1. Mutual Support

2. Mutually supportive???

3. Mutual support & teamwork  Willingness and preparedness to assist others, and to ask for assistance when needed  In support of patient safety, it should be expected  Mutual support is the essence of teamwork

4. What kind of team do you think your work group is most like? How does this affect teamwork?

5. Mutual support: How does it fit into the TeamSTEPPS puzzle?  Willingness and preparedness to assist others, enhanced by team leadership  Ability to anticipate patient needs and other team members’ needs, supporting situation awareness  Moderated by communication

6. What are some of the situational factors that influence workload and the need for mutual support in your area?

7. What behaviors do you currently see, or would you like to see, in your work area to enhance mutual support?

8. Tools for mutual support  Task assistance  Feedback  Advocacy and assertion  Conflict resolution

9. Task assistance  Guided by situation monitoring, allows team members to identify need for assistance  Can be influenced by: type of situation, attitudes/beliefs, communication styles  What can happen when we don’t seek task assistance?

10. Task assistance  Remember to: Communicate clear and specific availability of time and skills Foster climate supportive of task assistance- may start “domino effect” Use common courtesy when asking for help Close the loop- ensure task was completed correctly Account for experience level

11. Feedback  Benefits team in several ways: Fosters improvement in work performance Meet’s team’s and individual’s need for growth Promotes better working relationships Helps team set goals for ongoing improvement

12. Feedback  Formal or informal  Constructive feedback Task-specific, focuses attention on performance, not individual Provided by all team members, provided regularly  Evaluative feedback Focused on individual’s performance based on standards or past performance Usually provided by mentor/coach/supervisor

13. Feedback  Effective feedback (positive or negative) is: Timely Respectful Specific Directed Considerate  Unacceptable negative feedback: Delayed Publicly delivered (negative)

14. Advocacy, assertion, and conflict resolution  Advocating for patients and asserting viewpoints are important aspects of mutual support  May lead to conflict even when used correctly  Conflict resolution skills needed to handle interactions resulting from system and patient care problems

15. Advocacy, assertion, and conflict resolution  Scenario: A recovery room nurse is caring for a 4 year old patient who just had a tonsillectomy. The surgeon and the anesthesiologist have both stated that the patient is well enough for discharge. The RN checks the patient’s vital signs one last time and notes that the patient’s respiratory rate is lower than before, and the patient’s oxygen saturation dips into the 80’s frequently when the patient is sleeping. Despite concerns, the nurse discharges the patient because both physicians made it clear that the patient is well enough to go home, and both doctors are very busy that day and aren’t in very good moods. Besides, both are well-respected authorities in the hospital.

16. Advocacy and assertion  Techniques are invoked when team member’s viewpoint does not coincide with that of a decision maker  Correct errors or loss of situation awareness  Should be firm and respectful

17. The Assertive Statement  Respect and support authority  Clearly assert concerns and suggestions  Use an Assertive statement (nonthreatening; ensures that critical information is addressed) Make an opening State the concern State the problem Offer a solution Reach an agreement

18. Conflict resolution  Two types of conflict:  Information conflict Impersonal, involves different views, ideas, & opinions  Personal conflict Stems from interpersonal compatibility, not usually task-related  Both types should be addressed before interfering with work, compromising quality and safety

19. Conflict resolution strategies…

20. Two-Challenge Rule  Invoked by any team member when initial assertion ignored…  Your responsibility to assertively voice your concern at least 2 times to ensure it has been heard  Member being challenged must acknowledge  If outcome still not acceptable: Take stronger course of action Use chain of command

21. CUS  Utilizes “signal” words to catch people’s attention  C: “I am concerned…”  U: “This makes me uncomfortable because…”  S: “I believe that this is a safety risk.”

22. DESC script  Used if conflict becomes personal in nature  D: Describe the specific situation  E: Express your concerns about the situation  S: Suggest other alternatives  C: Consequences should be stated

23. Tips for using DESC  Have timely discussion  Choose the location (away from patients/other staff)  Frame problem from your own experience  Use “I” statements to minimize defensiveness  Avoid blaming statements  Critique is not criticism  Focus on what is right, not who is right

24. Common approaches to conflict resolution  Several common methods do not result in best outcome: Compromise- both parties settle for less Avoidance- issues ignored or sidestepped Accommodation- focus on preserving relationships, rather than safety and patient care Dominance- conflict managed through directives for change

25. Goal: Collaboration

26.  Win-Win-Win situation (team members, team, and patient)  Requires commitment to common mission  Is a process, not an event  Meet goals without compromising relationships

27. Challenges to collaboration  Time Use: task assistance  Hierarchy Use: Assertive statements, respectful feedback, focus on quality and safety  Defensiveness Use: Two-Challenge Rule  Conventional thinking/Culture Encourage mutual support, work to fight “rite of passage” mentality

28. Culture is affected by behavior. If behavior is exhibited consistently, it becomes part of the culture.