1. TeamSTEPPS: Practical Tools to Create a Better Environment for You, Your Teams and Your HRO to Thrive
January 25, 2019
Christopher Hund, MFA
Jen Braun, MPH

2. Today’s Facilitators Jennifer Braun, MPH Christopher Hund, MFA
Both
Mention Kip/Michelle/Bob
Christopher Hund, MFA
Director
AHA Center for Health Innovation
Jennifer Braun, MPH
Senior Program Manager
AHA Center for Health Innovation

3. Today, we’ll…
Learn how TeamSTEPPS principles and tools can be used both clinically and non-clinically.
Demonstrate an understanding of TeamSTEPPS principles and tools through interactive activities.
Connect TeamSTEPPS principles and tools to improve collaboration and strengthen HRO efforts.
Determine a plan for what you’ll do Today, Tomorrow and in Two Weeks.
Chris

4. Some Considerations We’re covering a lot together
We’ll keep it super interactive
When you coach others try to connect the tools to what they are already doing
This shouldn’t be another initiative

5. Exercise #1 RULES You have 90 seconds to build the tallest tower
You must follow the building pattern: one large, three small
No two of the same color may touch
There are:
RUNNERS – only can be runners
BUILDERS– only can be builders
ONLY 5 items per runner/per trip
All unused materials must be returned before ‘TIME’ is called

6. Debrief What went well? What could be improved?
If you had a chance to do this again, what would you do different?

7. Why is Teamwork Important?
Two jumbo jet crashes/day
29 airline passengers dying/hour
688 airline passengers dying/day
Barb

8. Why TeamSTEPPS?
Joint Commission reports that 79% of adverse events are down to failures in
Leadership
Communication
Human factors
PCMH Certification focuses on
Care coordination
How effectively a primary care clinician and interdisciplinary team work in partnership with the patient

9. What’s Your Familiarity with TeamSTEPPS?
Team Strategies and Tools to Enhance Performance and Patient Safety
Evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals
Communication
Leadership
Situation Monitoring
Mutual Support

10. High Performing Teams What makes a high performing team?
Teams that perform well:
Hold shared mental models
Have clear roles and responsibilities
Have clear, valued, and shared vision
Optimize resources
Have strong team leadership
Engage in a regular discipline of feedback
Develop a strong sense of collective trust and confidence
Create mechanisms to cooperate and coordinate
Manage and optimize performance outcomes
(Salas, et al., 2004)

11. Shared Mental Model on HROs
Sensitivity to Operations
Preoccupation with Failure
Deference to Expertise
Resilience
Reluctance to Simplify Interpretations

12. TeamSTEPPS Tools BARRIERS TOOLS and STRATEGIES OUTCOMES
Inconsistency in Team Membership
Lack of Time
Lack of Information Sharing
Hierarchy
Defensiveness
Conventional Thinking
Complacency
Varying Communication Styles
Conflict
Lack of Coordination and Followup With Coworkers
Distractions
Fatigue
Workload
Misinterpretation of Cues
Lack of Role Clarity
TOOLS and STRATEGIES
Communication
SBAR
Call-Out
Check-Back
Handoff
Leading Teams
Brief
Huddle
Debrief
Situation Monitoring
STEP
I’M SAFE
Mutual Support
Task Assistance
Feedback
Assertive Statement
Two-Challenge Rule
CUS
DESC Script
OUTCOMES
Shared Mental Model
Adaptability
Team Orientation
Mutual Trust
Team Performance
Patient Safety!!

13. Communication Effective Communication must be:
complete: relevant information avoiding unnecessary detail
clear: standard terminology, minimize an acronyms
brief: be concise
timely: avoid delays, verify, validate or acknowledge

15. SBAR
A framework for team members to effectively communicate information to one another
Communicate the following information:
Situation―What is going on currently?
Background―What is the background or context?
Assessment―What do I think?
Recommendation/Request―What would I recommend or request?

16. Non-Clinical Ways to use SBAR
Report outs in meetings
1:1 verbal communication s
Presentations
Proposals
Handoff on tasks
Other creative ideas

18. SBAR Exercise (1-Table-All)

19. Strengthening Your HRO with SBAR
Encourages sensitivity to operations through
Use of a standardized communication format that is clear, brief, complete, timely
Allows for deference to expertise in the Assessment and Recommendation phases

20. Call-Outs and Check-Backs

21. Example

22. Strengthening Your HRO with Closed-Loop Communication
Encourages a sensitivity to operations as increased situational awareness leads to an improved shared mental model.
Improves resilience. This is a non-negotiable process that cuts down on crushing errors.

23. Ant video

24. Leading Teams What are some key attributes of leading a team?
Identify and articulate clear goals
Facilitate information sharing
Model effective team work
Encourage team member to assist one another
Manage and allocate resources
Task assignment, prioritization, reassignment

25. Brief, Huddle, Debrief Brief
Short sessions prior to the start of something (share the plan, discuss team formation, assign roles and responsibilities, establish expectations)
Huddle
Ad hoc meetings (re-establish situational awareness, reinforce plans and assess the need to adjust the plan)
Debrief
Review the team’s performance (what went well, what can be improved, what’s one thing you’ll do different next time)

26. Exercise #2 RULES No two of the same color may touch
You have 15 seconds to conduct a brief
You have 75 seconds to build the tallest tower
No two of the same color may touch
There are:
RUNNERS who can only be runners
BUILDERS who can only be builders
Only 5 items per runner per trip
All unused material must be returned before time is called

27. Change of Plans!! All runners have to become builders
All builders have to become runners

28. Debrief What went well? What could be improved?
If you had a chance to do this again, what would you do different?

29. Strengthening Your HRO with B/H/DB
Improving sensitivity to operations by understanding the work being done by those who do it
Supporting a healthy preoccupation with failure by providing time
Review and address
Plan and prepare to fix
In this way resilience is also supported

30. break

31. Mutual Support
Team members protect each other from work overload situations
Team members foster a climate where it is expected that assistance will be actively sought and offered
Team members are comfortable flagging errors or concerns

32. Mutual Support

33. CUS (In the moment…) CUS Clinical CUS Non-Clinical I am CONCERNED!
I am UNCOMFORTABLE!
This is a SAFETY ISSUE!
This is a SUCCESS ISSUE!

34. A DESC (A bit later…)
A constructive approaching for communicating and providing feedback
A = Ask…is now a good time to talk?
D = Describe the specific situation
E = Express/Explain your concerns
S = Suggest other alternatives
C = Consequences should be stated
Does not need to be negative
Not meant to be an ultimatum or threat
C = Consensus/Conclusion

35. Strengthening Your HRO with CUS and DESC
Encourages a culture with a deference to expertise as it allows for someone to speak up and for the listener to hear them
Creates a more resilient environment
Strengthens a sensitivity to operations through the use of standardized language

36. Situation Monitoring
Why is it important to monitor what is going on around you?
Ensures new or changing information is identified for communication and decision-making
Leads to effective support of fellow team members

37. Situation Monitoring (Individual Skill)
Situation Awareness (Individual Outcome)
Shared Mental Model (Team Outcome)
Situation Monitoring: the process of continually scanning and assessing a situation to gain and maintain an understanding of what’s going on around you.

38. A Situation Monitoring Tool
Status of the patient:
Patient History
Vital Signs
Medications
Physical Exam
Plan of Care
Psychosocial Condition

39. Team Members Fatigue Workload Task Performance Skill Level
Stress Level

40. Environment Facility Information Administrative Information
Human Resources
Triage Acuity
Equipment

41. Progress Toward Goal Call a Huddle! Status of Team’s Patient(s)
Goal of Team
Tasks/Actions That Are or Need To Be Completed
Plan Still Appropriate?

42. Situation Awareness (Individual Outcome)
Situation Monitoring (Individual Skill)
Situation Awareness (Individual Outcome)
Shared Mental Model (Team Outcome)
Situation Awareness: the state of “knowing what’s going on around you.”

43. Shared Mental Model (Team Outcome)
Situation Monitoring (Individual Skill)
Situation Awareness (Individual Outcome)
Shared Mental Model (Team Outcome)
Shared Mental Model: results from each team member maintaining situation awareness and ensures that all team members are “on the same page.”
Check for this in your briefs, debriefs, and huddles!

44. Shared Mental Model

45. Strengthening Your HRO with SA
Coming to that Hive Mind state is the ultimate sensitivity to operations
Everyone knowing what is going on with everyone leads to greater resilience

46. So, how do we get a SMM as a Team?
When:
How:
Briefs
SBAR
Huddles
Call-outs
Debriefs
Check-backs
CUS
DESC
STEP

47. What About Reluctance to Simplify?
Being reluctant to simplify doesn’t mean we shouldn’t have standardized language and processes.
It means also to continually ask questions and find the cause (5 whys)
Check for it in debriefs
Encourage it through all the ways you speak up

48. Exercise #3 Each team will designate a leader.
Only the leader can view the algorithm.
The leader may not view the tower as it is being built.
You will have 30 seconds to brief.
You will have 2 minutes to build the tallest tower.
Runners may only take 5 items per trip.
Runners are not allowed to build and builders are not allowed to run.
Any unused materials that are not returned when time is called will be counted against the overall height of the tower.

49. Debrief What went well? What could be improved?
If you had a chance to do this again, what would you do different?

50. Today, Tomorrow, Two Weeks
What can you do after you walk out the door today?
What can you do tomorrow?
What do you want to accomplish two weeks from now?

51. Contact Us AHA TEAM TRAINING
Web: 
Phone: 
All
*Note: we should debrief with the participants on how the course went