TeamSTEPPS Overview and Essentials Situation Monitoring Communication Mutual Support Leadership PATIENT CARE TEAM KNOWLEDGE ATTITUDES PERFORMANCE SKILLS TeamSTEPPS Overview and Essentials Notes:

Sue Sheridan Video Spokesperson, World Health Organization’s World Health Alliance for Patient Safety

Teamwork is all around us…

After Team Training 50% reduction in adverse outcomes, based on averaged scores after they were weighted for severity (Mann, 2006) After implementation of a interdisciplinary communication tools to improve rounds, the average length of ICU stays were reduced by 50% (Pronovost, 2003) Teamwork and communication skills, more than previous surgical experience, determine how quickly medical personnel develop expertise in new technology (e.g., robotics for minimally invasive cardiac surgery) (Pisano 2001)

Evolution of TeamSTEPPS Department of Defense Agency for Healthcare and Quality Research Organizations Universities Medical and Business Schools Hospitals – Military and Civilian, Teaching and Community-Based Healthcare Foundations Private Companies Subject Matter Experts in Teamwork, Human Factors, an Crew Resource Management (CRM)

Team Strategies & Tools to Enhance Performance & Patient Safety TeamSTEPPS Team Strategies & Tools to Enhance Performance & 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”

Patient Safety Movement JCAHO National Patient Safety Goals “To Err is Human” IOM Report TeamSTEPPS 1995 1999 2001 2003 2004 2005 2006 Medical Team Training DoD MedTeams® ED Study Executive Memo from President Institute for Healthcare Improvement 100k lives Campaign Patient Safety and Quality Improvement Act of 2005

TeamSTEPPS at Newport Hospital The Department of Defense (DoD) and the Agency for Healthcare Research and Quality (AHRQ) developed TeamSTEPPS, a teamwork system which offers a powerful solution to improving collaboration and communication within Healthcare Newport Hospital implemented TeamSTEPPS in 2007 to support its Culture of Safety

Implementation Plan Hospital-wide training Overview sessions in September of 2007 Management overview in January of 2008 Champion development in April / May 2008 Ongoing specific skill focus on the 3rd Thursday of every month Hospital-wide phrase for clarity “I need clarity” Action Planning coordinated by Directors/VPs Specific tools and techniques for departments

Your Opportunity If I had a “Magic Wand” and could make changes within my unit or department in the areas of patient quality and safety…

Why Do Errors Occur – Some Obstacles Workload fluctuations Interruptions Fatigue Multi-tasking Failure to follow up Poor handoffs Ineffective communication Not following protocol Excessive professional courtesy Halo effect Passenger syndrome Hidden agenda Complacency High-risk phase Strength of an idea Task (target) fixation

Institute of Medicine Report Impact of Error 44,000 – 98,000 annual deaths occur as a result of errors Medical errors are the leading cause, followed by surgical mistakes and complications More Americans die from medical errors than from breast cancer, AIDS, or car accidents 7% of hospital patients experience a serious medication error Cost associated with medical errors is $8 - $29 billion annually.

Team Competency Outcomes Knowledge Shared Mental Model Attitudes Mutual Trust Team Orientation Performance Adaptability Accuracy Productivity Efficiency Safety TeamSTEPPS is an evidence-based framework to optimize performance across the healthcare delivery system Situation Monitoring Communication Mutual Support Leadership PATIENT CARE TEAM KNOWLEDGE ATTITUDES PERFORMANCE SKILLS Notes:

Key Principles Team Structure Leadership Situation Monitoring Delineates fundamentals such as team size, membership, leadership, composition, identification and distribution Leadership Ability to coordinate the activities of team members by ensuring team actions are understood, changes in information are shared, and that team members have the necessary resources Situation Monitoring Process of actively scanning and assessing situation elements to gain information, understanding, or maintain awareness to support functioning of the team Mutual Support The ability to anticipate and support other team members' needs through accurate knowledge about their responsibilities and workload Communication Process by which information is clearly and accurately exchanged among team members Notes:

Multi-Team System For Patient Care CONTINGENCY TEAMS CORE TEAM COORDINATING TEAM ANCILLARY SERVICES Notes: ADMINISTRATION Team Structure

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 What other characteristics do effective Team Leaders possess?

Team Events Planning Problem Solving Process Improvement Brief Huddle Debrief Which of the above Team Events would be helpful in your department?

Situation Monitoring Situation monitoring is the process of continually scanning and assessing what’s going on around you to maintain situation awareness. Situation awareness is “knowing what is going on around you.” With a shared mental model, all team members are “on the same page.” Situation Awareness (Individual Outcome) Situation Monitoring (Individual Skill) Notes Shared Mental Model (Team Outcome)

Cross Monitoring An error reduction strategy that involves: Monitoring actions of other team members Providing a safety net within the team Ensuring mistakes or oversights are caught quickly and easily “Watching each other’s back” Notes:

STEP A tool for monitoring situations in the delivery of health care S TATUS OF THE PATIENT T EAM MEMBERS Notes: E NVIRONMENT P ROGRESS TOWARD GOAL

I’m SAFE Checklist I = Illness M = Medication S = Stress A = Alcohol and Drugs F = Fatigue E = Eating and Elimination Notes:

Task Assistance Team members protect each other from work overload situations Effective teams place all offers and requests for assistance in the context of patient safety Team members foster a climate where it is expected that assistance will be actively sought and offered Notes:

Feedback Information provided for the purpose of improving team performance Timely – given soon after the target behavior has occurred Respectful – focus on behaviors, not personal attributes Specific – be specific about what behaviors need correcting Directed towards improvement – provide directions for future improvement Considerate – consider team member’s feelings and deliver negative information with fairness and respect Notes:

Advocacy and Assertion Advocate for the patient Invoked when team members’ viewpoints don’t coincide with that of the decision maker Assert a corrective action in a firm and respectful manner Make an opening State the concern Offer a solution Obtain an agreement Notes:

Two-Challenge Rule When an initial assertion is ignored: Empowers all team members to “stop the line” if they sense or discover an essential safety breach! When an initial assertion is ignored: It is your responsibility to assertively voice concern at last two times to ensure it has been heard The team member being challenged must acknowledge If the outcome is still not acceptable Take a stronger course of action Utilize a supervisor or chain of command Notes:

CUS I am This is a ONCERNED! NCOMFORTABLE! AFETY ISSUE! C U S Notes:

DESC Script A constructive approach for managing and resolving conflict D – Describe the situation or behavior, provide concrete data E – Express how the situation makes you feel/what your concerns are S – Suggest other alternatives and seek agreement C – Consequences should be stated in terms of impact on established team goals; strive for consensus Notes:

SBAR A technique for communicating critical 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 do to correct it? Notes:

Call Out Strategy used to communicate important or critical information Informs all team members simultaneously during emergent situations Helps team members anticipate next steps Important to direct responsibility to a specific individual responsible for carrying out the task Notes:

Check Back Process of employing closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended Sender initiates the message Receiver accepts the message and provides feedback Sender double-checks to ensure that the message was received Notes:

Handoff The 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 Shift changes Physicians transferring complete responsibility Patient transfers Notes:

TeamSTEPPS Overview and Essentials Situation Monitoring Communication Mutual Support Leadership PATIENT CARE TEAM KNOWLEDGE ATTITUDES PERFORMANCE SKILLS Notes: