1. Building an (H1N1) Interdisciplinary Team Capt J. Sue Arnold Director of Pharmacy Claremore Indian Hospital

2. Background / Acquisition CDC managed distribution to the states CDC managed distribution to the states State Health Departments Controlled Distribution of H1N1 State Health Departments Controlled Distribution of H1N1 OK Area IHS Office meets routinely with OK Health Department on emergency management - DEVELOPED history. OK Area IHS Office meets routinely with OK Health Department on emergency management - DEVELOPED history. Weekly meetings, at the state level, providing information on IHS needs Weekly meetings, at the state level, providing information on IHS needs Constant feed back of ability to store and deliver vaccine Constant feed back of ability to store and deliver vaccine Repeated input from individual clinics ability to deliver in a timely manner. Repeated input from individual clinics ability to deliver in a timely manner.

3. Distribution CDC to State CDC to State State to IHS NSSC (OK city) State to IHS NSSC (OK city) NSSC to Claremore Pharmacy NSSC to Claremore Pharmacy Pharmacy received and entered lots Pharmacy received and entered lots Distributed to clinic areas Distributed to clinic areas Evaluated vaccines given/ 4 in 4 days Evaluated vaccines given/ 4 in 4 days Were asked to develop and implement a plan on Thurs afternoon Were asked to develop and implement a plan on Thurs afternoon Had it in place, advertised, and gave first four immunizations from it Thurs evening Had it in place, advertised, and gave first four immunizations from it Thurs evening

4. Great teams have Shared roles in leadership and rotating other roles as needed Shared roles in leadership and rotating other roles as needed All participating in idea generation, problem solving, and decision making All participating in idea generation, problem solving, and decision making Members showing support, respect and trust for each other Members showing support, respect and trust for each other All members taking actions and doing work to reach team goals All members taking actions and doing work to reach team goals Members managing conflict and inappropriate behaviors Members managing conflict and inappropriate behaviors Shirley Fine Lee, “R.A.! R.A.! A Meeting Wizard’s Approach” Five Characteristics of a Great Team.

5. 5 P’s of Team Design by Shirley Fine Lee Purpose: what is our mission Purpose: what is our mission –What is our desired final product Participation: who do we NEED Participation: who do we NEED – a mix of skill sets, professional attitudes, process knowledge Placement: where will we be PHYSICALLY Placement: where will we be PHYSICALLY Process: How will this work Process: How will this work –Nuts and bolts of the process or procedure Plan: define goals, deadlines, outcomes Plan: define goals, deadlines, outcomes –What do we want, what can we really expect, how can we improve our plan to improve our results

6. Build a Team using Vision, Commitment and Trust Vision: being able to excite the team with a large, desired outcome-define success Vision: being able to excite the team with a large, desired outcome-define success –Use all H1N1 received on CDC defined risk groups quickly Vaccinate 900 children, all pregnant, health care givers by Mon. Vaccinate 900 children, all pregnant, health care givers by Mon. Commitment: define time expectations, define productivity expectations, best case scenario Commitment: define time expectations, define productivity expectations, best case scenario –Short planning time, LOTS of redirection of staff, Trust: list unknowns, define worst case & results of such Trust: list unknowns, define worst case & results of such –How many pts., how, when, where, why, why not, who will, who won’t Inclusion: get (allow) others to commit, support through their doubts, ensure real give & take Inclusion: get (allow) others to commit, support through their doubts, ensure real give & take –Give it up…you don’t know it all, think outside of the box, think in the WE CAN/YOU CAN mode : With this plan we CAN vaccinate greater than half of our at risk population, within one week. Go for the biggest positive! High Performance Teamwork training course

7. So… what’s different with an H1N1 interdisciplinary team? Nothing, except … Nothing, except … –more professional ego’s to negotiate –more people with time limitations – patient safety issues –possible legal issues, standing orders –with the H1N1, the negative public opinion and skeptic issue –Mostly live virus issued … who wants live virus?

8. Solutions Let’s look at our 5 P’s again: Purpose: what is our mission Purpose: what is our mission – this case, get H1N1 to the high risk group/fast –school age for OK –So we can get more as it is available… show success in distribution Participation: who do we NEED - a mix of skill sets, professional attitudes, process knowledge Participation: who do we NEED - a mix of skill sets, professional attitudes, process knowledge –Place (admin), patient (how do we notify), access (admin), registration, (chart/OSSIS), pt. ed materials (handouts), nurse/pharmacist (injector ) Placement: where will we be PHYSICALLY Placement: where will we be PHYSICALLY Process: How will this work Process: How will this work –Timeliness for pts., parking, registration, documentation, availability, standing orders, patient education Plan: define goals, deadlines, outcomes Plan: define goals, deadlines, outcomes –What do we want, 900 immunized; what can we really expect, 120/day how can we contact the target patients – mail, telephone, “shout-out” –We expect to give at least 200 inj., of a controversial vaccination, over holiday weekend, with limited staff, no prior planning, we have no in house admin., no approved OT, it is Thurs. afternoon, etc.

9. 5 P’s of Team Design by Shirley Fine Lee Purpose: what is our mission Purpose: what is our mission – this case, get H1N1 to the high risk group/fast –school age for OK –So we can get more as it is available… show success in distribution Participation: who do we NEED - a mix of skill sets, professional attitudes, process knowledge Participation: who do we NEED - a mix of skill sets, professional attitudes, process knowledge –Place (admin), patient (how do we notify), access (admin), registration, (chart/OSSIS), pt. ed materials (handouts), nurse/pharmacist (injector ) Placement: where will we be PHYSICALLY Placement: where will we be PHYSICALLY Process: How will this work Process: How will this work –Timeliness for pts., parking, registration, documentation, availability Plan: define goals, deadlines, outcomes Plan: define goals, deadlines, outcomes –What do we want, what can we really expect, how can we improve our outcomes –We expect to give at least 200 inj., of a controversial vaccination, over holiday weekend, with limited staff, no prior planning, we have no in house admin., no approved OT, it is Thurs. afternoon, etc.

10. We expect to give at least 200 inj., of a controversial vaccination, over holiday weekend, with limited staff, no prior planning, we have no in house admin., no approved OT, it is Thurs. afternoon, etc. We expect to give at least 200 inj., of a controversial vaccination, over holiday weekend, with limited staff, no prior planning, we have no in house admin., no approved OT, it is Thurs. afternoon, etc. What is the most urgent step after you develop a process for this is going to happen? What is the most urgent step after you develop a process for this is going to happen? What will impeded this process? What will impeded this process? and accelerate it? and accelerate it? What different needs to happen? What different needs to happen? How more can we do? How more can we do? Potential road blocks? Potential road blocks? Plan: define goals, deadlines, outcomes. What do we want, what can we really expect, how can we improve our outcomes Contact the population Skepticism, no contact, hrs., Time, place

11. Planned flu sot clinics Sept 14-19 Drive through, seasonal Sept 14-19 Drive through, seasonal Oct 5 – 10 Drive through, seasonal Oct 5 – 10 Drive through, seasonal Nov 9-14 seasonal, H1N1 Nov 9-14 seasonal, H1N1 Dec 14-19 seasonal, H1N1 Dec 14-19 seasonal, H1N1

12. Inventory Time line - nasal 10/14 Wed. received 90; 110 inj. 10/14 Wed. received 90; 110 inj. Thurs. had given 4 pedi. Challenged to give rest by Monday. Thurs. had given 4 pedi. Challenged to give rest by Monday. 10/22 received 460 doses 10/22 received 460 doses 10/26 received 120 doses 10/26 received 120 doses 11/3 received 90 doses 11/3 received 90 doses 11/7 received 80 doses 11/7 received 80 doses 11/13 received 120 doses 11/13 received 120 doses 11/24 received 40 doses 11/24 received 40 doses 12/1 received 210 doses 12/1 received 210 doses 1320 doses 1320 doses

13. Inventory time line-prefilled 10/22 received 160 10/22 received 160 10/26 received 40 10/26 received 40 11/03 received 180 11/03 received 180 11/13 received 160 Total=1030 11/13 received 160 Total=1030 11/17 received 180 11/17 received 180 11/24 received 110 11/24 received 110 12/01 received 80 12/01 received 80 12/11 received 120 12/11 received 120

14. Inventory time-line vials 10/14 received 110 10/14 received 110 10/22 received 800 10/22 received 800 10/26 received 100 10/26 received 100 11/03 received 380 11/03 received 380 11/13 received 380 Total=3330 11/13 received 380 Total=3330 11/17 received 160 11/17 received 160 11/24 received 380 11/24 received 380 12/01 received 600 12/01 received 600 12/11 received 420 12/11 received 420

15. Time line -Immunizations given 10/4 – 10 14 10/4 – 10 14 10/11-17 142 10/11-17 142 10/18-24 177 10/18-24 177 10/25-31 524 10/25-31 524 11/1-7 690 11/1-7 690 11-8-14 768 11-8-14 768 11/15-21 423 11/15-21 423

16. What does Sue think it takes to build a great interdisciplinary team? #5 Common goal #5 Common goal #4 Eager/ respectful participation #4 Eager/ respectful participation #3 Trust #3 Trust #2 Desire to go beyond the norm #2 Desire to go beyond the norm #1 Sense of Humor

18. Sue.Arnold@ihs.gov Thank you. Thank you.