HANYS Teamwork – Technique: Achieving Critical Care Excellence A presentation by Capt. Stephen Harden A presentation by Capt. Stephen Harden

Agenda 1. Quick review of CRM and its two key components 2. The five step formula for changing culture 3. Key components of the methodology to permanently improve teamwork and system processes 4. Identify the leaders in your organization who are critical to the success of your improvement project 5. The formula to recruit and win the support of project champions 6. How to explain the impact of your project to gain credibility and support

“Our Systems are too complex to expect merely extraordinary people to perform perfectly 100% of the time. We, as leaders, have a responsibility to put into place systems to support safe practice.” James Conway, IHI Senior Fellow

CRM is… Crew –Any team … cockpit, maintenance, ATC, etc... ICU staff, ICU physicians, ECMO team Resource –Other team members, equipment, procedures, systems Management –Specific behavioral skills to lead, communicate, decide and catch errors before they become serious /fatal (Example: Pilots working with ATC, conducting a “readback” of a new altitude clearance… or ICU team transferring pt. to Step Down unit and conducting a “readback” of critical information) Managing the Resources of the Crew

CRM Teamwork Training + Systems Approach Error is inevitable because of human limitations The key to safety is managing error –“Stop being surprised by it, and be prepared for it” Aviation (and some hospitals) manages error by training specific team & communication behaviors & implementing systems that require those behaviors The behaviors and the systems supporting the behaviors is CRM

Aviation’s Solution Technology Teamwork Skills Systems that Hardwire Teamwork into Daily Operations Software + Hardware plus plus

The Formula for Changing Culture Thoughts (training) Actions (system tools) Habits (leadership actions + proof it works) Character Culture

The Formula for Permanent Improvement

Leadership Development Prepare the System To Succeed Philosophy Policy Procedures Practices How do you change the culture and go from “Me” to “We?” The 80/20 rule

How do you change the culture and go from “Me” to “We?” Leadership Development Prepare the System To Succeed Skills Workshops Equip staff with error- catching teamwork skills

How do you change the culture and go from “Me” to “We?” Leadership Development Prepare the System To Succeed Skills Workshops Equip staff with error- catching teamwork skills Safety Tools Workshops Hardwire the behaviors into daily operations

How do you change the culture and go from “Me” to “We?” Leadership Development Prepare the System To Succeed Skills Workshops Equip staff with error- catching teamwork skills Safety Tools Workshops Hardwire the behaviors into daily operations Project Measurement Document Results Project Measurement Document Results

How do you change the culture and go from “Me” to “We?” Leadership Development Prepare the System To Succeed Skills Workshops Equip staff with error- catching teamwork skills Safety Tools Workshops Hardwire the behaviors into daily operations Project Measurement Document Results Project Measurement Document Results Sustainability Train-the-Trainer Become an “owner” not a “renter” Sustainability Train-the-Trainer Become an “owner” not a “renter”

Aviation’s Solution Technology Teamwork Skills Systems that Hardwire Teamwork into Daily Operations plus plus

Tools in the “Safety Toolkit” Pre –briefs – pre-op time outs, morning huddles Checklists – room set-up, holding room exit, line insertion protocol, pregnant trauma treatment flow, Hand-offs Debriefings – post-procedure, conflict mediation, teaching moments Standardized communication formats Hardwire the behaviors into daily operations “This is just the way we do business.”

SBAR A standardized format for hand-off communication Addresses a JCAHO Safety Goal for 2006 Used by RN’s, Attendings, and Housestaff

Hybrid OR Checklist

Debriefing Checklist

Trauma Protocol Standardized, common approach to OB patients with severe trauma. Jointly developed by OB and Trauma Services Covers care in ER, L&D and Trauma Units

OB-GYN Standardized Morning “Huddle” for complex L&D Unit with full-time faculty, mid-wives, housestaff, Newborn Nursery and L&D staff.

Take Advantage of History Guerilla Campaign –Secure Base of Operations –Support of Strong Government –Support of 15% of population Cultural Change Campaign –Secure Base: No end runs allowed, willing to impose consequences for non- compliance, leadership mandate –Government Support: Board support, Executive support, funding, Med Exec, Joint Commission, CMS –Support of 15%: Champions

The Key Members of the 15%... CEO or COO or President (funding) CMO or VPMA (Med Exec – MD partnership) Chief of Service or Department Chair (Support of Tools) Director of Department (Daily reinforcement) Key departmental managers (Daily reinforcement) At least two physician champions (MD partners) Leaders from Quality/Safety/Risk Management (Measurement and feedback)

Recruiting Champions Pages 1-12 and 1-13

The Briefing Protocol Page 3 - 1

Page Briefing the Implementation Process

Objectives The five step formula for changing culture Key components of the methodology to permanently improve teamwork and system processes Identify the leaders in your organization who are critical to the success of your improvement project The formula to recruit and win the support of project champions How to explain the impact of your project to gain credibility and support

Focus Simplicity Follow-up Discipline Focus on doing the simple things (follow the formulas). Follow up after you do them. Have the discipline to do them without fail.

Thank You