Implementing TeamSTEPPS toImprove Patient & Staff Safety

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Texas Health ResourcesMarcie Williams RN, MS, FASHRM, CPHRM, CPPS, CLNC

Vice President, Safety & Risk Management

Objectives

Understand the importance of Leadership in successfully implementing TeamSTEPPS

Explain the importance of early metrics selectionDescribe 3 pilot site selection criteria for successful

TeamSTEPPS implementationState 3 implementation success factors for

TeamSTEPPS and how they can be applicable to your healthcare system or hospital

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5,500 active physicians

21,775 employees

24 centers in North Texas(14 wholly owned hospitals)

Over 4,100 licensed beds

133,903 inpatient discharges

1,238,929 outpatient encounters

469,309 ER visits

89,452 surgeries

27,200 deliveries

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Texas Health Resources

Importance of Effective Communication

• Communication failure has been identified as a leading root cause of sentinel events over the past 10 years (Joint Commission)

• Communication failure is a primary contributing factor in almost 80% of more than 6000 root cause analyses of adverse events and close calls (VA Center for Patient Safety

Patient Safety Movement

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2006

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

Medical Team Training

20112008

National Implementation of

TeamSTEPPS

Adoption by Military Health

System from 2007-2011

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Medical Team Training

Indemnity Experience

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11

0

5

10

15

20

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Malpractice Claims, Suits, and Observations

Pre-Teamwork Training Post-Teamwork Training

Adverse Outcomes

50%Reduction

50%Reduction

Beth Israel Deaconess Medical CenterOB/GYN

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1.2

1.4

1.6

1.8

2

2.2

2.4

June July August Sept Oct Nov Dec Jan Feb M arch April M ay

Avg

. L

eng

th o

f S

tay

(day

s)

Length of ICU Stay After Team Training

50% Reduction

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

Johns HopkinsJohns Hopkins

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WHO Surgical Checklist

“Checklist Manifesto”

Annals of Surgery, Sept 2010Medical Team Training Supports Improvement in Dept Performance, Reduced Complications, Increased Staff and Physician Communication & Satisfaction

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TeamSTEPPSImplementation Considerations

• Be ready for the resistors – get Sr. Leaders on board early

• Training materials free, easily accessed via internet – copying fees for education materials

• Cost for distributing teaching aids

• Vendor Selection – needed or not?

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Metrics Selection• Patient Safety Culture Survey pre implementation

results vs post implementation results

• Direct on site observations pre and post implementation using the TS observation tool- THR added to each metric observation criteria or questions to ask during the interview process to provide consistency and observer reliability

• Pre and post implementation HCAHPS scores

• Stories sell – collect them and share

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TeamSTEPPS framework builds on team skills

Communi-cation

Situationmonitoring

Leader-ship

Mutualsupport

Knowledge Attitudes

Performance

Skills

The TeamSTEPPS tools include many

things we already do... but also adds new team

skill sets to assure effective

communication

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1111

Learning the Language

Communication

7. SBAR8. Call-outs9. Check-backs10.Hand-offs

Leadership1. Briefs2. Huddles3. Debriefs

SituationMonitoring

4. Situational awareness– Cross

monitoring

Mutual Support 5. Task assistance6. CUS

IMPLEMENTATION PLAN

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Approach Overview

Baseline and pilot preparation Pilot implementation Large scale rollout

CorpApproval

Leadership meetings

Vision Setting

Comprehensive baseline• Pre observations• PS Culture Survey• Satisfaction Results

Pilot Selection

Pilot preparation and design

Pre ObservationsPilot Launch

90 days 10 Months 2 years

Pilot execution

Pilot monitoring and refinement

PilotMid year Check

Pilot Post Obs

Large scale rollout plan

Rollout – Wave 1

Rollout – Wave 2

Ongoing monitoring and refinement

Progress check

Non-Clinical2012

PreObs

MstTrainer

PostObs

Ed PSCSurvey

Pilot Site Selection CriteriaCriterion considered Description

Leadership (Sr.) • Leadership ready, willing and able to support initiative

Svc Line/Dept Size • Needs to be large enough for multiple team players

Department Culture • Culture open to change• Positioned for success

Nurse leadership & support • Likelihood of broad nursing participation / support and availability of local champions

Willingness to communicate openly

• Encourage feedback as to what works well, and what changes are needed

• Dept open to honest feedback

Safety culture scores • Strength of safety culture as measured by PSC survey

Adverse Events • Willingness to report

Positive staff attitude • Indicator of being open to team training and use of tools

Educator support • Dedicated resource to train and reinforce tool utilization

Must haves

Variables

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Direct Observation Tool

• Observer – Master or Champion trained

• Developed to ensure observer objectivity and consistency

• When completing a Service Line takes 4-6 hours

• When completing a Dept takes 2-3 hours

• Complete all shifts so the staff understand this is not just for one shift

Perinatal Pilot

• Meeting with Formal leaders

• Patient Safety Culture Survey

• Trained hospital Risk Managers/Patient Safety as the facilitators

• Pre-implementation Observations

• Selection of Champions (3-5 from each dept within the service line)

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• Champion training– Formal and informal leaders from each shift– Educators to maintain the focus

• Staff Education slides with talking points• Mid year sampling observations • Champion meeting connecting the dots

between patient safety programs and TeamSTEPPS

• Shared stories with Leadership and staff• End of year post implementation observations

Perinatal Pilot

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Pilot ResultsStrengths• Effectively using TS tools in

critical situations in early implementation

• Successful shift briefs with dept leaders in the service line

• Consistent use of SBAR and handoffs

• Improved intercollaborative discharge briefings in certain departments

• Use of the word “concern” stops the line

Opportunities for Improvement

• Early Sr. leadership engagement

• Improve physician engagement

• Ensuring use of the TS common language

• Consistent debriefings

• Good leadership needed in the service line to set the expectation that TS is 24/7

• Shorten length of pilot

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0 = expected but not observed or found in discussions with staff1 = observed/discussions but poor2 = observed/discussions but marginal3 = observed/discussions and acceptable4 = observed/discussions and good

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PG Patient Satisfaction Scores Post TeamSTEPPS Implementation

OB/GYN

System Implementation

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Operationalize TeamSTEPPS

• Develop education for several levels

• Need a committed leader

• Physician engagement – elevator speech for brief conversations or info in lounges

• Large hospitals - implement per Service Line

• Small hospitals – Single kick off as staff are cross trained to different departments

• Implement clinical and non-clinical

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Levels of TeamSTEPPS Education

• Facilitator Education (Master Trainer Level)

• Master Trainers (system Super Users)

• Champions Training (4 hours session)

• Staff Training – 1 hour by Champion, all received the TeamSTEPPS Pocket Guide

• Executive Training (1 hour, basic concepts)

• Physician Training (20 minutes, what is needed the most for their participation)

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TeamSTEPPS

Skills

Outcomes

CommunicationSpeak clearly usingSBAR, read back, handoff, call out

Situationmonitoring

Ensure all teammembers are on

same page

LeadershipArticulate

clear goals through

briefs, huddles & debriefs

MutualSupport

Ask for and offer task

assistance, CUS

PerformanceAdaptability,

Accuracy, Productivity, Efficiency, Safety

AttitudesMutual trust,

Team Orientation

KnowledgeShared mental model

Improve patient outcomes

Actively promote teamwork and communication

Create tools so as to communicate effectively

Key Benefits

LegendLegend

Team Strategies and Tools to Enhance Performance and

Patient Safety

Leadership •Brief: Planned, assign roles, establish expectations, anticipate outcomes

•Huddle: Gather as needed to discuss critical issues & emerging events•Debrief: End of activity, discuss what went well and what we can do better

Situation monitoring

•Situation awareness: Know what is going on around you, including cross monitoring your team members

Mutual support •Task assistance: Ask for and offer support with all team members•CUS: When appropriate, use a CUS word: I am ONCERNED!

I am NCOMFORTABLE! This is a AFETY ISSUE!

Communication •SBAR: Summarize your critical messages in a standard format – Situation, Background, Assessment, Recommendation

•Call-out: Communicate important information and inform team members simultaneously during emergency situations

•Check-Back: Verbally confirm instructions – "closing the loop"•Handoff: During transitions in care, clearly transfer both information and accountability – make sure to offer opportunity for questions

TeamSTEPPS Language Definitions

TeamSTEPPS

Team Strategies and Tools to Enhance Performance and Patient Safety

What is it?TeamSTEPPS is an evidence-based communication toolkit to improve

team performance across the health care delivery system.

Team Competency Outcomes Knowledge – how to understand being on the “same page”

Attitudes – the importance of “team” orientation” Performance – improve safety and outcomes in your daily practice

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This is not a new program but a framework in which we can communicate more effectively with each other.

Integrating TeamSTEPPS into Patient Safety Initiatives

• Not just another program • Presented as a framework for many existing

communication activities• Added to the annual goals for Dept Managers• TeamSTEPPS prior to Safe Surgery Initiative • Integrated into job descriptions• Integrated into event investigations• Integrated into electronic health record’s

procedural and surgical checklists

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TeamSTEPPS Corporate Implementation Checklist

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√ Responsible Task CommentDeliverable

DateMeet with entity leadership for TS implementation plan for service lines.

Contact Michelle Hutson with rollout plan to schedule pre-observation for service line.

Decide if entity wants specific department pre-observations. Can use the observation tool with Tier II’s.

Approach the selected department manager with TS overview.

Select department champions for selected departments.

4 hour department champion training for either at entity or system services. Can use entity Master trainers. Contact Jeanne Campbell to schedule System Services MT to come to your entity or to sign up for the 4 hour training at THR.

TeamSTEPPS Hospital Implementation Checklist

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Key success factors Key success factors

Implementation Success FactorsTopicTopic

Implementation philosophy &

approach

Initiative leadership

Sustained performance

• TeamSTEPPS is consistently used throughout THR as the communication and patient safety language.• An understanding exists that good teamwork results in reducing preventable errors, better patient

outcomes, reducing length of stay, etc.• Constantly engage physicians and diverse stakeholders recognizing the value of interdisciplinary teams.

• Executive and department leaders visibly endorse and support TeamSTEPPS.• Physician department leaders support utilization of the TeamSTEPPS tools.

• Patient Satisfaction responses improve for the question “Staff works together to provide patient care”.• Reduce turnover times in the OR and Procedural areas• SBAR used to communicate critical patient information via the phone.

• Stories shared to demonstrate TeamSTEPPS successes.• Direct observations reflect engaged stakeholders in the TeamSTEPPS process.• Publicize progress (e.g., newsletters, publications, state or national conferences, hospital Patient Safety

newsletters, etc.)

• Improved performance in the Patient Safety Culture Survey with all hospitals at no less than the 75 th %tile in all categories.

• Direct observations during the observation survey reflect active implementation of the TeamSTEPPS tools.

• TeamSTEPPS training provided to all new employees.• Annual performance review demonstrates assessment of using the TS tools & team competencies.

Stakeholder engagement

Improve Satisfaction

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Comments or Questions

Contact Information:MarcieWilliams@TexasHealth.org