© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 Teamwork Data Armstrong Institute for Patient Safety and Quality Presented by: Heather Halvorson, MD; Nana Khunlertkit, PhD; Ayse Gurses, PhD

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

Toolkit Armstrong Institute for Patient Safety and Quality 3

Teamwork Across Units Activity Methods Collected from Teamwork Across Units Activity –May 24, 2012 face-to-face meeting Performed analysis of prioritized needs Included ‘triangle’ and ‘circle’ needs –Coded and analyzed coded data for themes –Coded prioritized needs into themes –Analyzed the coded data

Teamwork Across Units Activity Results Total of 399 needs reported –‘What do they need from my unit?’ = 225 –‘What do I need from them?’ = 168 –Across unit needs = 6 Total of 59 needs prioritized –‘Challenging to meet’ / ‘Most frequently not met’ –‘What do they need from my unit?’ = 28 –‘What do I need from them?’ = 30 –Across Units = 1 10 Barrier Themes defined

Teamwork Across Units Activity Results

Teamwork Across Units Activity Results - Barrier Themes Armstrong Institute for Patient Safety and Quality 8

Teamwork Across Units Activity Barrier Themes, cont. Armstrong Institute for Patient Safety and Quality 9

Teamwork Across Units Activity Barrier Themes, cont. Armstrong Institute for Patient Safety and Quality 10

Teamwork Across Units Activity Results

Teamwork Across Units Activity Results - Summary Who identified the prioritized needs? –~ 35% reported by one site –~ 40% reported by ICU What was reported? –10 barriers themes identified –Variation in barrier themes between units and sites Top three – all units –Delay in care –Variation in care process –Lack of standard communication

Teamwork Across Units Activity Results - Summary –ICU: delay in care, lack of standardized communication, barriers to team work –Floor: delay in care, lack of standardized communication, variation in care process –OR: variation in care process –Prep/Recovery: lack of shared patient information, variation in care

Teamwork Across Units Activity Results - Summary Barrier theme arising from: Responding UnitWhat they need from my unit What I need from them All48%52% ICU58%42% Floor57%43% OR27%73% Prep/Recovery33%67%

Teamwork Across Units Activity Results - Summary ‘What they need from my unit’ –Delay in care –Lack of standard communication –Variation of care process –Barriers to teamwork ‘What I need from them’ –Variation in care –Delay in care –Lack of shared patient information

Teamwork Across Units Activity Recommendations / Strategies Review site specific results with team –Review barrier themes for each unit –Prioritize barriers Impact on care, impact on teamwork, ease of solution, team buy-in/ownership –Solicit team recommendations to address identified barriers Repeat exercise with additional staff

Results of Teamwork Data Analysis Recommendations / Strategies Barrier Theme: delay in care –Identify reported causes Staffing? Equipment? Space? Medications? –Evaluate organizational/cultural factors Barrier theme: variation in care –Search for source of variation –Is a standardized process in place and not being adhered to? –Is an acceptable standard process available that can be implemented? –Evaluate organizational/cultural factors

Results of Teamwork Data Analysis Recommendations / Strategies Barrier Theme: lack of standardized communication –Is a standardized tool / process in place and not being adhered to? –Is an acceptable tool available that can be implemented? Checklists, forms, communication technique –Can an acceptable tool be developed to that supports needs of involved units? –Evaluate for organizational/cultural factors Share lessons learned

Discussion about the tool Usage of the tool back at the unit Usability of the tool –Barriers –Improvements Armstrong Institute for Patient Safety and Quality 26