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Teamwork and communication working within the Behavioral Health system
Robert S. Steele, MD, FAAFP
Bree Watzak PharmD, BCPS
A&M Rural and Community Health Institute (ARCHI)
Texas A&M University – College of Medicine
TEAMSTEPPS 05.2Mod 1 2.0 Page 3
Introduction
3
Teamwork ExerciseSetting the Stage
Think of a team you have been on that was high-functioning. What were the characteristics of that
team?
TEAMSTEPPS 05.2Mod 1 2.0 Page 4
Introduction
4
Objectives
Describe the impact of errors and why they occur
Describe the TeamSTEPPS framework
State the outcomes of the TeamSTEPPS framework
TEAMSTEPPS 05.2Mod 1 2.0 Page 5
Introduction
Core Teamwork Skills
5
TEAMSTEPPS 05.2Mod 1 2.0 Page 6
Introduction
6
Just a Routine Operation
https://www.youtube.com/watch?v=JzlvgtPIof4
TEAMSTEPPS 05.2Mod 1 2.0 Page 7
Introduction
7
Video Discussion
What breakdowns in teamwork did you observe in the stories?
How can we prevent medical errors?
How can we continue to improve communication with all those we work with?
TEAMSTEPPS 05.2Mod 1 2.0 Page 8
Introduction
8
Barriers to Team Performance
Inconsistency in team membership
Lack of time
Lack of information sharing
Hierarchy
Defensiveness
Conventional thinking
Varying communication styles
Conflict
Lack of coordination and followup
Distractions
Fatigue
Workload
Misinterpretation of cues
Lack of role clarity
TEAMSTEPPS 05.2Mod 1 2.0 Page 9
Introduction
Patient Safety Movement & Team Training
Patient Safety
and Quality
Improvement
Act of 2005
Executive
Memo from
President
DoD
MedTeams®
ED Study
Institute for
Healthcare
Improvement
100K lives
Campaign
“To Err
Is Human”
IOM Report TeamSTEPPS®
1995 1999 2001 2003 2004 2005
JCAHO National
Patient Safety
Goals
2006
TeamSTEPPS
Released to the
Public
2007
TeamSTEPPS
National
Implementation
Program Began
2008
National
Implementation
of CUSP
Centers for
Medicare &
Medicaid Services
Partnership for
Patients Campaign
2011
Medical Team Training
TEAMSTEPPS 05.2Mod 1 2.0 Page 10
Introduction
10
Team Strategies & Tools to Enhance Performance & Patient Safety
Based on more than 30 years of research and evidence
Team training programs have been shown to improve attitudes, increase knowledge, and improve behavioral skills
Salas, et al. (2008) meta-analysis provided evidence that team training had a moderate, positive effect on team outcomes (ρ = .38)
TEAMSTEPPS 05.2Mod 1 2.0 Page 11
Introduction
11
What Makes Up Team Performance?
Knowledge
Cognitions
“Think”
Attitudes
Affect
“Feel”
Skills
Behaviors
“Do”
TEAMSTEPPS 05.2Mod 1 2.0 Page 12
Introduction
12
Outcomes of Team Competencies
Knowledge Shared Mental Model
Attitudes Mutual Trust Team Orientation
Performance Adaptability Accuracy Productivity Efficiency Safety
TEAMSTEPPS 05.2Mod 1 2.0 Page 13
Introduction
Evidence That TeamSTEPPS Works
13
Capella, et al. (2010)
Trauma resuscitation team implementation
Pre- and post-TeamSTEPPS training results:
Team performance improved across all teamwork skills: Leadership, Situation Monitoring, Mutual Support, Communication
Significantly decreased times from arrival to CT scanner, endotracheal intubation, and operating room
Thomas & Galla (2013)
Systemwide implementation
Pre- and post-TeamSTEPPS training results:
Significant improvement in HSOPS scores on Feedback and Communication AboutError, Frequency of Events Reported, Hospital Handoffs and Transitions, and Teamwork Across Units
Incremental changes evident through reduction of nosocomial infections, falls, birth trauma, and other incidents
Team Structure, Leadership, & Communication
NEXT:
TEAMSTEPPS 05.2Mod 1 2.0 Page 15
Introduction
15
Objectives
Discuss benefits of teamwork and team structure
Define a “team”
Identify the role of patients and their families as part of the care team
Describe the components and composition of a multi-team system
Describe how communication affects team outcomes
Identify TeamSTEPPS tools and strategies that can improve team communication
TEAMSTEPPS 05.2Mod 1 2.0 Page 16
Introduction
Team Structure
Teamwork cannot occur in the absence of a clearly defined team
Understanding a team’s structure and how multiple teams interact is critical for implementation planning
16
TEAMSTEPPS 05.2Mod 1 2.0 Page 17
Introduction
17
Two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and may have a time-limited membership
What Defines a Team?
TEAMSTEPPS 05.2Mod 1 2.0 Page 18
Introduction
18
Exercise: Teams and Teamwork
1. What is the GOAL of your unit or work area?
2. Are you a group or a team?
3. What characteristics make you a team or are what should you do to become a team?
TEAMSTEPPS 05.2Mod 1 2.0 Page 19
Introduction
19
Partnering With the Patient
Strategies for involving patients in their care
Include patients in bedside rounds
Conduct handoffs at the patient’s bedside
Provide patients with tools for communicating with their care team
Involve patients in key committees
Actively enlist patient participation
TEAMSTEPPS 05.2Mod 1 2.0 Page 20
Introduction
20
Clinical Team Responsibilities
Embrace patients and their families as valuable and contributing partners in patient care
Listen to patients and their families
Assess patients’ preference regarding involvement
Ask patients about their concerns
Speak to them in lay terms
Allow time for patients and families to ask questions
Ask for their feedback
Give them access to relevant information
Encourage patients and their families to proactively participate in patient care
TEAMSTEPPS 05.2Mod 1 2.0 Page 21
Introduction
Patient and Family Responsibilities
Provide accurate patient information
Comply with the prescribed plan of care (e.g., schedule and attend appointments as directed)
Ask questions and/or voice any concerns regarding the plan of care
Monitor and report changes in the patient’s condition
Manage family members
Follow instructions of the clinical team
21
TEAMSTEPPS 05.2Mod 1 2.0 Page 22
Introduction
22
Multi-Team System (MTS) for Patient Care
TEAMSTEPPS 05.2Mod 1 2.0 Page 23
Introduction
23
Core Team members have the closest contact with
the patient!
A Core Team is…
A group of care providers
who work interdependently
to manage a set of
assigned patients
from point of
assessment to
disposition
TEAMSTEPPS 05.2Mod 1 2.0 Page 24
Introduction
24
A time-limited team formed
for emergent or specific
events and composed
of members from
various teams
A Contingency Team is…
TEAMSTEPPS 05.2Mod 1 2.0 Page 25
Introduction
25
A team comprising those
work area members who are
responsible for managing
the operational
environment that
supports the
Core Team
A Coordinating Team is…
TEAMSTEPPS 05.2Mod 1 2.0 Page 26
Introduction
26
Ancillary Services provide direct, task-specific, time-limited care to patients.
Support Services provide
indirect service-focused tasks
which help to facilitate the
optimal health care experience
for patients and their families.
Ancillary & Support Services
TEAMSTEPPS 05.2Mod 1 2.0 Page 27
Introduction
27
Establish and communicate vision
Develop policies and set expectations for staff related to teamwork
Support and encourage staff during implementation and culture change
Hold teams accountable for team performance
Define the culture of
the organization
The Role of Administration is to…
TEAMSTEPPS 05.2Mod 1 2.0 Page 28
Introduction
28
Team Structure Video
https://www.youtube.com/watch?time_conti
nue=5&v=bO2HHEWDD3w
TEAMSTEPPS 05.2Mod 1 2.0 Page 29
Introduction
29
Team Structure Video Analysis
What breakdowns could occur between the components of this multi-team system?
What could have been done to ensure a positive outcome?
TEAMSTEPPS 05.2Mod 1 2.0 Page 30
Introduction
30
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)
Communication
Assumptions
Fatigue
Distractions
HIPAA
TEAMSTEPPS 05.2Mod 1 2.0 Page 32
Introduction
Video: Lost in Translation (Berlitz Coast Guard)
32
http://www.youtube.com/watch?v=yR0lWICH3rY
TEAMSTEPPS 05.2Mod 1 2.0 Page 33
Introduction
33
Communication
Effective communication skills are vital for patient safety
Enables team members to effectively relay information
The mode by which most TeamSTEPPS strategies and tools are executed
TEAMSTEPPS 05.2Mod 1 2.0 Page 34
Introduction
34
Importance of Communication
Joint Commission data continues to demonstrate the importance of communication in patient safety
1995 - 2005: Ineffective communicationidentified as root cause for nearly 66 percent of all reported sentinel events*
2010 - 2013: Ineffective communication among top 3 root causes of sentinel events reported**
* (JC Root Causes and Percentages for Sentinel Events (All Categories) January 1995−December 2005)
** (JC Sentinel Event Data (Root Causes by Event Type) 2004-2012)
Teamwork Exercises
TEAMSTEPPS 05.2Mod 1 2.0 Page 36
Introduction
BREAKING NEWS!!
TEAMSTEPPS 05.2Mod 1 2.0 Page 37
Introduction
Tater Trauma Your team has been tasked with reassembling MVA victims
Roles include:
Triage (has photos of patients)
Whatever other roles the team feels is needed
Rules:
Only Triage can see the pictures of the patients and must relay this information to the rest of the team
Triage cannot see what the team is doing (back turned toward the group)
Triage may not change roles once time starts because they will have seen the pictures
You have 1 minute to select roles
You will have 12 minutes to put your patients back together
TEAMSTEPPS 05.2Mod 1 2.0 Page 38
Introduction
Picture Story Teamwork Exercise
DO NOT turn over or look at the piece of paper until you are told to do so.
You are all members of one big team. Each of you have been given a part of a picture story. The pictures are all connected to each other in sequence. Please practice your teamwork/communication skills and put the pictures in correct order.
Rules: You can talk about your picture but cannot show it to others. Hide your picture from others and please do not look at anyone else’s pictures.
TEAMSTEPPS 05.2Mod 1 2.0 Page 39
Introduction
39
Shared understanding
The process by which information is exchanged
The lifeline of the Core Team
Effective when itpermeates every aspect of an organization
Communication is…
Assumptions
Fatigue
Distractions
HIPAA
TEAMSTEPPS 05.2Mod 1 2.0 Page 40
Introduction
Shared understanding?
https://www.youtube.com/watch?v=_Dj_sZt
CVPc
TEAMSTEPPS 05.2Mod 1 2.0 Page 41
Introduction
41
Body Language
In face-to-face communication:
Words: 7% of meaning
Tone of voice: 38%
Body language: 55%
Visual Cues
Such as color coding
Non-verbal Communication
TEAMSTEPPS 05.2Mod 1 2.0 Page 42
Introduction
42
Brief Clear
Timely
TEAMSTEPPS 05.2Mod 1 2.0 Page 43
Introduction
43
Communication Challenges
Language barrier
Distractions
Physical proximity
Personalities
Workload
Varying communication styles
Conflict
Lack of information verification
Shift change
TEAMSTEPPS 05.2Mod 1 2.0 Page 44
Introduction
Video: Communication Challenges (Lighthouse vs. Destroyer)
https://www.youtube.com/watch?v=cAsT4sb8d9M
44
TEAMSTEPPS 05.2Mod 1 2.0 Page 45
Introduction
45
Four Information Exchange Strategies
Situation – Background – Assessment –Recommendation (SBAR)
Call-Out
Check-Back
Handoffs
TEAMSTEPPS 05.2Mod 1 2.0 Page 46
Introduction
46
#1: SBAR Provides…
A framework for team members to effectively communicate information to one another
Communicate the following information:
Situation―What is going on?
Background―What is the background or context?
Assessment―What do I think the problem is?
Recommendation―What would I recommend?
TEAMSTEPPS 05.2Mod 1 2.0 Page 47
Introduction
47
Example SBAR
Situation―What is going on?
Background―What is the background or context?
Assessment―What do I think the problem is?
Recommendation―What would I recommend?
TEAMSTEPPS 05.2Mod 1 2.0 Page 48
Introduction
48
#2: 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
TEAMSTEPPS 05.2Mod 1 2.0 Page 49
Introduction
49
#3: Check-Back is…
TEAMSTEPPS 05.2Mod 1 2.0 Page 50
Introduction
Check Back
https://www.youtube.com/watch?v=mLFZT
zR5u84
TEAMSTEPPS 05.2Mod 1 2.0 Page 51
Introduction
#4: Handoff is… The transfer of information during transitions in
responsibility across the continuum
Includes an opportunity to ask questions, clarify, and confirm
51
TEAMSTEPPS 05.2Mod 1 2.0 Page 52
Introduction
Handoff Consists of…
Transfer of responsibility and accountability
Clarity of information
Verbal communication of information
Acknowledgment by receiver
Opportunity to review
52
Leadership
TEAMSTEPPS 05.2Mod 1 2.0 Page 54
Introduction
54
Types of Team Leaders
Designated – The person assigned to lead and organize a team, establish clear goals, and facilitate open communication and teamwork among team members
Situational – Any team member who has the skills to manage the situation at hand
TEAMSTEPPS 05.2Mod 1 2.0 Page 55
Introduction
55
Define, assign, share, monitor, and modify a plan
Review the team’s performance
Establish “rules of engagement”
Manage and allocate resources effectively
Provide feedback regarding assigned responsibilities
and progress toward the goal
Facilitate information sharing
Encourage team members to assist one another
Facilitate conflict resolution
Model effective teamwork
Effective Team Leaders
TEAMSTEPPS 05.2Mod 1 2.0 Page 56
Introduction
When to share
Brief: short session before you start to share the plan
Huddle: ad hoc meeting to monitor & modify the plan
Debrief: after you are done, informal session to review team performance. What went well and what can we do better next time. NOT a vent session
TEAMSTEPPS 05.2Mod 1 2.0 Page 57
Introduction
57
When:
Briefs
Huddles
Debriefs
When and How to Share information?
How:
SBAR
Call-outs
Check-backs
TEAMSTEPPS 05.2Mod 1 2.0 Page 58
Introduction
58
Tools & Strategies Summary
TOOLS and STRATEGIES
Communication
• SBAR
• Call-Out
• Check-Back
• Handoff
Leading Teams
• Brief
• Huddle
• Debrief
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 Followup With Coworkers
Distractions
Fatigue
Workload
Misinterpretation of Cues
Lack of Role Clarity
TEAMSTEPPS 05.2Mod 1 2.0 Page 59
Introduction
Questions?