Sitka Community Hospital

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”

What is TeamSTEPPSTM? An evidence-based teamwork system Designed to improve: Quality Safety Efficiency of health care Practical and adaptable Provides ready-to-use materials for training and ongoing teamwork Evidence-Based Teamwork System TeamSTEPPS is a teamwork system based on 20 years experience and lessons learned from High-Reliability Organizations (HROs) (for example, military operations, aviation, community emergency response services). These types of organizations have been conducting extensive research on how teams work, what makes them effective and how to enhance their performance. Delivering effective care requires teamwork. Designed to Improve Team Effectiveness TeamSTEPPS has developed a program to improve the quality, safety, and effectiveness of health care by improving communication and teamwork skills. These skills allow the teams to: Adapt to changing situations. Have a shared understanding of the care plan. Develop positive attitudes toward and appreciate the benefits of teamwork. Provide more safe, reliable, and efficient care.

Why Use TeamSTEPPS? Goal: Produce highly effective medical teams that optimize the use of information, people and resources to achieve the best clinical outcomes Teams of individuals who communicate effectively and back each other up dramatically reduce the consequences of human error Team skills are not innate; they must be trained TeamSTEPPS provides the resources to optimize team performance across our hospital. Human factors research has shown that even highly skilled, motivated professionals are vulnerable to error due to human limitations. But research has also shown that: Teams that communicate effectively and back each other up reduce the potential for error, which results in improved safety and performance. For example, the Joint Commission analyzed the sentinel events that were reported to them over the last 10 years and identified communication malfunction as the leading root cause of these events. TeamSTEPPS improves communication and other teamwork skills. This is important because teamwork is not innate; it must be learned.

People make fewer errors when they work in teams.

Sue Sheridan Video

How Often do Medical Errors Occur? 44,000-98,000 deaths per year in hospitals due to medical errors Equal to one jumbo jet crashing EVERY DAY!

Why Do Errors Occur—Some Human Factors Workload fluctuations Interruptions Fatigue Multi-tasking Failure to follow up Poor handoffs Ineffective communication Not following protocol Complacency Excessive professional courtesy Halo effect Passenger syndrome Rigid Hierarchies High-risk phase Strength of an idea Task fixation (lack of situational awareness) Excessive professional courtesy—giving someone of higher rank or status too much respect so that it affects the level of healthcare they receive. May also occur among team members having higher rank or status, resulting in a hesitancy of team members to point out deficiencies in performance. Halo effect— occurs when someone else’s “great” reputation or extensive experience clouds our judgment. Passenger syndrome—Team members experience “passenger syndrome” when they abandon responsibility because they believe someone else is in charge. Complacency—When individuals or teams become comfortable with the most routine to the most difficult tasks. Becomes a hazard when individuals and teams lose their vigilance. High-risk phase—a procedure or time in which a medical error is likely to happen (e.g., shift change). Task (target) fixation—a condition in which an individual’s or team’s focus on a task may impair their decision-making or make them oblivious to “the big picture.” Strength of an idea—Once people get certain ideas in their heads, it can be difficult or impossible for them to alter that idea regardless of how much conflicting information is received. 8 8

What Will Our Teams Learn? If we implement TeamSTEPPS, our teams will learn about the four areas that lead to improved team performance, safer practices, and change in culture: Leadership Situation monitoring – how to develop common understandings of team environment, apply strategies to monitor teammate performance and maintain a shared mental model. Mutual support – how to anticipate other team members’ needs through accurate knowledge and shift workload to achieve balance during periods of high workload or stress. Communication – how to effectively exchange information among team members, regardless of how it is communicated. The end result will be a higher-performing team, where members: Share a clear vision of the plan Utilize concise, structured communication techniques Adapt readily to changing situations Maximize the use of information, skills, and resources for optimal outcomes

How Does TeamSTEPPS Work? I. Assessment Clearly define the need II. Planning, Training, and Implementation Plan to sustain the effort Train individuals Implement and test the strategies III. Sustainment Integrate into daily practice Monitor and measure programs A TeamSTEPPS Initiative occurs in three phases: Phase I — Assessment (Set The Stage) This phase determines our organizational readiness for the initiative. Phase II — Planning, Training, and Implementation (Decide What To Do and Make It Happen) This phase is where planning and execution take place. Develop an Action Plan Conduct training Phase III — Sustainment (Make It Stick) This phase is designed to sustain and spread the improvements in teamwork performance, clinical processes, and outcomes throughout the organization. TeamSTEPPS is an initiative designed to change how our teams work together on an ongoing basis. It’s not just about the training but about providing sufficient time for teams to continue to practice the teamwork tools and strategies in their daily work.

What Do We Need to Make This Work? Clearly define the need Focus on enhancing teamwork and establishing a teamwork and safety culture Support from senior leadership Allocate sufficient resources Personnel Time Resources Measure success Reward and reinforce teamwork Clearly define the need This should be something that we think a teamwork solution will work for e.g., improving communication between nurses and physicians, ensuring everyone on the care team knows the plan, etc. We need to align this initiative with other ongoing initiatives that we have (e.g., safety initiatives) so that it is not another “new program” but an integral part of achieving our vision. Focus on enhancing teamwork and establishing a teamwork and safety culture For this initiative to be successful, we need to establish a culture of teamwork and safety, so that it’s not just a training program that staff go to, but a new way of working together. Senior leadership support Allocate sufficient resources Appropriate time, personnel, and funding to establish the program, conduct the training, and then follow through on emphasizing the importance of teamwork in our daily work. For example, this means: Identifying trainers and coaches. Providing an infrastructure to support training. Allowing time for staff to attend training (nurses, physicians, key personnel). Providing time for coaches to meet with staff members on an ongoing basis. Measure success We’ll need to continually evaluate whether the process is achieving the outcomes we anticipated. Reward and reinforce teamwork Since we need to create a teamwork and safety culture for this to be a success, it’s important that we reward and reinforce teams for engaging in the teamwork behaviors and learning teamwork skills. Leaders, trainers, and coaches should be willing to provide ongoing feedback to others within the hospital. Successes need to be formally recognized and showcased throughout the organization.

This is how it works.

Pulling it All Together Summary Pulling it All Together “The truth of the matter is that you always know the right thing to do. The hard part is doing it.” -Norman Schwarzkopf “The problem is not bad people; the problem is that the system needs to be made safer . . .” --unknown