Human Resource Factors

TEAM STEPPS

Margaret O’Donnell BSN MBA CEN CMTE EMT-P September 2014

TEAM STEPPS IS

• An evidence-based framework to optimize team performance across the health care

delivery system

• Scientifically rooted in more than 20 years of research and lessons from the application of

teamwork principles.

• Developed by Department of Defense's Patient Safety Program in collaboration with the

Agency for Healthcare Research and Quality.

TEAM STEPPS SEEKS TO

• Produce highly effective medical teams that optimize the use of information, people, and

resources to achieve the best clinical outcomes for patients.

• Increasing team awareness and clarifying team roles and responsibilities.

• Resolving conflicts and improving information sharing.

• Eliminating barriers to quality and safety.

Based on Team structure & four teachable – learnable skills

Communication

Leadership

Situation Monitoring

Mutual Support

TEAM STRUCTURE

Patient

Core Team

Coordinating Team

Ancillary & Support Services

Administration

Contingency Teams

Multi – Team System For Patient Care

COMMUNICATION

• SBAR (Q)

• Call Out

• Check Back

• Hand Off

SBAR (Q)

• 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 & Request: What would I do to correct it

• Questions: When handing off patient – What questions do you have for me

CALL OUT

• Strategy used to communicate important or critical information

• Informs all members of team simultaneously

• Helps team members anticipate next step

• Important to direct responsibility to a specific individual for carrying out

the task

CHECK BACK & HAND OFF

• Use of closed loop communication to ensure information conveyed by the

sender is understood by the receiver as intended

• Transfer of patient information along with authority and responsibility during

transitions in care across the continuum

• Includes opportunity to ask questions, clarify, and confirm (Q)

I

Introduction Introduce yourself and your role/job (include

patient)

P Patient Name, identifiers, age, sex, location

A

Assessment Present chief complaint, vital signs, symptoms, and

diagnoses

S Situation Current status/circumstances, including code

status, level of (un)certainty, recent changes, and response to treatment

S

Safety Concerns Critical lab values/reports, socioeconomic

factors, allergies, and alerts (falls, isolation, etc.)

THE

B

Background Comorbidities, previous episodes, current

medications, and family history

A Actions Explain what actions were taken or are required.

Provide rationale.

T Timing Level of urgency and explicit timing and

prioritization of actions

O Ownership Identify who is responsible (person/team), including

patient/family members

N Next What will happen next? Anticipated changes? What

is the plan? Are there contingency plans?

I PASS the BATON / Hand Off

LEADERSHIP• Effective Leaders

• Organize the team

• Identify and articulate clear goals (i.e., the plan)

• Assign tasks and responsibilities

• Monitor and modify the plan; communicate changes

• Review the team’s performance; provide feedback when needed

• Manage and allocate resources

• Facilitate information sharing

• Encourage team members to assist one another

• Facilitate conflict resolution in a learning environment

• Model effective teamwork

TEAM EVENTS

• Brief

• Short – Prior to start – Share plan

• Huddle

• Ad hoc meeting to reestablish situational awareness

• Debrief

• Informal information exchange to improve team performance and effectiveness

through lessons learned

SITUATION MONITORING

• Continually scanning and assessing current situation

• Awareness: state of knowing what is going on around you

• Shared mental model: each team member maintains situational awareness

to insure all are ‘on the same page’

CROSS - MONITORING

• Monitor each others actions

• Provide safety net within the team

• Ensure mistakes or oversights are caught quickly and easily

• “Watching each others back”

MUTUAL SUPPORT

• Task Assistance

• Protect each other from overload situations

• Place all offers and requests for assistance in the context of patient safety

• Climate in which it is expected assistance will be actively sought and offered

FEEDBACK

• SHOULD BE

• Timely

• Respectful

• Specific

• Directed

• Considerate

ADVOCATE FOR THE PATIENT

• When team members have differing viewpoints than the decision maker

• Assert a corrective action in firm and respectful manner

• Make opening

• State concern

• State problem (real or perceived)

• Offer solution

• Reach agreement on next steps

TWO CHALLENGE RULE

• If initial assertive statement ignored

• Make statement at least two times to ensure you have been heard

• Team member being challenged must acknowledge you have been heard

• If safety issue not addressed

• Take stronger course of action

• Use chain of command

CUS WORDS

• I am C oncerned

• I am U ncomfortable

• This iS a Safety issue

STOP!

DESC SCRIPT

• D = Describe specific situation, provide concrete data

• E = Express how your feel / what your concerns are

• S = Suggest alternatives, seek agreement

• C = Consequences stated in terms of impact, strive for consensus