techniques Serving as a mediator

20 20 TeamSTEPPS Situation Monitoring

21 21 A Continuous Process Situation Monitoring (Individual Skill) Situation Awareness (Individual Outcome) Shared Mental Model (Team Outcome)

22 22 Process of actively scanning behaviors and actions to assess elements of the situation or environment Fosters mutual respect and team accountability Provides safety net for team and patient Includes cross monitoring Situation Monitoring (Individual Skill) …Remember, engage the patient whenever possible.

23 23 Cross Monitoring Mechanism to help maintain accurate situation awareness Way of “watching each other’s back” Ability of team members to monitor each other’s task execution and give feedback during task execution

24 24 Components of Situation Monitoring:

25 25 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)

26 26 Shared Mental Model?

27 27 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 How Shared Mental Models Help Teams “Shared mental models help teams avoid errors that place patients at risk.”

28 28 TeamSTEPPS Mutual Support

29 29 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!”

30 30 Can be formal or informal Constructive feedback – Is considerate, task-specific, and focuses attention on performance and away from the individual (Baron 1988) – Is provided by all team members Evaluative feedback – Helps the individual by comparing behavior to standards or to the individual’s own past performance (London, Larson, and Thisted 1999) – Most often used by an individual in a coaching or mentoring role Feedback

31 31 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.”

32 32 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 Advocacy and Assertion

33 33 Two-Challenge Rule 1 2

34 34 Please Use CUS Words but only when appropriate!

35 35 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.

36 36 Collaboration Achieves a mutually satisfying solution resulting in the best outcome – All Win!: Patient Care Team (team members, the team, and the patient) – Includes commitment to a common mission Meet goals without compromising relationships “True collaboration is a process, not an event.”

37 37 TeamSTEPPS Communication

38 38 JCAHO: Importance of Communication Ineffective communication is a root cause for nearly 66 percent of all sentinel events reported* * (JCAHO Root Causes and Percentages for Sentinel Events (All Categories) January 1995−December 2005)

39 39 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

40 40 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?

41 41 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

42 42 Check-Back is…

43 Handoff Optimized Information Responsibility– Accountability Uncertainty Verbal Structure Checklists IT Support Acknowledgement

44 44 Communication Challenges Language barrier Distractions Physical proximity Personalities Workload Varying communication styles Conflict Lack of information verification Shift change

45 45 TeamSTEPPS

46 46 Team Formation Video


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