1. Strategies and Tools to Enhance Performance and Patient Safety

2. T EAM STEPPS 05.2 Mod 1 05.2 Page 2 Introduction Mod 1 06.2 Page 2 2 Objectives Describe the TeamSTEPPS training initiative Explain your organization’s patient safety program Describe the impact of errors and why they occur Describe the TeamSTEPPS framework State the outcomes of the TeamSTEPPS framework

3. T EAM STEPPS 05.2 Mod 1 05.2 Page 3 Introduction Mod 1 06.2 Page 3 3 Joint Commission Sentinel Events

4. T EAM STEPPS 05.2 Mod 1 05.2 Page 4 Introduction Mod 1 06.2 Page 4 4 (Mann, 2006) Beth Israel Deaconess Medical Center Contemporary OB/GYN (Sexton, 2006) Johns Hopkins (Pronovost, 2003) Johns Hopkins Journal of Critical Care Medicine

5. T EAM STEPPS 05.2 Mod 1 05.2 Page 5 Introduction Mod 1 06.2 Page 5 5 “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military, aviation, nuclear power, business and industry…to acquire team competencies” Team Strategies & Tools to Enhance Performance & Patient Safety

6. T EAM STEPPS 05.2 Mod 1 05.2 Page 6 Introduction Mod 1 06.2 Page 6 6 The Components of a Patient Safety Program

7. T EAM STEPPS 05.2 Mod 1 05.2 Page 7 Introduction Mod 1 06.2 Page 7 7 What Comprises Team Performance? Knowledge Cognitions “Think” …team performance is a science…consequences of errors are great… Attitudes Affect “Feel” Skills Behaviors “Do”

8. Team Structure The ratio of We’s to I’s is the best indicator of the development of a team. –Lewis B. Ergen NEXT:

9. T EAM STEPPS 05.2 Mod 1 05.2 Page 9 Introduction Mod 1 06.2 Page 9 9 Two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and have a time-limited membership What Defines a Team?

10. T EAM STEPPS 05.2 Mod 1 05.2 Page 10 Introduction Mod 1 06.2 Page 10 10 High-Performing Teams 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. T EAM STEPPS 05.2 Mod 1 05.2 Page 11 Introduction Mod 1 06.2 Page 11 11 Multi-Team System (MTS) for Patient Care

12. Leadership

13. T EAM STEPPS 05.2 Mod 1 05.2 Page 13 Introduction Mod 1 06.2 Page 13 13 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 Effective Team Leaders

14. T EAM STEPPS 05.2 Mod 1 05.2 Page 14 Introduction Mod 1 06.2 Page 14 14 Core Team Leader Information –Patient & Family –Plan of care –Facilities Time Equipment Information Administrative –Facilities Time Equipment Patient flow Other departments Coordinating Team Leader FOCUS Team & Your Unit FOCUS Support Units Resource Management HUMAN CAPITAL

15. T EAM STEPPS 05.2 Mod 1 05.2 Page 15 Introduction Mod 1 06.2 Page 15 15 Method of re-distributing tasks or assignments Process includes 4 steps: Decide what to delegate Decide to whom to delegate Communicate clear expectations Request feedback Delegation

16. T EAM STEPPS 05.2 Mod 1 05.2 Page 16 Introduction Mod 1 06.2 Page 16 16 Effective leaders cultivate desired team behaviors and skills through: Open sharing of information Role modeling and effectively cueing team members to employ prescribed teamwork behaviors and skills Constructive and timely feedback Facilitation of briefs, huddles, debriefs, and conflict resolution Promoting & Modeling Teamwork

17. T EAM STEPPS 05.2 Mod 1 05.2 Page 17 Introduction Mod 1 06.2 Page 17 17 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

18. T EAM STEPPS 05.2 Mod 1 05.2 Page 18 Introduction Mod 1 06.2 Page 18 18 Teamwork Actions Empower team members to speak freely and ask questions Utilize resources efficiently to maximize team performance Balance workload within the team Delegate tasks or assignments, as appropriate Conduct briefs, huddles, and debriefs Utilize conflict resolution techniques (i.e., Two-Challenge rule and DESC script)

19. Situation Monitoring “Attention to detail is one of the most important details...” –Author Unknown

20. T EAM STEPPS 05.2 Mod 1 05.2 Page 20 Introduction Mod 1 06.2 Page 20 20 A Continuous Process Situation Monitoring (Individual Skill) Situation Awareness (Individual Outcome) Shared Mental Model (Team Outcome)

21. T EAM STEPPS 05.2 Mod 1 05.2 Page 21 Introduction Mod 1 06.2 Page 21 21 Components of Situation Monitoring:

22. T EAM STEPPS 05.2 Mod 1 05.2 Page 22 Introduction Mod 1 06.2 Page 22 22 Knowing the status of a particular event Knowing the status of the team’s patients Understanding the operational issues affecting the team Maintaining mindfulness The state of knowing the current conditions affecting the team’s work Situation Awareness is…

23. T EAM STEPPS 05.2 Mod 1 05.2 Page 23 Introduction Mod 1 06.2 Page 23 23 Conditions that Undermine Situation Awareness (SA) Failure to— Share information with the team Request information from others Direct information to specific team members Include patient or family in communication Utilize resources fully (e.g., status board, automation) Document

24. T EAM STEPPS 05.2 Mod 1 05.2 Page 24 Introduction Mod 1 06.2 Page 24 24 A Shared Mental Model is… The perception of, understanding of, or knowledge about a situation or process that is shared among team members through communication. “Teams that perform well hold shared mental models.” (Rouse, Cannon-Bowers, and Salas 1992)

25. T EAM STEPPS 05.2 Mod 1 05.2 Page 25 Introduction Mod 1 06.2 Page 25 25 Shared Mental Model?

26. T EAM STEPPS 05.2 Mod 1 05.2 Page 26 Introduction Mod 1 06.2 Page 26 26 Teamwork Actions Conduct team exercises to increase situation monitoring skills Share information in a timely fashion Include patient and/or family in communication Use cross monitoring Apply the STEP process when monitoring the situation Foster communication to ensure that all members of the team have a shared mental model Share information during briefs, team huddles, debriefs, and transitions in care “Teams do not seek consensus; they seek the best answer.” – Katzenbach and Smith

27. Mutual Support “A chain is only as strong as its weakest link.” –Author Unknown

28. T EAM STEPPS 05.2 Mod 1 05.2 Page 28 Introduction Mod 1 06.2 Page 28 28 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

29. T EAM STEPPS 05.2 Mod 1 05.2 Page 29 Introduction Mod 1 06.2 Page 29 29 Team members foster a climate in which it is expected that assistance will be actively sought and offered as a method for reducing the occurrence of error. “In support of patient safety, it’s expected!” Task Assistance

30. T EAM STEPPS 05.2 Mod 1 05.2 Page 30 Introduction Mod 1 06.2 Page 30 30 Characteristics of Effective Feedback Good Feedback is— TIMELY RESPECTFUL SPECIFIC DIRECTED toward improvement Helps prevent the same problem from occurring in the future CONSIDERATE “Feedback is where the learning occurs.”

31. T EAM STEPPS 05.2 Mod 1 05.2 Page 31 Introduction Mod 1 06.2 Page 31 31 Advocate for the patient Invoked when team members’ viewpoints don’t coincide with that of a decision maker Assert a corrective action in a firm and respectful manner Advocacy and Assertion

32. T EAM STEPPS 05.2 Mod 1 05.2 Page 32 Introduction Mod 1 06.2 Page 32 32 Conflict Resolution Options Information Conflict (We have different information!) Two-Challenge rule Personal Conflict (Hostile and harassing behavior) DESC script

33. T EAM STEPPS 05.2 Mod 1 05.2 Page 33 Introduction Mod 1 06.2 Page 33 33 Please Use CUS Words but only when appropriate!

34. T EAM STEPPS 05.2 Mod 1 05.2 Page 34 Introduction Mod 1 06.2 Page 34 34 Conflict Resolution DESC Script A constructive approach for managing and resolving conflict D —Describe the specific situation E —Express your concerns about the action S —Suggest other alternatives C —Consequences should be stated Ultimately, consensus shall be reached.

35. T EAM STEPPS 05.2 Mod 1 05.2 Page 35 Introduction Mod 1 06.2 Page 35 35 Teamwork Actions Foster a climate supportive of task assistance Provide timely and constructive feedback Be assertive and advocate for the patient Use the Two-Challenge rule, CUS, and DESC script to resolve conflict Resolve conflict through collaboration — Create a “Win-Win-Win” situation “Those whom we support hold us up in life.” –Marie von Ebner-Eschenbauch

36. Communication Assumptions Fatigue Distractions HIPAA

37. T EAM STEPPS 05.2 Mod 1 05.2 Page 37 Introduction Mod 1 06.2 Page 37 37 Standards of Effective Communication Complete Communicate all relevant information Clear Convey information that is plainly understood Brief Communicate the information in a concise manner Timely Offer and request information in an appropriate timeframe Verify authenticity Validate or acknowledge information

38. T EAM STEPPS 05.2 Mod 1 05.2 Page 38 Introduction Mod 1 06.2 Page 38 38 Call-Out is… 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 your unit, what information would you want called out?

39. T EAM STEPPS 05.2 Mod 1 05.2 Page 39 Introduction Mod 1 06.2 Page 39 39 Check-Back is…

40. T EAM STEPPS 05.2 Mod 1 05.2 Page 40 Introduction Mod 1 06.2 Page 40 Handoff Optimized Information Responsibility– Accountability Uncertainty Verbal Structure Checklists IT Support Acknowledgement Great opportunity for quality and safety

41. T EAM STEPPS 05.2 Mod 1 05.2 Page 41 Introduction Mod 1 06.2 Page 41 41 Teamwork Actions Communicate with team members in a brief, clear, and timely format Seek information from all available sources Verify and share information Practice communication tools and strategies daily (SBAR, call-out, check-back, handoff)

42. T EAM STEPPS 05.2 Mod 1 05.2 Page 42 Introduction Mod 1 06.2 Page 42 42 Pulling it All Together Recognize opportunities to improve patient safety Assess your current organizational culture and existing Patient Safety Program components Identify teamwork improvement action plan by analyzing data and survey results Design and implement initiative to improve team- related competencies among your staff Integrate TeamSTEPPS into daily practice. “High-performance teams create a safety net for your healthcare organization as you promote a culture of safety."