TeamSTEPPS: The Present and the Future

TeamSTEPPS Plans for the Future (2.0) and the Present User Support Network TeamSTEPPS National Conference June 22, 2012

T EAM STEPPS 05.2 Mod Page 3 TeamSTEPPS Session Moderator Andrea Amodeo, MS, IMPAQ International

T EAM STEPPS 05.2 Mod Page 4 TeamSTEPPS Purpose To Provide Updates on the National Implementation of TeamSTEPPS Program in terms of: Support Training Future directions

T EAM STEPPS 05.2 Mod Page 5 TeamSTEPPS Agenda Introduction User Support Network & Resources TeamSTEPPS “2.0” TeamSTEPPS Training & National Meeting Panel Q&A

T EAM STEPPS 05.2 Mod Page 6 TeamSTEPPS Panel Introductions Kathryn Schulke, Booz Allen Hamilton David P. Baker, PhD, IMPAQ International Stephen Hines, PhD, Health Research & Educational Trust

T EAM STEPPS 05.2 Mod Page 7 TeamSTEPPS User Support Network and Resources Kathryn Schulke Booz Allen Hamilton

T EAM STEPPS 05.2 Mod Page 8 TeamSTEPPS OVERVIEW OF TeamSTEPPS USER SUPPORT NETWORK AND RESOURCES

T EAM STEPPS 05.2 Mod Page 9 TeamSTEPPS Overview of TeamSTEPPS User Support Network AHRQ TeamSTEPPS Website General Information TeamSTEPPS Assessment Tools Training Calendar TeamSTEPPS Tools & Materials User Support Portal Announcements Event Calendar Resource Center Archives Discussion Forum Technical Assistance AHRQ TeamSTEPPS Website TeamSTEPPS User Support Portal

T EAM STEPPS 05.2 Mod Page 10 TeamSTEPPS AHRQ TeamSTEPPS Website Resources

T EAM STEPPS 05.2 Mod Page 11 TeamSTEPPS AHRQ TeamSTEPPS Website Resources General Information Overview of TeamSTEPPS National Implementation Plan Description Regional Training Centers How to contact the TeamSTEPPS Implementation Team Leadership Briefing Slides Assessment Tools TeamSTEPPS Readiness Assessment TeamSTEPPS Teamwork Perception Questionnaire (T-TPQ) TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ)

T EAM STEPPS 05.2 Mod Page 12 TeamSTEPPS AHRQ TeamSTEPPS Website Resources cont. Training Registration & Dates TeamSTEPPS Tools and Materials TeamSTEPPS Rapid Response System training module Using Simulation in TeamSTEPPS training guide How to Order TeamSTEPPS materials Implementation Stories

T EAM STEPPS 05.2 Mod Page 13 TeamSTEPPS TeamSTEPPS User Support Portal Overview Announcements Calendar of Events Resource Center Discussion Forum Request Support Opportunities to receive TA from SMEs

T EAM STEPPS 05.2 Mod Page 14 TeamSTEPPS Specific Resources Available for TeamSTEPPS Users Potential Users Announcements Calendar of Events TeamSTEPPS Trainee s Resource Center Pre-Training Material Tools by Key Principle Existing Users Discussion Forum Request Support TeamSTEPPS Potential Users TeamSTEPPS Trainees TeamSTEPPS Existing Users

T EAM STEPPS 05.2 Mod Page 15 TeamSTEPPS Specific Resources Available for TeamSTEPPS Users cont. TeamSTEPPS Potential Users

T EAM STEPPS 05.2 Mod Page 16 TeamSTEPPS Specific Resources Available for TeamSTEPPS Users cont. TeamSTEPPS Potential Users

T EAM STEPPS 05.2 Mod Page 17 TeamSTEPPS Specific Resources Available for TeamSTEPPS Users cont. TeamSTEPPS Trainees

T EAM STEPPS 05.2 Mod Page 18 TeamSTEPPS Specific Resources Available for TeamSTEPPS Users cont. TeamSTEPPS Existing Users

T EAM STEPPS 05.2 Mod Page 19 TeamSTEPPS OVERVIEW OF 2012 WEBINAR

T EAM STEPPS 05.2 Mod Page 20 TeamSTEPPS TeamSTEPPS Pre-Training Webinar May 18, participants Held May 18, 2012 with over 80 participants Presenter: David Baker, PhD Vice President Research, IMPAQ Webinar Objectives: Describe the importance of TeamSTEPPS and the Master Trainer Program Describe what participants should do prior to TeamSTEPPS Master Training Describe what happens after TeamSTEPPS Master Training

T EAM STEPPS 05.2 Mod Page 21 TeamSTEPPS Using TeamSTEPPS to Prevent High Priority Harms May 31, participants Held May 31, 2012 with over 300 participants Presenter: Stephen Hines, PhD Vice-President, Health Research and Education Trust Webinar Objectives: Frame teamwork as part of an integrated quality improvement strategy Provide a short overview of TeamSTEPPS and AHRQ’s national implementation strategy Discuss strategies to maximize the impact of TeamSTEPPS in efforts to reduce all 9 HACs and readmissions

T EAM STEPPS 05.2 Mod Page 22 TeamSTEPPS FUTURE TeamSTEPPS USER RESOURCES

T EAM STEPPS 05.2 Mod Page 23 TeamSTEPPS Future TeamSTEPPS User Resources Future Webinars Two additional webinars will be hosted this year Discussions during the national meeting will determine subject matter for the webinars Special Topic TeamSTEPPS Master Trainings Inter-professional Education held at University of Minnesota Fairview Medical Center, August 6-7, 2012 Patient Engagement held at Duke University, August 30-31, 2012

T EAM STEPPS 05.2 Mod Page 24 TeamSTEPPS Additional Resources Department of Defense Patient Safety Program Website Order TeamSTEPPS Materials Phone: Civilian Orders: DoD/TRICARE Orders: Contact National Implementation Team Phone:

T EAM STEPPS 05.2 Mod Page 25 TeamSTEPPS User Support Network and Resources Fosters collaboration Prevents TeamSTEPPS users from “reinventing the wheel” Provide support to ease the implementation process Create a support system for TeamSTEPPS users

T EAM STEPPS 05.2 Mod Page 26 TeamSTEPPS In Conclusion Keep on STEPPIN’ The sky’s the limit!

T EAM STEPPS 05.2 Mod Page 27 TeamSTEPPS TeamSTEPPS “2.0” David P. Baker, PhD IMPAQ International

T EAM STEPPS 05.2 Mod Page 28 TeamSTEPPS History of “1.0” TeamSTEPPS Curriculum Developed by AHRQ and DoD Development completed in 2005 Released to the public in 2006 TeamSTEPPS National Implementation 2008 – 2009: Created a national infrastructure to support the adoption of TeamSTEPPS 2009 – Present: Support the spread of TeamSTEPPS nationally

T EAM STEPPS 05.2 Mod Page 29 TeamSTEPPS Patient Safety Movement Prior to

T EAM STEPPS 05.2 Mod Page 30 TeamSTEPPS (Pronovost, 2003) Johns Hopkins Journal of Critical Care Medicine (Mann, 2006) Beth Israel Deaconess Medical Center Contemporary OB/GYN (Sexton, 2006) Johns Hopkins 30

T EAM STEPPS 05.2 Mod Page 31 TeamSTEPPS Medical Errors Still Claiming Many Lives By Elizabeth Weise, USA TODAY As many as 98,000 Americans still die each year because of medical errors despite an unprecedented focus on patient safety over the last five years, according to a study released today. Significant improvements have been made in some hospitals since the Institute of Medicine released a landmark report in 2000 that revealed many thousands of Americans die each year because of medical mistakes. But nationwide, the pace of change is painstakingly slow, and the death rate has not changed much, according to the study in The Journal of the American Medical Association. The researchers blame the complexity of health care systems, a lack of leadership, the reluctance of doctors to admit errors and an insurance reimbursement system that rewards errors — hospitals can bill for additional services needed when patients are injured by mistakes — but often will not pay for practices that reduce those errors. "The medical community now knows what it needs to do to deal with the problem. It just has to overcome the barriers to doing it," says study co-author Lucian Leape of Harvard's School of Public Health. The institute, a public policy organization, pushed key health care organizations to focus on patient safety, the new report says. As a result, reductions as much as 93% have been made in certain kinds of error-related illnesses and deaths. Computerized prescriptions, adding a pharmacist to medical teams and team training in the delivery of babies are among the improvements medical centers are making, the study finds. But "we have to turn the heat up on the hospitals," Leape says. For example, 5% to 8% of intensive-care patients on ventilators develop pneumonia, the study says. But by strictly following a simple protocol of bed elevation, drugs and periodic breathing breaks, those outbreaks can be reduced to almost zero. "A little hospital in DeSoto, Miss., called Baptist Memorial did it, so it doesn't take a big academic medical center," Leape says. Hospitals that eliminate infections should receive bonuses, Leape says. "If insurance companies paid 20% more for patients in (intensive-care units) where there were no infections, they'd cut costs substantially. "We really need to rethink how we pay for health care. What we do now is pay for services, but what we should do is pay for care and outcomes." 05/18/2005 …little progress towards the goal Leape and Berwick, JAMA May Hospitals have taken steps to reduce medical errors and injuries. Examples: Computerized prescriptions: 81% decrease in errors. Including pharmacist in medical team: 78% decrease in preventable drug reactions. Team training in delivery of babies: 50% decrease in harmful outcomes — such as brain damage — in premature deliveries. Source: Journal of the American Medical Association Improvements 31

T EAM STEPPS 05.2 Mod Page 32 TeamSTEPPS 32 JCAHO Sentinel Events

T EAM STEPPS 05.2 Mod Page 33 TeamSTEPPS Since 2005 The science of patient safety and quality has grown and is now established Michigan Keystone CUSP CLABSI PfP Importance of teamwork and team training is well accepted in healthcare There has been tremendous research on the topic

T EAM STEPPS 05.2 Mod Page 34 TeamSTEPPS What is “2.0?” Part of Effort to Continually Evolve TeamSTEPPS Provides an Opportunity to: Leverage what has been learned so far Lessons learned through National Implementation Feedback from users New and emerging evidence Consider meaningful ways to integrate current and future TeamSTEPPS efforts Should be Considered a Work in Progress…. Scope of revisions/additions has not yet been determined Recommendations due to AHRQ in Aug 2012

T EAM STEPPS 05.2 Mod Page 35 TeamSTEPPS Gathering Input for “2.0” Meetings with AHRQ and DoD Focus Groups with Experienced TeamSTEPPS Users and Trainers Participants referred by AHRQ and/or DoD 5 virtual focus groups conducted DoD, RTRC, others Over 80 years combined experience with teaching and/or implementing TeamSTEPPS!

T EAM STEPPS 05.2 Mod Page 36 TeamSTEPPS What We’ve Been Hearing… The Following Slides Provide a High-Level Summary of What We Have Heard Topics include: TeamSTEPPS pre-training, materials, delivery, and implementation/sustainment Not comprehensive; intended to provide an overview Still defining what 2.0 will be We Want to Hear YOUR Thoughts and Ideas!

T EAM STEPPS 05.2 Mod Page 37 TeamSTEPPS What We’ve Been Hearing… Pre-Training Provide overview of Master Training course and role of a Master Trainer (it’s more than attending training…) Provide guidance on who to send to training Update/augment resources for obtaining buy-in Emphasize the need to develop a plan! What are the goals for implementation? In which unit/areas of the organization will you begin? How will implementation be measured or monitored?

T EAM STEPPS 05.2 Mod Page 38 TeamSTEPPS What We’ve Been Hearing… Materials CD/DVD Provide all materials and files on a single disk Update contents Improve labeling and reorganize Pocket Guide Continues to be useful Many users customizing and printing Guide to Action Many agreed useful as an electronic resource

T EAM STEPPS 05.2 Mod Page 39 TeamSTEPPS What We’ve Been Hearing… Materials (Cont’d) Instructor Guide Variable feedback on hard copy vs. electronic materials Improve labeling of modules and contents Improve ease of updating materials Eliminate redundancies Update slides, introductory information, and references that support evidence base Consistent agreement on usefulness of Instructor Notes Add new scenarios that address more clinical areas

T EAM STEPPS 05.2 Mod Page 40 TeamSTEPPS What We’ve Been Hearing… Materials (Cont’d) Other suggested improvements Improve information about coaching (e.g., why important and how it fits in implementing TeamSTEPPS) Consider the variety of audiences (new vs. experienced users; Master trainers vs. staff; unit vs. institutional change agents) Link TeamSTEPPS to other change models Include more resources for obtaining buy-in and gaining physician engagement Integrate work on patient engagement

T EAM STEPPS 05.2 Mod Page 41 TeamSTEPPS What We’ve Been Hearing… Delivery Variable feedback on 2-day vs. 2.5-day course Variable feedback on use of teach-backs Some users eliminate this exercise Other users emphasize its importance in ensuring the trainees understand the material and feel comfortable teaching it Importance of simulation Demonstrates how trainers can integrate tools and strategies into simulation at any level of fidelity Provides another way for trainees to relate to materials (i.e., tells a story)

T EAM STEPPS 05.2 Mod Page 42 TeamSTEPPS What We’ve Been Hearing… Implementation & Sustainment Provide more specific guidance and examples related to coaching, implementation, and measurement Emphasize importance of post-training follow-up Ensure accountability for following the plan Provide guidance on anticipated barriers Integrate TeamSTEPPS into new employee orientation, annual competency training, and performance appraisals Strengthen evaluation information and resources Provide information and emphasize integration of TeamSTEPPS into other patient safety and quality initiatives

T EAM STEPPS 05.2 Mod Page 43 TeamSTEPPS The Components of a Patient Safety Program 43

T EAM STEPPS 05.2 Mod Page 44 TeamSTEPPS Next Steps Analyze and summarize the focus group results Make recommendations to AHRQ/DoD Implement recommendations – FY13 Important considerations Demand for TeamSTEPPS Master Training The available resources Demand for 2.0

T EAM STEPPS 05.2 Mod Page 45 TeamSTEPPS TeamSTEPPS Training and the 2013 National Conference Steve Hines, PhD Health Research & Educational Trust

T EAM STEPPS 05.2 Mod Page 46 TeamSTEPPS TeamSTEPPS Trainings Changes We’ve Made Expanded number of centers to reach broader audience Increased number of seats available in trainings Fostering cross-pollination across Centers Designing advance topic trainings: Use of simulation TS in professional education Making patients a part of the team Encouraging innovation in the trainings

T EAM STEPPS 05.2 Mod Page 47 TeamSTEPPS TeamSTEPPS Training  Advanced topics: IPE, Patient Engagement, and Simulation States with RTRCs:  WA (Seattle): University of Washington  CO (Denver): Presbyterian / St. Luke’s  MN (Minneapolis): University of Minnesota  LA (New Orleans): Tulane University  NC(Durham): Duke University  NY (New Hyde Park): North Shore LIJ

T EAM STEPPS 05.2 Mod Page 48 TeamSTEPPS TeamSTEPPS Trainings How we’re doing: Enrollment: Every training has been full Waiting list of 600+ persons Satisfaction: Evaluations from all trainings positive & insightful Impact: Ultimate standard, but hardest to assess Plans to follow-up with participants to monitor their progress Goal: Continuous improvement

T EAM STEPPS 05.2 Mod Page 49 TeamSTEPPS TeamSTEPPS Trainings What we’re learning About excellence in training teams Clinical backgrounds Diversity Adult education Experience Behavioral feedback About maximizing success rates Improving “prequipping” via homework and readiness assessment Linking TS training to other support activities

T EAM STEPPS 05.2 Mod Page 50 TeamSTEPPS 2013 National Conference 2012 Conference 150+ more attendees than last year More & more diverse presentations 2013 Conference (pending contract extension) Parameters Location: San Antonio Time: mid- to late-June Size: larger venue to accommodate demand Changes Poster sessions to facilitate sharing

T EAM STEPPS 05.2 Mod Page 51 TeamSTEPPS 2013 National Conference 2013 Conference (pending contract extension) Changes Theme: soliciting ideas Poster sessions to facilitate sharing Call for papers & panels Increased number of concurrent sessions Recruitment of conference sponsors Networking forums Other changes based on feedback from this year

T EAM STEPPS 05.2 Mod Page 52 TeamSTEPPS Questions and Answers We’d like to hear your questions and feedback about: The User Support Network Plans for “2.0” Upcoming national meeting TeamSTEPPS national trainings Resources that prospective and current users of TeamSTEPPS would like to see available

T EAM STEPPS 05.2 Mod Page 53 TeamSTEPPS Thank You! For more information, please contact our team at: