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Implementing TeamSTEPPS to Improve Patient & Staff Safety
Texas Health Resources Marcie Williams RN, MS, FASHRM, CPHRM, CPPS, CLNC Vice President, Safety & Risk Management
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Objectives Understand the importance of Leadership in successfully implementing TeamSTEPPS Explain the importance of early metrics selection Describe 3 pilot site selection criteria for successful TeamSTEPPS implementation State 3 implementation success factors for TeamSTEPPS and how they can be applicable to your healthcare system or hospital
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Texas Health Resources
24 centers in North Texas (14 wholly owned hospitals) Over 4,100 licensed beds 133,903 inpatient discharges 1,238,929 outpatient encounters 469,309 ER visits 89,452 surgeries 27,200 deliveries Updated demographics from Marketing 5,500 active physicians 21,775 employees
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Importance of Effective Communication
Communication failure has been identified as a leading root cause of sentinel events over the past 10 years (Joint Commission) Communication failure is a primary contributing factor in almost 80% of more than 6000 root cause analyses of adverse events and close calls (VA Center for Patient Safety Supporting info: The Joint Commission analyzed the sentinel events that were reported to them over the last 10 years and identified communication failure as the leading root cause of sentinel events. The Veterans Administration (VA) National Center for Patient Safety database shows similar results, with communication failure cited as a primary contributing factor to adverse events and close calls. 4
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Patient Safety Movement
Institute for Healthcare Improvement 100K lives Campaign TeamSTEPPS “To Err is Human” IOM Report National Implementation of TeamSTEPPS JCAHO National Patient Safety Goals DoD MedTeams® ED Study Patient Safety and Quality Improvement Act of 2005 Executive Memo from President Adoption by Military Health System from Arm yourself with the evidence based research that medical team training improves effective communication and thus reduces preventable injuries. 1995 1999 2001 2003 2004 2005 2006 2008 2011 Medical Team Training 5
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Medical Team Training Johns Hopkins Johns Hopkins
Beth Israel Deaconess Medical Center OB/GYN
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WHO Surgical Checklist “Checklist Manifesto”
Annals of Surgery, Sept 2010 Medical Team Training Supports Improvement in Dept Performance, Reduced Complications, Increased Staff and Physician Communication & Satisfaction Build the case for spread
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TeamSTEPPS Implementation Considerations
Be ready for the resistors – get Sr. Leaders on board early Training materials free, easily accessed via internet – copying fees for education materials Cost for distributing teaching aids Vendor Selection – needed or not? Agency for Healthcare Research and Quality well respected and known to influence national initiatives, including CMS Discuss with leaders how the TS tools directly influence your PS Culture Survey and HCAHPS scores, especially nurse comm and discharge instructions
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Metrics Selection Patient Safety Culture Survey pre implementation results vs post implementation results Direct on site observations pre and post implementation using the TS observation tool - THR added to each metric observation criteria or questions to ask during the interview process to provide consistency and observer reliability Pre and post implementation HCAHPS scores Stories sell – collect them and share Begin with the end in mind
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TeamSTEPPS framework builds on team skills
The TeamSTEPPS tools include many things we already do... but also adds new team skill sets to assure effective communication Performance Leader- ship Communi- cation Situation monitoring Mutual support From the beginning discuss that its not a new “program” but TS provides the framework for comm tools already being used, SBAR, Speaking up, Shift change between chg nurses and supervisors, huddles following an event or pt injury, repeat backs, hand offs Patient care team Skills Knowledge Attitudes
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Learning the Language 1. Briefs Leadership 2. Huddles 3. Debriefs
Communication 7. SBAR 8. Call-outs 9. Check-backs 10. Hand-offs Leadership 1. Briefs 2. Huddles 3. Debriefs Situation Monitoring 4. Situational awareness – Cross monitoring Mutual Support 5. Task assistance 6. CUS Decide on which tools to use 11
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IMPLEMENTATION PLAN
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Approach Overview Baseline and pilot preparation Pilot implementation
90 days 10 Months 2 years Baseline and pilot preparation Pilot implementation Large scale rollout Vision Setting Pilot Selection Comprehensive baseline Pre observations PS Culture Survey Satisfaction Results Pilot preparation and design Pilot execution Pilot monitoring and refinement Large scale rollout plan Whether for a system or hospital you need a process map or timeline. Vision setting – leaders, influential groups, educators Pilot selection – based on a positive dept, solid leadership will drive accountability 24/7 Rollout – Wave 1 Rollout – Wave 2 Pre Obs Ongoing monitoring and refinement Leadership meetings Corp Approval Pre Observations Pilot Launch Pilot Mid year Check Pilot Post Obs Mst Trainer Ed Non-Clinical 2012 Progress check Post Obs PSC Survey
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Pilot Site Selection Criteria
Criterion considered Description Leadership (Sr.) Leadership ready, willing and able to support initiative Svc Line/Dept Size Needs to be large enough for multiple team players Department Culture Culture open to change Positioned for success Nurse leadership & support Likelihood of broad nursing participation / support and availability of local champions Willingness to communicate openly Encourage feedback as to what works well, and what changes are needed Dept open to honest feedback Safety culture scores Strength of safety culture as measured by PSC survey Adverse Events Willingness to report Positive staff attitude Indicator of being open to team training and use of tools Educator support Dedicated resource to train and reinforce tool utilization Must haves Variables
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Direct Observation Tool
Observer – Master or Champion trained Developed to ensure observer objectivity and consistency When completing a Service Line takes 4-6 hours When completing a Dept takes 2-3 hours Complete all shifts so the staff understand this is not just for one shift Observer not completing in home dept
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Perinatal Pilot Meeting with Formal leaders
Patient Safety Culture Survey Trained hospital Risk Managers/Patient Safety as the facilitators Pre-implementation Observations Selection of Champions (3-5 from each dept within the service line)
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Perinatal Pilot Champion training
Formal and informal leaders from each shift Educators to maintain the focus Staff Education slides with talking points Mid year sampling observations Champion meeting connecting the dots between patient safety programs and TeamSTEPPS Shared stories with Leadership and staff End of year post implementation observations
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Pilot Results Opportunities for Improvement Strengths
Effectively using TS tools in critical situations in early implementation Successful shift briefs with dept leaders in the service line Consistent use of SBAR and handoffs Improved intercollaborative discharge briefings in certain departments Use of the word “concern” stops the line Early Sr. leadership engagement Improve physician engagement Ensuring use of the TS common language Consistent debriefings Good leadership needed in the service line to set the expectation that TS is 24/7 Shorten length of pilot
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0 = expected but not observed or found in
discussions with staff 1 = observed/discussions but poor 2 = observed/discussions but marginal 3 = observed/discussions and acceptable 4 = observed/discussions and good
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PG Patient Satisfaction Scores Post TeamSTEPPS Implementation OB/GYN
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System Implementation
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Operationalize TeamSTEPPS
Develop education for several levels Need a committed leader Physician engagement – elevator speech for brief conversations or info in lounges Large hospitals - implement per Service Line Small hospitals – Single kick off as staff are cross trained to different departments Implement clinical and non-clinical
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Levels of TeamSTEPPS Education
Facilitator Education (Master Trainer Level) Master Trainers (system Super Users) Champions Training (4 hours session) Staff Training – 1 hour by Champion, all received the TeamSTEPPS Pocket Guide Executive Training (1 hour, basic concepts) Physician Training (20 minutes, what is needed the most for their participation) Did provide a 60 min CME presentation at a couple of Med Staff Exec meetings
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TeamSTEPPS Key Benefits
Performance Adaptability, Accuracy, Productivity, Efficiency, Safety Key Benefits Team Strategies and Tools to Enhance Performance and Patient Safety Improve patient outcomes Actively promote teamwork and communication Create tools so as to communicate effectively Leadership Articulate clear goals through briefs, huddles & debriefs Legend Communication Speak clearly using SBAR, read back, handoff, call out Situation monitoring Ensure all team members are on same page Badge Buddies or Table Cards Skills Mutual Support Ask for and offer task assistance, CUS Outcomes Patient Care Team Knowledge Shared mental model Attitudes Mutual trust, Team Orientation
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TeamSTEPPS Language Definitions
Leadership Brief: Planned, assign roles, establish expectations, anticipate outcomes Huddle: Gather as needed to discuss critical issues & emerging events Debrief: End of activity, discuss what went well and what we can do better Situation monitoring Situation awareness: Know what is going on around you, including cross monitoring your team members Mutual support Task assistance: Ask for and offer support with all team members CUS: When appropriate, use a CUS word: I am ONCERNED! I am NCOMFORTABLE! This is a AFETY ISSUE! Communication SBAR: Summarize your critical messages in a standard format – Situation, Background, Assessment, Recommendation Call-out: Communicate important information and inform team members simultaneously during emergency situations Check-Back: Verbally confirm instructions – "closing the loop" Handoff: During transitions in care, clearly transfer both information and accountability – make sure to offer opportunity for questions CUS The back
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TeamSTEPPS Team Strategies and Tools to Enhance Performance and Patient Safety What is it? TeamSTEPPS is an evidence-based communication toolkit to improve team performance across the health care delivery system. Team Competency Outcomes Knowledge – how to understand being on the “same page” Attitudes – the importance of “team” orientation” Performance – improve safety and outcomes in your daily practice Posters, fliers, physician lounges, newsletters, alerts This is not a new program but a framework in which we can communicate more effectively with each other.
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Integrating TeamSTEPPS into Patient Safety Initiatives
Not just another program Presented as a framework for many existing communication activities Added to the annual goals for Dept Managers TeamSTEPPS prior to Safe Surgery Initiative Integrated into job descriptions Integrated into event investigations Integrated into electronic health record’s procedural and surgical checklists Checklists refer to briefing and debriefing
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TeamSTEPPS Corporate Implementation Checklist
√ Responsible Task Comment Deliverable Date Marcie RMs note of Thank you 1-31 Marcie CQOs and CNOs their Master Trainer Attendees and encourage them. Have them ask about elevator speech. How do they want to receive training? Jeanne Checklist for RMs implementation 2-4 Marcie, Faye, Jeanne Physician Engagement Card With the next printing do we need to add check backs, call-outs as closing the loop communication – something the BCG consultants are discussing? Next Printing Redo Champion Slides with videos inserted Will revise when Champion books are gone. If Champion slides with notes are revised to include only slides used then good videos could be inserted. Check with Jeanne on plans of revising them Check back on 4-30 HEB Video at beginning of Champion Training discussing how well Perinatal did. Jeanne to put in Champion slides used by instructors Marcie, Faye, Jeanne, and Patricia Develop “Trainer Guide for Champion Training” – take slide set and write talking points 2/5 Marcie done - to Jeanne 2/5 Faye almost done Will slide set only have slides that are discussed? Can Patricia do these? Discuss with Patricia by 2-11 Need checklists to keep you on track with competing priorities
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TeamSTEPPS Hospital Implementation Checklist
√ Responsible Task Comment Deliverable Date Meet with entity leadership for TS implementation plan for service lines. Contact Michelle Hutson with rollout plan to schedule pre-observation for service line. Decide if entity wants specific department pre-observations. Can use the observation tool with Tier II’s. Approach the selected department manager with TS overview. Select department champions for selected departments. 4 hour department champion training for either at entity or system services. Can use entity Master trainers. Contact Jeanne Campbell to schedule System Services MT to come to your entity or to sign up for the 4 hour training at THR.
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Implementation Success Factors
Topic Key success factors Implementation philosophy & approach TeamSTEPPS is consistently used throughout THR as the communication and patient safety language. An understanding exists that good teamwork results in reducing preventable errors, better patient outcomes, reducing length of stay, etc. Constantly engage physicians and diverse stakeholders recognizing the value of interdisciplinary teams. Initiative leadership Executive and department leaders visibly endorse and support TeamSTEPPS. Physician department leaders support utilization of the TeamSTEPPS tools. Improve Satisfaction Patient Satisfaction responses improve for the question “Staff works together to provide patient care”. Reduce turnover times in the OR and Procedural areas SBAR used to communicate critical patient information via the phone. Stakeholder engagement Stories shared to demonstrate TeamSTEPPS successes. Direct observations reflect engaged stakeholders in the TeamSTEPPS process. Publicize progress (e.g., newsletters, publications, state or national conferences, hospital Patient Safety newsletters, etc.) Sustained performance Improved performance in the Patient Safety Culture Survey with all hospitals at no less than the 75th %tile in all categories. Direct observations during the observation survey reflect active implementation of the TeamSTEPPS tools. TeamSTEPPS training provided to all new employees. Annual performance review demonstrates assessment of using the TS tools & team competencies. 30
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