Essentials Course

TEAMSTEPPS 05.2Mod 3 05.2 Page 1

Essentials®

Essentials Course


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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


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“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


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The Components of a Patient Safety Program


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Patient Safety Program Initiatives Patient Safety Leadership WalkRounds™ Family-Activated Rapid Response Patient Safety Guide (Escalation of Concerns) Incident Decision Tree Annual Morehead survey Q Award (physician recognition) Q at the U Member of the National Patient Safety Foundation


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If I had a “Magic Wand” and could make changes within my unit or facility in the areas of patient quality and safety…

Introductions and Exercise: Magic Wand


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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


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Institute of Medicine Report Impact of Error: 44,000–98,000 annual deaths

occur as a result of errors Medical errors are the leading

cause, followed by surgical mistakes and complications

More Americans die from medical errors than from breast cancer, AIDS, or car accidents

7% of hospital patients experience a serious medication error

Cost associated with medical errors is $8–29 billion annually.

Federal Action:

By 5 years;

medical errors by 50%,

nosocomial by 90%; and

eliminate “never-events” (such as wrong-site surgery)


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Teamwork Actions 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."


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Partnering with the PatientEmbrace patients as valuable and contributing partners in patient care Learn to listen to patients Assess patients’ preference regarding involvement Ask patients about their concerns Speak to them in lay terms Ask for their feedback Give them access to relevant information Encourage patients and their families to proactively

participate in patient care


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Outcomes of Team Competencies Knowledge

Shared Mental Model

Attitudes Mutual Trust Team Orientation

Performance Adaptability Accuracy Productivity Efficiency Safety


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Team Structure

The ratio of We’s to I’s is the best indicator of the development of a team.

–Lewis B. ErgenNEXT:

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Multi-Team System (MTS) for Patient Care

Leadership

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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


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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


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BriefsPlanning Form the team Designate team roles

and responsibilities Establish climate and

goals Engage team in short

and long-term planning


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HuddleProblem solving Hold ad hoc, “touch-base”

meetings to regain situation awareness

Discuss critical issues and emerging events

Anticipate outcomes and likely contingencies

Assign resources Express concerns


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DebriefProcess Improvement Brief, informal information exchange and

feedback sessions Occur after an event or shift Designed to improve teamwork skills Designed to improve outcomes

An accurate reconstruction of key events Analysis of why the event occurred What should be done differently next time

Situation Monitoring

“Attention to detail is one of the most important details ...”

–Author Unknown

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A Continuous Process

SituationMonitoring

(Individual Skill)Situation

Awareness(Individual Outcome)

Shared Mental Model

(Team Outcome)


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Process of actively scanning behaviors and actions to assess elements of the situation or environment

Fosters mutual respect and team accountability Provides safety net for team and patient Includes cross monitoring

Situation Monitoring(Individual Skill)

… Remember, engage the patient whenever possible.


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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…


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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)


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Shared Mental Model?


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What Do You See?


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Process of monitoring the actions of other team members for the purpose of sharing the workload and reducing or avoiding errors Mechanism to help maintain accurate situation

awareness Way of “watching each other’s back” Ability of team members to monitor each other’s task

execution and give feedback during task execution

Cross Monitoring is…

Mutual performance monitoring has been shown to be an important team competency.

(McIntyre and Salas 1995)


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Components of Situation Monitoring:


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Patient History Vital Signs Medications Physical Exam Plan of Care Psychosocial Condition

Status of the Patient


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Fatigue Workload Task Performance Skill Level Stress Level

Team Members


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I = IllnessM = MedicationS = StressA = Alcohol and DrugsF = FatigueE = Eating and Elimination

An individual team member’s responsibility …

I’M SAFE Checklist


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Facility Information Administrative Information Human Resources Triage Acuity Equipment

Environment


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Status of team’s patient(s)?

Goal of team? Tasks/actions that are

completed or that need to be done?

Plan still appropriate?

Progress Toward Goal

Mutual Support

“A chain is only as strong as its weakest link.”

–Author Unknown

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http://mx.ha.osd.mil/FileDir/71ba9987-c5df-40ca-ab62-405d959a22ac/Module%204-05.1-MutualSupport.ppt


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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


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“Feedback is the giving, seeking, and receiving of performance-related information among the members of a

team.”

(Dickinson and McIntyre 1997)

What Is Feedback?


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Can be formal or informal Constructive feedback

Is considerate, task-specific, and focuses attention on performance and away from the individual (Baron 1988)

Is provided by all team members

Evaluative feedback Helps the individual by comparing behavior to standards

or to the individual’s own past performance (London, Larson, and Thisted 1999)

Most often used by an individual in a coaching or mentoring role

Types of Feedback


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Characteristics of Effective FeedbackGood 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.”


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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


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Respect and support authority Clearly assert concerns and suggestions Use an assertive statement (nonthreatening

and ensures that critical information is addressed) Make an opening State the concern State the problem Offer a solution Reach an agreement

The Assertive Statement


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Conflict Resolution Options

Information Conflict(We have different information!)

Two-Challenge rule

Personal Conflict

(Hostile and harassing behavior)

DESC script


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Two-Challenge Rule Invoked when an initial assertion is ignored… It is your responsibility to assertively voice your

concern at least two times to ensure that it has been heard

The member being challenged must acknowledge If the outcome is still not acceptable

Take a stronger course of action Use supervisor or chain of command


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Two-Challenge Rule

“Empower any member of the team to “stop the line” if he or she senses or discovers an essential safety breach.”

This is an action never to be taken lightly, but it requires immediate cessation of the process and resolution of the safety issue.


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Please Use CUS Wordsbut only when appropriate!


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Conflict ResolutionDESC Script

A constructive approach for managing and resolving conflictD—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.


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Have timely discussion Frame problem in terms

of your own experience Use “I” statements to

minimize defensiveness Avoid blaming

statements Critique is not criticism Focus on what is right,

not who is right

DESC-ItLet’s “DESC-It!”


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Common Approaches to Conflict Resolution

Often used to manage conflict; however, typically do not result in the best outcome— Compromise—Both parties

settle for less Avoidance—Issues are

ignored or sidestepped Accommodation—Focus is

on preserving relationships Dominance—Conflicts are

managed through directives for change


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Collaboration Achieves a mutually satisfying solution

resulting in the best outcome All Win!: Patient Care Team (team members, the

team, and the patient) Includes commitment to a common mission

Meet goals without compromising relationships

“True collaboration is a process, not an event.”

Communication

Assumptions Fatigue Distractions HIPAA

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http://mx.ha.osd.mil/FileDir/7dfd63a3-415d-451f-8056-0aaea4cca38f/Module%205-05.1-Communication.ppt


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The Joint Commission: Importance

of CommunicationIneffective communication is a root cause for nearly 66 percent of all sentinel events reported*

* (The Joint Commission Root Causes and Percentages for Sentinel Events (All Categories) January 1995−December 2005)


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Information Exchange Strategies Situation–Background– Assessment–

Recommendation (SBAR) Call-Out Check-Back Handoff


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SBAR provides… A framework for team members to effectively

communicate information to one another Communicate the following information:

Situation―What is going on with the patient? Background―What is the clinical background or

context? Assessment―What do I think the problem is? Recommendation―What would I recommend?

Remember to introduce yourself…


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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?


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Check-Back is…


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HandoffThe transfer of information (along with authority and responsibility) during transitions in care across the continuum; to include an opportunity to ask questions, clarify, and confirm


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Handoff Optimized Information Responsibility– Accountability Uncertainty Verbal Structure Checklists IT Support Acknowledgement

Great opportunity for quality and safety


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“I PASS THE BATON” Introduction: Introduce yourself and your role/job (include patient)Patient: Identifiers, age, sex, locationAssessment: Present chief complaint, vital signs, symptoms, and

diagnosisSituation: Current status/circumstances, including code status,

level of uncertainty, recent changes, and response to treatment Safety: Critical lab values/reports, socio-economic factors, allergies, and alerts

(falls, isolation, etc.)THEBackground: Co-morbidities, previous episodes, current medications, and family

historyActions: What actions were taken or are required? Provide brief rationaleTiming: Level of urgency and explicit timing and prioritization of actionsOwnership: Who is responsible (nurse/doctor/team)?

Include patient/family responsibilitiesNext: What will happen next? Anticipated changes?

What is the plan? Are there contingency plans?


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Communication Challenges Language barrier Distractions Physical proximity Personalities Workload Varying communication styles Conflict Lack of information verification Shift change

GreatOpportunity for

Quality and Safety

SummaryPulling it All Together

“The truth of the matter is that you always know the right thing to do. The hard part is doing it.”

–Norman Schwarzkopf®

http://mx.ha.osd.mil/FileDir/7dfd63a3-415d-451f-8056-0aaea4cca38f/Module%206-05.1-SummaryExercise.ppt


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Barriers to Team Effectiveness TOOLS and

STRATEGIESBrief

Huddle DebriefSTEP

Cross MonitoringFeedback

Advocacy and AssertionTwo-Challenge Rule

CUSDESC ScriptCollaboration

SBARCall-Out

Check-BackHandoff

OUTCOMES

Shared Mental Model

Adaptability

Team Orientation

Mutual Trust

Team Performance

Patient Safety!!

BARRIERS Inconsistency in Team

Membership Lack of Time Lack of Information Sharing Hierarchy Defensiveness Conventional Thinking Complacency Varying Communication

Styles Conflict Lack of Coordination and

Follow-Up with Co-Workers Distractions Fatigue Workload Misinterpretation of Cues Lack of Role Clarity


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Summary

In the preceding section, we learned that teamwork strategies and tools— Are available to both team members and leaders Can be categorized according to the specific

barriers to team effectiveness in a given situation Can all be applied to most situations because they

complement one another


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Action Planning

“To improve teamwork in your unit, what can you commit to focusing on?”

“The achievements of an organization are the results of the combined effort of each individual.”

–Vince Lombardi

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