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TeamSTEPPS® Primary Care Module
Richard Ricciardi, PhD, NPAgency for Healthcare Research and
QualityCenter for Primary Care, Prevention and
Clinical Partnerships
September 10, 2012
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TeamSTEPPS
Acknowledgement
Deborah A. Milne, RN MPAAmerican Institutes for Research
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TeamSTEPPS
First Step
Convened Technical Expert Panel (TEP) December 2010
Representatives from AHRQ and DoD Experts in primary care and quality improvement Interprofessional primary health care providers
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TeamSTEPPS
Laying the Groundwork
Defined the “team”
Identified the “system”
Evaluated the challenges
Decided areas of focus
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TeamSTEPPS
Primary Care Office (PCO) Team
Technical Expert Panel defined the scope of “team” for purpose of this project
Focus of the project was intended to be on optimizing teamwork within the medical office
Caveat - it was noted that external care coordination is of extreme importance for future work
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TeamSTEPPS
Primary Care Team Structure
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TeamSTEPPS
Primary Care Office Environment
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TeamSTEPPS
Some of the Inputs Patient phone
calls/emails Scheduling Medication refills Interruption of patient
flow Walk-ins, lab results Formulary questions
Missed appointments Population data
management Information from
insurers Urgent appointments Calls from
consultants/external providers
Personnel transitions
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TeamSTEPPS
Challenges to Teamwork in Primary Care Offices
Quality Measures (Process and Outcome)
Standardization
Definitions
Role Ambiguity
Non – linear work flow
Assumptions/Habits/Change
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TeamSTEPPS
Curriculum Training Structure
When training teams to implement TeamSTEPPS:
Developed to be taught in conjunction with TeamSTEPPS Essentials
OR
When training Master Trainers:
To be taught as an addition to TeamSTEPPS Fundamentals
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TeamSTEPPS
Next Steps
Literature review
Curriculum design guide development
Developed draft curriculum slides and instructor guide
Begin preliminary scripts for video vignettes
We asked all TEP members to send us brief “stories” that represented actual scenarios they had experienced
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TeamSTEPPS
Field Testing
Two sites
TeamSTEPPS essentials followed by Primary Care Office Module
Data collection
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TeamSTEPPS
Highlights of Field Testing Focus Groups “What parts of the module are most relevant to
primary care?” Patient advocacy and communication
Conflict resolution
Situation monitoring
Debriefing
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TeamSTEPPS
Highlights of Field Testing Focus Groups “What improvements could be made to the module?”
More emphasis on roles of non-clinical staff in the care team
More case-based scenarios, especially across team roles
Non clinical staff felt that they often had important information to communicate but no process to do so
Quote: “Little bits that you don’t automatically put into the records as a formal thing are so important.”
Resulting module change:
Included 4 scenarios in module that emphasize non-clinical staff
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TeamSTEPPS
Highlights, cont… “What parts of the module do not make sense?”
Definitions of “Huddles” and “Briefs” conflicts with NCQA Primary Care Medical Home (PCMH) language
Quote: “PCMH designates the TeamSTEPPS Brief as a Huddle. We all need to know what we mean in terms of what we’re doing.”
Resulting module change:
More emphasis on flexibility/customizability throughout the curriculum, as long as each team member shares the same mental model.
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TeamSTEPPS
Video Production
Scenario video production – 4 paired scenarios (right way and wrong way)
Script changes influenced by field testing results
Each based on an actual event
Leadership, Communication, Mutual Support, Situation Monitoring
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TeamSTEPPS
Leadership in the Primary Care Medical Office
Let’s watch the primary care team demonstrate proper team leadership.
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TeamSTEPPS
Questions?
