Improving Patient Safety Worldwide Through Teamwork and Communication TeamSTEPPSTM Improving Patient Safety Worldwide Through Teamwork and Communication Track1A.Powell&Hohenhaus--8.20@4pm QC

Presenters Susan M Hohenhaus, RN, MA, FAEN President, Hohenhaus & Associates, Inc. Stephen M Powell, MS, Captain, Principal, Healthcare Team Training, LLC This is about face-to-face interaction. This is about people who are a team of experts becoming an expert team centered upon safe and reliable patient care. Track1A.Powell&Hohenhaus--8.20@4pm QC

Empowering Local Teams This is where Teamwork Improvement begins: Multi-discipline front line providers and staff join together to solve identified teamwork and communication problems at a local level. Trust and understanding is developed. Buy-in to change is secured. Evidence based tools are implemented systematically. Notice the cultural differences (customs, religion, gender, language, ethnicity) Track1A.Powell&Hohenhaus--8.20@4pm QC

Objectives Provide examples of personalized and culturally customized teamwork and communication improvement in the US and abroad Identify the multi-cultural barriers to communication and other teamwork skills Create awareness of the mandates for improved teamwork and communication worldwide

What is TeamSTEPPSTM? Evidence Based Public Domain Internet available- Worldwide Access Many expert colleagues have shared the evidence-base for teamwork in patient safety improvement. The AHRQ and Department of Defense made the TS curriculum available in the public domain in November 2006. This is an extensive teamwork curriculum that included trainer materials such as case studies and videos. These materials were posted on the internet and made available to anyone who called the Government Printing Office. The CD/DVD made it portable and easy to send around the world. Googling “teamwork improvement in healthcare” would lead you to the TS site. The proverbial Cat was out of the bag. Crew Resource Management was influential in the development of this curriculum. Two main outcomes of the curriculum are 1) Empowerment of all Team Members (Culture Change) and 2) Improved Team Performance for safer patient outcomes. Track1A.Powell&Hohenhaus--8.20@4pm QC

CRM did not export well at first! High Power-Distance cultures in Asia and many Latin America countries promote absolute authority of leaders Uncertainty Avoidance is high in Korea, Greece and Latin America and low in the US Key factor for CRM acceptance was achieving “cultural harmony” or balance with these national culture dimensions. Helmreich, R., et al. (1999). The Evolution of CRM. IJAP, 9(1), 19-32. High Power Distance cultures tend to be more collectivist (team or group orientation). US is low PD and favors individualism. In the US, harder to tell someone how to do something and expect them to follow the rules (SOP). Uncertainty Avoidance: The need for rule-governed behavior and clearly defined procedures High Uncertainty Avoidance cultures are less likely to question automation or the SOP in which they follow. Low Uncertainty Avoidance cultures have more healthy skepticism. Track1A.Powell&Hohenhaus--8.20@4pm QC

Situation Hierarchy Paternalistic vs. Collaborative Gender Language Religion Socio-economic position

Background Visits to all US regions Visits to all types of clinical settings (rural, urban, suburban, critical access) Visits to international sites Formal training in large groups AND observations and coaching IN THE UNIT

Assessment The issues are the same regardless of what country, ethnicity, language Only the faces change Human error is inevitable Prioritizing the challenges is the challenge

Recommendation Formal communication and teamwork skills training is essential Evidence-based TeamSTEPPSTM creates a common language for teamwork knowledge, performance and attitudes

Debrief S- Cultural barriers in healthcare are universal B- TeamSTEPPSTM is an evidenced-based teamwork curriculum to aid any healthcare organization anywhere A- Implementation of teamwork and communication training across ALL disciplines is incredibly important for safe and effective patient care R- Spread teamwork and communication skills

Lessons Learned Respect local customs Survey the Culture Information age breaking down barriers “LET SBAR help you find your Voice” L-Language (common) E-Empowerment T-Trust and teamwork

Patient Safety and Teamwork Knows NO Boundaries Sense of Urgency Worldwide JCI Patient Safety Goals R2: Closed Loop Communication R4: Use a Pre-procedure √ list R5: Complete a “pre-flight” R6: Include the Patient WHO Patient Safety Solutions Andrea Harris “Beyond Boundaries”

WHO World Alliance for Patient Safety Nine Solutions for Patient Safety Teamwork Competencies in the Solutions S2: Patient Identification S3: Communication during Handovers S4: Correct procedure/Correct patient S6: Assuring medication accuracy at handovers S9: Improved hand hygiene Sir Liam Donaldson, Chair of the Alliance and Chief Medical Officer for England, said: “Patient safety is now recognized as a priority by health systems around the world.”

Changing National Culture Dimensions Traveling Nurses from abroad Almost 12 percent of nurses in the U.S., and 20 percent of physicians, are foreign born Foreign National MDs 40,000 Indian Physicians in US 105,300 Asian Physicians in US 1000 physician J1 VISA exemptions annually mostly for rural MD coverage US Census Bureau 2005

What about our patients? 49.6 million Americans (19%) speak a language other than English at home Between 1990-2000, this number grew by 15.1 million or 47% In ED visits, no interpreter was used in 46% of patients with limited English Only 23% of US teaching hospitals provide training for clinicians working with interpreters Flores, G. (2006). Language Barriers to Health Care in the United States. NEJM, 355:3

Teamwork & Cultural Dimensions Lingard, L. 2006 The Wilson Centre of the Canadian Patient Safety Institute.

Questions