1. Strategies and Tools to Enhance Performance and Patient Safety Adoption in Action AHRQ funded project UNCHCS/RTI partnership

2. T EAM STEPPS 05.2 Mod 1 05.2 Page 2 Introduction Mod 1 06.2 Page 2 Institute of Medicine, 1999 Annually, 44,000-98,000 patients die in hospitals due to preventable medical error More than motor vehicle accidents, breast cancer, and AIDS

3. T EAM STEPPS 05.2 Mod 1 05.2 Page 3 Introduction Mod 1 06.2 Page 3 5 year study: 2002-2007 Stratified random sample of 10 hospitals in NC 100 admissions reviewed/quarter for a total of 2341 admissions Internal reviewers identified 588 harms among 2341 admissions (25.1 harms/100 admissions) 364 of the 588 harms were preventable (15.5 harms/100 admissions) No significant change in rate of harms per 1000 patient-days NEJM363;22 Nov 25, 2010 NY Times: search Improving Patient Safety (last 12 months)

4. T EAM STEPPS 05.2 Mod 1 05.2 Page 4 Introduction Mod 1 06.2 Page 4 Johns Hopkins receives $10 million for the establishment of the Armstrong Institute for Patient Safety and Quality: headed by Peter Pronovost, MD PhD, new center will conduct research and develop methods for use worldwide May 26 th, 2011

5. T EAM STEPPS 05.2 Mod 1 05.2 Page 5 Introduction Mod 1 06.2 Page 5

6. T EAM STEPPS 05.2 Mod 1 05.2 Page 6 Introduction Mod 1 06.2 Page 6 PICU Story

7. T EAM STEPPS 05.2 Mod 1 05.2 Page 7 Introduction Mod 1 06.2 Page 7 7 Objectives Describe effective team structure Describe effective leadership and leadership skills Describe the relationship between situation monitoring, shared mental models, and team effectiveness Describe effective verbal and task related mutual support Describe effective communication skills Recognize barriers to effective teamwork

8. T EAM STEPPS 05.2 Mod 1 05.2 Page 8 Introduction Mod 1 06.2 Page 8 8 Teamwork Is All Around Us

9. T EAM STEPPS 05.2 Mod 1 05.2 Page 9 Introduction Mod 1 06.2 Page 9 9

10. T EAM STEPPS 05.2 Mod 1 05.2 Page 10 Introduction Mod 1 06.2 Page 10 10 Why Do Errors Occur—Some Obstacles Workload fluctuations Interruptions Fatigue Multi-tasking Failure to follow up Poor handoffs Ineffective communication Not following protocol Excessive professional courtesy Halo effect Passenger syndrome Hidden agenda Complacency High-risk phase Strength of an idea Task (target) fixation

11. T EAM STEPPS 05.2 Mod 1 05.2 Page 11 Introduction Mod 1 06.2 Page 11 11 Multi-Team System for Patient Care Contingency Teams

12. Team Structure

13. T EAM STEPPS 05.2 Mod 1 05.2 Page 13 Introduction Mod 1 06.2 Page 13 13 What are the roles in your team? Who are the team leaders in your unit? Who are the team members in your unit? How do they make decisions? How do they manage resources? How do team roles change from situation to situation? Can it be done better?

14. T EAM STEPPS 05.2 Mod 1 05.2 Page 14 Introduction Mod 1 06.2 Page 14 14 Required Skills for Team Performance Leadership Situation Awareness Mutual Support Communication

15. T EAM STEPPS 05.2 Mod 1 05.2 Page 15 Introduction Mod 1 06.2 Page 15 15 Effective Team Leaders Organize the team Articulate clear goals Make decisions through collective input of members Empower members to speak up and challenge, when appropriate Actively promote and facilitate good teamwork Skillful at conflict resolution

16. Team Events Briefs – planning Huddles – problem solving Debriefs – process improvement Leaders are responsible to assemble the team and facilitate team events But remember… Anyone can request a brief, huddle, or debrief 16

17. T EAM STEPPS 05.2 Mod 1 05.2 Page 17 Introduction Mod 1 06.2 Page 17 17 Briefing Team membership and roles Clinical status of the patient Team goals and potential pitfalls Resources

18. T EAM STEPPS 05.2 Mod 1 05.2 Page 18 Introduction Mod 1 06.2 Page 18 18

19. T EAM STEPPS 05.2 Mod 1 05.2 Page 19 Introduction Mod 1 06.2 Page 19 19 Team Huddles

20. T EAM STEPPS 05.2 Mod 1 05.2 Page 20 Introduction Mod 1 06.2 Page 20 20

21. T EAM STEPPS 05.2 Mod 1 05.2 Page 21 Introduction Mod 1 06.2 Page 21 21 Debriefs Debriefs should be conducted for the following reasons: So team members learn from actual situations So learning takes place collectively So team members can exchange information So teams can improve performance

22. T EAM STEPPS 05.2 Mod 1 05.2 Page 22 Introduction Mod 1 06.2 Page 22 22 Delegation of Resources Delegation is a means of managing resources whereby information, equipment, and key staff are allocated to specific tasks.

23. T EAM STEPPS 05.2 Mod 1 05.2 Page 23 Introduction Mod 1 06.2 Page 23 23 How Do You Delegate? Ask yourself: What tasks need to be done? Who has the skill set? (non-hierarchal) Who has the time? Clearly communicate the task Request feedback (closed loop communication) that task is completed Communication style influences process Delegation is a skill that anyone can learn.

24. T EAM STEPPS 05.2 Mod 1 05.2 Page 24 Introduction Mod 1 06.2 Page 24 24 Modeling Teamwork Effective team leaders utilize the team skills in their daily practice and encourage team behaviors by: Sharing information Displaying appropriate communication, monitoring, and support behaviors Helping team members achieve the effective team performance using the same behaviors Encouraging active participation by all team members

25. T EAM STEPPS 05.2 Mod 1 05.2 Page 25 Introduction Mod 1 06.2 Page 25 25 Required Skills for Team Performance Leadership Situation Awareness Mutual Support Communication

26. T EAM STEPPS 05.2 Mod 1 05.2 Page 26 Introduction Mod 1 06.2 Page 26 26 A Continuous Process

27. T EAM STEPPS 05.2 Mod 1 05.2 Page 27 Introduction Mod 1 06.2 Page 27 27 How can I contribute to a Shared Mental Model? Routinely update others Acknowledge deviations or changes in the situation Alert team to actual or potential problems Verbalize a course of action Request needed information

28. T EAM STEPPS 05.2 Mod 1 05.2 Page 28 Introduction Mod 1 06.2 Page 28 28 When to Share? Briefs Huddles Debriefs Shift Changes Handing off care to another

29. T EAM STEPPS 05.2 Mod 1 05.2 Page 29 Introduction Mod 1 06.2 Page 29 29 Required Skills for Team Performance Leadership Situation Awareness Mutual Support Communication

30. T EAM STEPPS 05.2 Mod 1 05.2 Page 30 Introduction Mod 1 06.2 Page 30 30 Mutual Support Mutual support is the essence of teamwork Protects team members from work overload situations that may reduce effectiveness and increase the risk of error Mutual support consists of helping your fellow teammates by offering assistance Two kinds of mutual support Task related Verbal

31. T EAM STEPPS 05.2 Mod 1 05.2 Page 31 Introduction Mod 1 06.2 Page 31 31 I’M SAFE Checklist I=Illness M=Medication S=Stress A=Alcohol and Drugs F=Fatigue E=Eating, Elimination, and Emotions

32. T EAM STEPPS 05.2 Mod 1 05.2 Page 32 Introduction Mod 1 06.2 Page 32 32 Required Skills for Team Performance Leadership Situation Awareness Mutual Support Communication

33. T EAM STEPPS 05.2 Mod 1 05.2 Page 33 Introduction Mod 1 06.2 Page 33 33

34. T EAM STEPPS 05.2 Mod 1 05.2 Page 34 Introduction Mod 1 06.2 Page 34 34 Please Use CUS Words but only when appropriate!

35. T EAM STEPPS 05.2 Mod 1 05.2 Page 35 Introduction Mod 1 06.2 Page 35 35

36. T EAM STEPPS 05.2 Mod 1 05.2 Page 36 Introduction Mod 1 06.2 Page 36 36 “I need clarity.”

37. T EAM STEPPS 05.2 Mod 1 05.2 Page 37 Introduction Mod 1 06.2 Page 37 37 SBARq SBARq is a technique for communicating clearly and concisely. Communicate the following information: Situation Background Assessment Recommendation Any Questions?

38. T EAM STEPPS 05.2 Mod 1 05.2 Page 38 Introduction Mod 1 06.2 Page 38 38

39. T EAM STEPPS 05.2 Mod 1 05.2 Page 39 Introduction Mod 1 06.2 Page 39 39 Be Complete and Brief

40. T EAM STEPPS 05.2 Mod 1 05.2 Page 40 Introduction Mod 1 06.2 Page 40 Be Clear

41. T EAM STEPPS 05.2 Mod 1 05.2 Page 41 Introduction Mod 1 06.2 Page 41 41 Be Timely

42. T EAM STEPPS 05.2 Mod 1 05.2 Page 42 Introduction Mod 1 06.2 Page 42 42 Check Back Receiver accepts the message and provides feedback confirmation Sender initiates the message Sender verifies that the message was received

43. T EAM STEPPS 05.2 Mod 1 05.2 Page 43 Introduction Mod 1 06.2 Page 43 43 Callout A strategy used to communicate important or critical information. It informs all team members simultaneously during emergency situations It helps team members anticipate next steps On you unit, what information would you want called out?

44. T EAM STEPPS 05.2 Mod 1 05.2 Page 44 Introduction Mod 1 06.2 Page 44 44 Role Play exercise

45. T EAM STEPPS 05.2 Mod 1 05.2 Page 45 Introduction Mod 1 06.2 Page 45 45

46. T EAM STEPPS 05.2 Mod 1 05.2 Page 46 Introduction Mod 1 06.2 Page 46 46 Thank You