1. Improving Patient Safety Worldwide Through Teamwork and Communication
TeamSTEPPSTM
Improving Patient Safety Worldwide Through
Teamwork and Communication QC

2. Presenters Susan M Hohenhaus, RN, MA, FAEN
President, Hohenhaus & Associates, Inc.
Stephen M Powell, MS, Captain, Principal, Healthcare Team Training, LLC
This is about face-to-face interaction. This is about people who are a team of experts becoming an expert team centered upon safe and reliable patient care. QC

3. Empowering Local Teams
This is where Teamwork Improvement begins: Multi-discipline front line providers and staff join together to solve identified teamwork and communication problems at a local level. Trust and understanding is developed. Buy-in to change is secured. Evidence based tools are implemented systematically. Notice the cultural differences (customs, religion, gender, language, ethnicity) QC

4. Objectives
Provide examples of personalized and culturally customized teamwork and communication improvement in the US and abroad
Identify the multi-cultural barriers to communication and other teamwork skills
Create awareness of the mandates for improved teamwork and communication worldwide

5. What is TeamSTEPPSTM? Evidence Based Public Domain
Internet available- Worldwide Access
Many expert colleagues have shared the evidence-base for teamwork in patient safety improvement.
The AHRQ and Department of Defense made the TS curriculum available in the public domain in November This is an extensive teamwork curriculum that included trainer materials such as case studies and videos. These materials were posted on the internet and made available to anyone who called the Government Printing Office.
The CD/DVD made it portable and easy to send around the world. Googling “teamwork improvement in healthcare” would lead you to the TS site. The proverbial Cat was out of the bag. Crew Resource Management was influential in the development of this curriculum. Two main outcomes of the curriculum are 1) Empowerment of all Team Members (Culture Change) and 2) Improved Team Performance for safer patient outcomes. QC

6. CRM did not export well at first!
High Power-Distance cultures in Asia and many Latin America countries promote absolute authority of leaders
Uncertainty Avoidance is high in Korea, Greece and Latin America and low in the US
Key factor for CRM acceptance was achieving “cultural harmony” or balance with these national culture dimensions.
Helmreich, R., et al. (1999). The Evolution of CRM. IJAP, 9(1),
High Power Distance cultures tend to be more collectivist (team or group orientation). US is low PD and favors individualism. In the US, harder to tell someone how to do something and expect them to follow the rules (SOP).
Uncertainty Avoidance: The need for rule-governed behavior and clearly defined procedures
High Uncertainty Avoidance cultures are less likely to question automation or the SOP in which they follow. Low Uncertainty Avoidance cultures have more healthy skepticism. QC

7. Situation Hierarchy Paternalistic vs. Collaborative Gender Language
Religion
Socio-economic position

8. Background Visits to all US regions
Visits to all types of clinical settings (rural, urban, suburban, critical access)
Visits to international sites
Formal training in large groups AND observations and coaching IN THE UNIT

9. Assessment
The issues are the same regardless of what country, ethnicity, language
Only the faces change
Human error is inevitable
Prioritizing the challenges is the challenge

10. Recommendation
Formal communication and teamwork skills training is essential
Evidence-based TeamSTEPPSTM creates a common language for teamwork knowledge, performance and attitudes

11. Debrief S- Cultural barriers in healthcare are universal
B- TeamSTEPPSTM is an evidenced-based teamwork curriculum to aid any healthcare organization anywhere
A- Implementation of teamwork and communication training across ALL disciplines is incredibly important for safe and effective patient care
R- Spread teamwork and communication skills

12. Lessons Learned Respect local customs
Survey the Culture
Information age breaking down barriers
“LET SBAR help you find your Voice”
L-Language (common)
E-Empowerment
T-Trust and teamwork

13. Patient Safety and Teamwork Knows NO Boundaries
Sense of Urgency Worldwide
JCI Patient Safety Goals
R2: Closed Loop Communication
R4: Use a Pre-procedure √ list
R5: Complete a “pre-flight”
R6: Include the Patient
WHO Patient Safety Solutions
Andrea Harris “Beyond Boundaries”

14. WHO World Alliance for Patient Safety
Nine Solutions for Patient Safety
Teamwork Competencies in the Solutions
S2: Patient Identification
S3: Communication during Handovers
S4: Correct procedure/Correct patient
S6: Assuring medication accuracy at handovers
S9: Improved hand hygiene
Sir Liam Donaldson, Chair of the Alliance and Chief Medical Officer for England, said: “Patient safety is now recognized as a priority by health systems around the world.”

15. Changing National Culture Dimensions
Traveling Nurses from abroad
Almost 12 percent of nurses in the U.S., and 20 percent of physicians, are foreign born
Foreign National MDs
40,000 Indian Physicians in US
105,300 Asian Physicians in US
1000 physician J1 VISA exemptions annually mostly for rural MD coverage
US Census Bureau 2005

16. What about our patients?
49.6 million Americans (19%) speak a language other than English at home
Between , this number grew by 15.1 million or 47%
In ED visits, no interpreter was used in 46% of patients with limited English
Only 23% of US teaching hospitals provide training for clinicians working with interpreters
Flores, G. (2006). Language Barriers to Health Care in the United States. NEJM, 355:3

17. Teamwork & Cultural Dimensions
Lingard, L The Wilson Centre of the Canadian Patient Safety Institute.

18. Questions