Teamwork Across Units Armstrong Institute for Patient Safety and Quality Presented by: Jill A. Marsteller

Motivation Feeling that “I’m done” when the patient leaves my area (must turn to next patient)(out of sight, out of mind) Lack of understanding across and between clinical areas/units (what, how, why, who) In-group and out-group (Halo and Horns effects) Cross-unit communications may lack explicit tools, vehicles for communication Leads to duplication; missed items; failure to interact; low inter-unit respect/ collegiality

Motivation Interactions among units can be strained CUSP is challenging to implement, units can support each other Some issues differ across units and others are common Consolidating effort in QI/PS may lead to better results (fragmented efforts less payoff) BRIEFLY

Elizabeth Dayton et al., Joint Commission Journal, Jan. 2007

Figure 2: Stages of communication, common problems and solutions Stage 5: Escalate Stage 1: Decide on message Stage 2: Encode Stage3: Decode Stage 4: Negotiate Groupthink, tunnel vision, low input Problems: Solutions: Psychological safety, pause points, diversity, situational awareness Ambiguous language Solutions: Structured communication tools such as SBAR Fatigue, distraction, noise, closed culture Solutions: Read back Failure to speak up, bullying, judging Assertive communication, role playing Failure to seek mediation Solutions: Set up clear chain of command and expectations for use

Aim For Cross-Unit Teamwork To facilitate and improve teamwork, communication, and coordination of quality improvement and patient safety activities across the CUSP teams working in the three clinical areas/units.

Improved understanding and interactions across units within a hospital Goals Thinking about keeping patients safe during entire episode of inpatient care Increased cross-unit interactions would encourage shared goals and problem-solving with respect to quality and safety issues/ initiatives across units within a hospital Improved understanding and interactions across units within a hospital We already spend an hour in the morning

Conceptual Supports Improvement of relationships due to: Work on common topics Increased exposure to problems/ successes of other units Shared problem-solving Creation of a super-ordinate identity Faster/ greater improvement in QI/PS issues due to: Increased availability of information/ ideas Benefits of multiple perspectives Coordinated approach across units with common issues

Interventions Meetings of an All-unit CUSP team Sharing local safety assessment and LFD results Joint LFD investigations of common safety issues Joint designation/development of new QI initiatives Cross-unit Shadowing

Cross-unit Shadowing What happened during the shadowing exercise that involved multiple practice domains? Were any health care providers difficult to approach? Did one provider get approached more often for patient issues? Did you observe any errors in transcription, interpretation, delivery of orders/ other processes? Were patient problems identified quickly? Were they handled as you would have handled them? Why/ why not? What obstacles were faced? Any suggestions for the shadowed unit to consider?

The hard question What could my unit/area do to help care go more smoothly in the shadowed unit?

Outcomes/Results We hypothesize that providers will note increased frequency of communication and better problem-solving interactions, higher ratings of shared goals, knowledge, and mutual respect across units at time 2 compared to time 1 Shared QI programs/ strategies will be observed at time 2 that were not present at time 1