TEAMSTEPPS ® CHAMPIONS OF CHANGE: AN EPIC JOURNEY DAVINA CRAIG, RNC-OB CLINICAL EDUCATION COORDINATOR TEAMSTEPPS MASTER TRAINER PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL

PURPOSE Utilize TeamSTEPPS® to mitigate staff stress and patient safety risk during implementation of a new electronic health record impacting every department in our Critical Access Hospital and 17 clinics in our community.

BACKGROUND Prior implementation of TeamSTEPPS® in our organization had positive impact on our Culture of Safety indicators. Ministry wide implementation of the electronic health record had been reported, in interviews and discussions with other organizations, to temporarily negatively impact productivity, staff morale and in some cases patient safety.

METHOD Safety Attitude Questionnaire Plus was conducted and reported to our organization by Pascal Metric Inc. Baseline data was established in Post implementation data collected within 90 days of implementation. Customized curriculum focusing on 4 tools (huddle, cross monitoring, C.U.S. and closed loop communication) with incorporation of change management principles was created by an interdisciplinary team (IDT). Participants were selected using a standardized application process created by the IDT that was conducted by the department manager and project lead. Four hours of training was conducted nine weeks prior to implementation using two modalities: class- room lecture and small group simulation. Web-based meeting technology was used to provide coaching to participants once a week, one hour, for six weeks prior to implementation Participants attended twice daily Shift Brief during their work shifts for two weeks post implementation. SBAR Practice Alerts were used to share patient safety concerns quickly. Only departments that had participants that met the following requirements were included in our analysis of impact: completed four hours of training, participated in weekly coaching events and attended Shift Briefs.

CUSTOM CURRICULUM Review of Key Tools & Strategies Huddle Cross Monitoring C.U.S. Closed Loop Communication –verification Change Management Principles Simulation

PROJECT DISCUSSION Participants stated that small group simulation facilitated by a master trainer was the most valuable part of the training in exit interview. Utilizing scenarios identified by clinical informaticists added value to the simulations. Master Trainers facilitating the small workgroup simulation sessions were able to identified unique, department-based cultural attitudes that led to focused support provided during weekly coaching sessions.

WEB BASED MEETING--HUDDLE Facilitated by Master Trainer Weekly after, our Champion class, up to go-live Champions & Department Managers Objectives Promoting coaching behaviors & leadership Information sharing—just in time info about Epic. Getting the pulse of front line issues/concerns Sharing strategies & stories Increase comfort with the technology as a communication tool

LIMITATIONS Only three of the eight safety domains were compared to assess impact of intervention. No evaluation of the ratio of participants (“Champions of Change”) to number of unit based staff. No day versus night shift comparative data Data collected in the standardized survey process was difficult to isolate for our 7 departments that qualified for the study.

IMPLICATIONS Organizations that have already implemented TeamSTEPPS® and are anticipating a stressful or disruptive change in operations should consider using a focused review of tools & change management principles to promote team growth. Interdisciplinary collaboration in customization of curriculum was valuable in creating scenarios specific to the organizational challenges we needed to overcome. Further investigation into the relationship of impact between the number of “champion(s)” to the number of staff within the department TeamSTEPPS is the remedy for…everything