Mutual Support Know the plan, share the plan, review the risks

Objectives Describe how mutual support affects team processes and outcomes Discuss specific strategies to foster mutual support (e.g., task assistance, feedback) Identify specific tools to facilitate mutual support Describe conflict resolution strategies

Mutual Support Dependent upon information gathered through situation monitoring Moderated by the communication of information Enhanced by leaders who encourage and role model mutual support behaviors

The Theory https://www.youtube.com/watch?v=Sin9M9boANo Effectiveness Team Leadership Orientation Mutual Performance Monitoring Back-up Behavior Adaptability Shared Mental Models Trust Effectiveness Closed Loop Communication Salas, Sims, Burke. Is there a “Big Five” in teamwork? Small Group Research. 2005; 36:555-599. Big 5 Coord. Mechanism https://www.youtube.com/watch?v=Sin9M9boANo Referring again to our theory of teamwork as a system, mutual support or back-up behavior is the essence of our ability to adapt to changing circumstances. Click on the URL that appears on the 2nd click. This is the video of the basketball coach offering task assistance/backup behavior to the young girl singing the national anthem.

Mutual Support The essence of teamwork… Anticipate the needs of other team members because you are monitoring the situation and know their tasks and responsibilities Provide a safety net for other team members when work overload situations may reduce effectiveness and increase the risk of error Mutual support involves members: Assisting each other (providing task assistance) Providing and receiving feedback Exerting assertive and advocacy behaviors when patient safety is threatened What behaviors do you think provide mutual support?

In support of patient safety, task assistance is expected. Team members foster a climate in which it is expected that assistance will be actively sought and offered as a method for reducing the occurrence of error. Why don’t we ask or offer help? Why don’t we ask or offer help: Situation Attitudes and beliefs Personality and style of communication In support of patient safety, task assistance is expected.

Task Assistance Think of two recent situations… Task assistance was offered Task assistance was not offered Think of the outcomes of these two situations…how do these outcomes compare in terms of staff burnout and patient outcomes? Discuss with the person next to you. Ancef for a 2 mo old infant…order 80 mg. Resident entered 0.8 g because that is what the POE required. He was unsure but said he had already asked too many questions that day. Ask for assistance when overwhelmed or unsure Offer members perform their tasks Shifting workload by redistributing tasks to other team members Delaying or rerouting work so the overburdened member can recover Filling in for overburdened team members Assistance should be actively offered and given whenever there is concern for patient safety related to workload

When was the last time you heard these words? “I’ve got 5 minutes…what can I do for you?” When was the last time you said these words? What would it be like to work in an environment in which these words were common?

What Is Feedback? Any team member can give feedback at any time Fosters improvement in work performance Meets the team’s and individual’s need for growth Promotes better working relationships “Feedback is the giving, seeking, and receiving of performance-related information among the members of a team” (Dickinson and McIntyre, 1997).

Types of Feedback Can be formal (e.g. performance review) or informal Constructive feedback Is considerate and task specific and focuses attention on (performance) knowledge and practical skills not the individual’s personality (Baron, 1988) Should be provided by all team members Evaluative feedback Helps the individual by comparing behavior to standards or to the individual’s own past performance (London, et al., 1999) Most often used by an individual in a coaching or mentoring role

Characteristics of Effective Feedback Think about the last time you received feedback……how did it make you feel? Discuss with your neighbor. Was this feedback… Timely Respectful Specific Directed toward improvement (intended to prevent problem from recurring Considerate Feedback is where the learning occurs. Provide constructive feedback during huddles and debriefs. You must give thought to when and where to give feedback to an individual Feedback must be timely enough for an individual to be able to readily associate it with the behavior Negative feedback should never be expressed to individuals in front of other team members

Providing Effective Feedback Video Play the video available on the AHRQ website at https://www.ahrq.gov/teamstepps/instructor/videos/ts_FeedbackDocToMedTech/feedbackDocToMedtech.html

Advocacy and Assertion Advocate for the patient when your viewpoint is not the same as a decision maker Failure to use advocacy and assertion is a primary contributor to the clinical errors found in malpractice cases and sentinel events Assert a corrective action in a firm and respectful manner.

The Assertive Statement Respectful and supportive of authority Clearly asserts concerns and suggestions Is nonthreatening and ensures that critical information is addressed Five-Step Process: Open the discussion (I’d like to share my thoughts…) State the concern (I’m concerned…) State the problem—real or perceived Offer a solution (In the future…) Obtain an agreement (Can we agree…)

Conflict Resolution Options Information Conflict (We have different information!) Two-Challenge Rule Personal Conflict (Hostile and harassing behavior) DESC script Conflict can result when we advocate for a patient. There are two basic types of conflict: information and personal. TeamSTEPPS tools are intended to keep conflict about information rather than escalating into a personal conflict.

Two-Challenge Rule 1 2

Two-Challenge Rule Invoked when an initial assertion is ignored… It is your responsibility to assertively voice your concern at least two times to ensure that it has been heard The member being challenged must acknowledge If the outcome is still not acceptable Take a stronger course of action Use supervisor or chain of command How do team members stop the line now? Can patients and families stop the line? Empower any team member to “stop the line” if patient safety is at stake

Please Use CUS Words to Challenge but only when appropriate!

Advocacy and Assertion Scenario A medical floor nurse (Linda) is assigned to a patient following a myocardial infarction. The attending physician (Dr. Brown) provides the final treatment, reviews the clinical situation, and determines that the patient is well enough to be discharged. Before the patient is discharged, Linda checks the patient’s vitals one last time. The nurse finds it unusual that the blood pressure (190/95) and heart rate (90) are substantially elevated. Role play Linda CUS-ing with Dr. Brown with the person next to you!

Conflict Resolution DESC Script A constructive approach for managing and resolving conflict: D — Describe the specific situation (When you…) E — Express your concerns about the action (I feel…) S — Suggest other alternatives (I suggest…) C — Consequences should be stated (If not…) When conflict does become personal, the DESC tool allows you to keep the focus on how the other person’s behavior makes you feel.

DESC-It Let’s “DESC-It!” Have timely discussion Work on “win-win” Frame problems in terms of your own experience Use “I” statements to minimize defensiveness Avoid blaming statements Critique is not criticism Focus on what is right, not who is right Let’s “DESC-It!”

Ineffective Approaches to Conflict Resolution Some commonly used–but ineffective–methods are: Compromise: both parties settle for less Avoidance: issues are ignored or sidestepped Accommodation: focus is on preserving relationships Dominance: conflicts are managed through directives for change

True collaboration is a process, not an event. Achieves a mutually satisfying solution resulting in the best outcome All Win!: Patient Care Team (team members, the team, and the patient) Includes commitment to a common mission Meets goals without compromising relationships True collaboration is a process, not an event.

Tools & Strategies Summary BARRIERS Inconsistency in Team Membership Lack of Time Lack of Information Sharing Hierarchy Defensiveness Conventional Thinking Complacency Varying Communication Styles Conflict Lack of Coordination and Followup With Coworkers Distractions Fatigue Workload Misinterpretation of Cues Lack of Role Clarity TOOLS and STRATEGIES Communication SBAR Call-Out Check-Back Handoff Leading Teams Brief Huddle Debrief Situation Monitoring STEP I’M SAFE Mutual Support Task Assistance Feedback Assertive Statement Two-Challenge Rule CUS DESC Script OUTCOMES Shared Mental Model Adaptability Team Orientation Mutual Trust Team Performance Patient Safety!!