. Strategies and Tools for Patient Safety “Initiative based on evidence derived from team...

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. Strategies and Tools for Patient Safety “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”

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Transcript of . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team...

Page 1: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Strategies and Tools for Patient Safety

“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”

Page 2: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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TeamSTEPPS

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Weathering a disaster is not a matter of luck

Page 4: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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It’s a team process

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Sue Sheridan Video

Play Video

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Understand the role of communication in patient safety

Acknowledge that conflict creates significant risk for patients

Gain a basic understanding of TeamSTEPPS tools and incorporate into patient care

Support co-workers in utilizing TeamSTEPPS tools to enhance patient safety

Objectives

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INEFFECTIVE COMMUNICATION

Impact?

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Joint Commission Sentinel Events

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How Health Care Systems have measured success with TeamSTEPPS:

– Length of Stay – Reduction in sentinel events– Quality Patient Indicators- Culture of safety

– Staff retention– Event reporting (STARS)– Staff satisfaction– Patient satisfaction

Page 10: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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1

1.2

1.4

1.6

1.8

2

2.2

2.4

June July August Sept Oct Nov Dec Jan Feb March April May

Avg

. L

eng

th o

f S

tay

(da

ys)

Length of ICU Stay After Team Training

50% Reduction

(Pronovost, 2003)Johns HopkinsJournal of Critical Care Medicine

Length of ICU Stay After Team Training

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OR Teamw ork Climate and Postoperative Seps is Rates (per 1000 discharges)

Group Mean

Low Teamwork Climate

Mid Teamwork Climate

High Teamwork Climate

0

2

4

6

8

10

12

14

16

18

A HRQ National A verage

Teamwork Climate Based on Safety Attitudes Questionnaire

Low High

(Sexton, 2006)Johns Hopkins

OR Teamwork Climate and Postoperative Sepsis Rates

(per 1000 discharges)

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(Mann, 2006) Beth Israel Deaconess Medical CenterContemporary OB/GYN

Adverse Outcomes

Page 13: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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If you had the tools to cure a critical illness, wouldn’t you

use them?

Page 14: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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What Defines a Team?

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

“Individual commitment to a group effort—that is what makes a team work, a company work, a society work, a civilization work.”

–Vince Lombardi

Page 15: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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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. Ergen

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High-Performing TeamsTeams that perform well:

– Have clear, valued, and shared vision– Engage in a regular discipline of feedback

• Briefs, huddles, debriefs

– Manage and optimize performance outcomes• Hold each other accountable• Give feedback and share information

(Salas et al. 2004)“The trick is understanding that only a special type of

teamwork and camaraderie can catch in time the types of medical errors a hospital will always generate.”

(Nance, 2009)“Why Hospitals Should Fly”

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Barriers to Team Performance

• Lack of information sharing

• Hierarchy• Defensiveness• Conflict• Distractions

• Fatigue• Workload• Lack of role clarity• Lack of coordination

and follow-up

Page 18: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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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)

Page 19: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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How Shared Mental Models Help Teams

• Help ensure that teams know what to expect, so if necessary, can regroup to get on the “same page”

• Foster communication to ensure care is synchronized• Ensure that everyone on the team has a picture of

what it should look like• Enable team members to predict and anticipate

better• Create commonality of effort and purpose

“ Shared mental models help teams avoid errors that place patients at risk.”

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Eight Steps of Change• Create sense of urgency• Build the guiding team• Develop a change vision and strategy• Understanding and buy-in• Empower others• Short term wins• Don’t let up – Be relentless• Create a new culture

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Leadership

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Team Leader

Two types of leaders:– Designated – The person assigned to lead

and organize a designated core 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

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Effective Team Leaders

• 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

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Promoting & Modeling Teamwork

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

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Communication

Assumptions Fatigue Distractions HIPAA

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Communication and Conflict Resolution Techniques

• Communication is a skill

• Communication starts with active listening

• Conflict resolution is a higher level skill built on effective communication and active listening plus….

Page 27: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Communication 101

DEPERSONALIZE: The more inappropriate communication is, the less you have to own it!!!!”

“No one can make me feel inferior without my consent” Eleanor Roosevelt

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Communication 101

• Being able to depersonalize inappropriate communication and/or behavior allows us to effectively begin the process of conflict resolution

• When we do not feel diminished or upset we can focus on the goal

Page 29: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Communication 101

Two goals of any conversation

including conflict resolution:

• Good working relationships with co-workers

• Safe and optimal patient care

Page 30: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Conflict resolution 101

• Make positive assumptions• Keep goal of communication in mind• If you meet with resistance…”I don’t know

what you’re talking about”, “whatever”..,” you’re crazy”, don’t respond to the words, respond to the feelings and keep focused on goal, “You’re getting upset, that’s not my intent”.

• Repeat goal of conversation

Page 31: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Communication Breakdown

Reasons for communication breakdown between nurse and physician

• Disagreement over discharge orders• Disagreement over treatment plan• Misunderstanding the other’s rationale for

action or for delay in meds or treatmentsFocus on:• Patient safety, danger or harm to patient• Ethical considerations

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Delegation• Process includes 4

steps:– Decide what to

delegate– Decide to whom to

delegate – Communicate

clear expectations– Request feedback

Why is it such a problem?

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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

• Respectful– Critical aspect of effective delegation

Page 34: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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TeamSTEPPS Tools for Effective Communication

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Tools for Conflict Resolution

DESC

D escribe the situation

E xpress concerns

S uggest alternatives

C onsequences of actions

CUS I am Concerned!

I am Uncomfortable!

This is a Safety issue!

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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 . . .

Page 37: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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SBAR Video

Play Video

Page 38: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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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

Page 39: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Handoff• Optimized Information

• Responsibility– Accountability

• ELIMINATE Uncertainty

• Verbal Structure

• Checklists

• Acknowledgement of Understanding, Feedback

Great opportunity for quality and safety

Page 40: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Additional TeamSTEPPS Team Communication Tools

• 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

Page 41: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Briefs

Planning– Form the team– Clarify team roles

and responsibilities– Establish goals

(shift, patient,unit)– Engage team in short

and long-term planning

Page 42: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Briefing Checklist

TOPIC

Who is on team?

All members understandand agree upon goals?

Roles and responsibilitiesunderstood?

Plan of care?

Staff availability?

Workload?

Available resources?

Page 43: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Brief Video

Play Video

Page 44: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Huddle

Problem 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

Page 45: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Huddle Video

Play Video

Page 46: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Debrief

Process 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

Page 47: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Debrief ChecklistTOPIC

Communication clear?

Roles and responsibilities understood?

Situation awarenessmaintained?

Workload distribution?

Did we ask for or offerassistance?

Were errors made or avoided?

What went well, what should change, what can improve?

Page 48: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Debrief Video

Play Video

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The primary role of all Healthcare providers is patient advocacy

• Effective communication and conflict resolution are essential

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ER Video

Play Video

Carter preps for surgery

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“When each member accepts full responsibility and strives for excellence…trust and performance increase exponentially…the team is ready to take off.”

- Scott ‘Yogi’ Beare

Page 52: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Kaleida Health Patient Safety Initiative 2010

• Educate staff on TeamSTEPPS tools*– Brief– Debrief– Huddle– Handoff– Situation monitoring

*Orientation, Preceptor Workshop, PICU at WCHOB

Page 53: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

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Using TeamSTEPPS tools will impact patient safety

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This is urgent…

This is personal.

Play Video

Page 55: . Strategies and Tools for Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military,

PROPERTIES

On passing, 'Finish' button: Goes to Next SlideOn failing, 'Finish' button: Goes to SlideAllow user to leave quiz: After user has completed quizUser may view slides after quiz: At any timeUser may attempt quiz: Unlimited times

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You have completed the TeamSTEPPS presentation.

Thank you


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