Strategies and Tools for 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”

TeamSTEPPS

Weathering a disaster is not a matter of luck

It’s a team process

Sue Sheridan Video Play Video

Objectives Understand the role of communication in patient safety Acknowledge that conflict creates significant risk for patients Gain a basic understanding of TeamSTEPPS tools and incorporate into patient care Support co-workers in utilizing TeamSTEPPS tools to enhance patient safety

INEFFECTIVE COMMUNICATION Impact?

Joint Commission Sentinel Events Targets for Teamwork

How Health Care Systems have measured success with TeamSTEPPS: Length of Stay Reduction in sentinel events Quality Patient Indicators- Culture of safety Staff retention Event reporting (STARS) Staff satisfaction Patient satisfaction

Avg. Length of Stay (days) Length of ICU Stay After Team Training 1 1.2 1.4 1.6 1.8 2 2.2 2.4 June July August Sept Oct Nov Dec Jan Feb March April May Avg. Length of Stay (days) Length of ICU Stay After Team Training 50% Reduction (Pronovost, 2003) Johns Hopkins Journal of Critical Care Medicine

OR Teamwork Climate and Postoperative Sepsis Rates (per 1000 discharges) (Sexton, 2006) Johns Hopkins

Adverse Outcomes (Mann, 2006) Beth Israel Deaconess Medical Center Contemporary OB/GYN

If you had the tools to cure a critical illness, wouldn’t you use them?

What Defines a Team? Two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and have a time-limited membership “Individual commitment to a group effort—that is what makes a team work, a company work, a society work, a civilization work.” –Vince Lombardi

Team Structure The ratio of We’s to I’s is the best indicator of the development of a team. –Lewis B. Ergen

High-Performing Teams Teams that perform well: Have clear, valued, and shared vision Engage in a regular discipline of feedback Briefs, huddles, debriefs Manage and optimize performance outcomes Hold each other accountable Give feedback and share information (Salas et al. 2004) “The trick is understanding that only a special type of teamwork and camaraderie can catch in time the types of medical errors a hospital will always generate.” (Nance, 2009) “Why Hospitals Should Fly”

Barriers to Team Performance Lack of information sharing Hierarchy Defensiveness Conflict Distractions Fatigue Workload Lack of role clarity Lack of coordination and follow-up

A Shared Mental Model is… The perception of, understanding of, or knowledge about a situation or process that is shared among team members through communication. “Teams that perform well hold shared mental models.” (Rouse, Cannon-Bowers, and Salas 1992)

How Shared Mental Models Help Teams Help ensure that teams know what to expect, so if necessary, can regroup to get on the “same page” Foster communication to ensure care is synchronized Ensure that everyone on the team has a picture of what it should look like Enable team members to predict and anticipate better Create commonality of effort and purpose “ Shared mental models help teams avoid errors that place patients at risk.”

Eight Steps of Change Create sense of urgency Build the guiding team Develop a change vision and strategy Understanding and buy-in Empower others Short term wins Don’t let up – Be relentless Create a new culture

Leadership

Team Leader Two types of leaders: Designated – The person assigned to lead and organize a designated core team, establish clear goals, and facilitate open communication and teamwork among team members Situational – Any team member who has the skills to manage the situation-at-hand

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

Promoting & Modeling Teamwork Effective leaders cultivate desired team behaviors and skills through: Open sharing of information Role modeling and effectively cueing team members to employ prescribed teamwork behaviors and skills Constructive and timely feedback Facilitation of briefs, huddles, debriefs, and conflict resolution

Communication Assumptions Fatigue Distractions HIPAA

Communication and Conflict Resolution Techniques Communication is a skill Communication starts with active listening Conflict resolution is a higher level skill built on effective communication and active listening plus….

Communication 101 DEPERSONALIZE: The more inappropriate communication is, the less you have to own it!!!!” “No one can make me feel inferior without my consent” Eleanor Roosevelt

Communication 101 Being able to depersonalize inappropriate communication and/or behavior allows us to effectively begin the process of conflict resolution When we do not feel diminished or upset we can focus on the goal

Communication 101 Two goals of any conversation including conflict resolution: Good working relationships with co-workers Safe and optimal patient care

Conflict resolution 101 Make positive assumptions Keep goal of communication in mind If you meet with resistance…”I don’t know what you’re talking about”, “whatever”..,” you’re crazy”, don’t respond to the words, respond to the feelings and keep focused on goal, “You’re getting upset, that’s not my intent”. Repeat goal of conversation

Communication Breakdown Reasons for communication breakdown between nurse and physician Disagreement over discharge orders Disagreement over treatment plan Misunderstanding the other’s rationale for action or for delay in meds or treatments Focus on: Patient safety, danger or harm to patient Ethical considerations

Delegation Why is it such a problem? Process includes 4 steps: Decide what to delegate Decide to whom to delegate Communicate clear expectations Request feedback Why is it such a problem?

Standards of Effective Communication Complete Communicate all relevant information Clear Convey information that is plainly understood Brief Communicate the information in a concise manner Timely Offer and request information in an appropriate timeframe Verify authenticity Validate or acknowledge information Respectful Critical aspect of effective delegation

TeamSTEPPS Tools for Effective Communication

Tools for Conflict Resolution DESC D escribe the situation E xpress concerns S uggest alternatives C onsequences of actions CUS I am Concerned! I am Uncomfortable! This is a Safety issue!

Remember to introduce yourself . . . SBAR provides… A framework for team members to effectively communicate information to one another Communicate the following information: Situation - What is going on with the patient? Background - What is the clinical background or context? Assessment - What do I think the problem is? Recommendation - What would I recommend? Remember to introduce yourself . . .

SBAR Video Play Video

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

Handoff Optimized Information Responsibility– Accountability ELIMINATE Uncertainty Verbal Structure Checklists Acknowledgement of Understanding, Feedback Great opportunity for quality and safety

Additional TeamSTEPPS Team Communication Tools Briefs – planning Huddles – problem solving Debriefs – process improvement Leaders are responsible to assemble the team and facilitate team events But remember… Anyone can request a brief, huddle, or debrief

Briefs Planning Form the team Clarify team roles and responsibilities Establish goals (shift, patient,unit) Engage team in short and long-term planning

Briefing Checklist TOPIC Who is on team? All members understand and agree upon goals? Roles and responsibilities understood? Plan of care? Staff availability? Workload? Available resources?

Brief Video Play Video

Huddle Problem solving Hold ad hoc, “touch-base” meetings to regain situation awareness Discuss critical issues and emerging events Anticipate outcomes and likely contingencies Assign resources Express concerns

Huddle Video Play Video

Debrief Process Improvement Brief, informal information exchange and feedback sessions Occur after an event or shift Designed to improve teamwork skills Designed to improve outcomes An accurate reconstruction of key events Analysis of why the event occurred What should be done differently next time

Debrief Checklist TOPIC Communication clear? Roles and responsibilities understood? Situation awareness maintained? Workload distribution? Did we ask for or offer assistance? Were errors made or avoided? What went well, what should change, what can improve?

Debrief Video Play Video

The primary role of all Healthcare providers is patient advocacy Effective communication and conflict resolution are essential

Carter preps for surgery ER Video Carter preps for surgery Play Video

“When each member accepts full responsibility and strives for excellence…trust and performance increase exponentially…the team is ready to take off.” - Scott ‘Yogi’ Beare

Kaleida Health Patient Safety Initiative 2010 Educate staff on TeamSTEPPS tools* Brief Debrief Huddle Handoff Situation monitoring *Orientation, Preceptor Workshop, PICU at WCHOB

Using TeamSTEPPS tools will impact patient safety

This is urgent… This is personal. Play Video

TeamSTEPPS Assessment

You have completed the TeamSTEPPS presentation. Thank you