© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 Cross-unit Teamwork: Tools and Data Armstrong Institute for Patient Safety and Quality Presented by: Jill Marsteller, PhD, MPP

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 QI and CUSP can be challenging to implement, units can support each other Some issues differ across units but others are common; some unit issues cannot be addressed without other units Consolidating effort in QI/PS may lead to better results (fragmented efforts less payoff) Transitions across units a critical, error prone juncture

Goals Thinking about keeping patients safe during entire episode of inpatient care Increased cross-unit interactions to encourage –shared goals –mutual respect –joint problem-solving Improved safety between units (and across all) Better coordination through transitions of care

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 Better transitions of care from one unit to another

Interventions All-unit Joint CUSP team (regular meetings) Same senior leader across units Sharing local safety assessment and LFD results Joint LFD investigations of common safety issues Joint designation/development of new QI initiatives

Interventions Cross-unit Shadowing Assessment of Care Transitions (ACT) tool (in development) User-centered design approach to handoff checklist development (how to create your own handoff checklists) Cross-unit teamwork assessment exercise

Cross-Unit Intervention Implementation Plan Armstrong Institute for Patient Safety and Quality 8 Cross-unit Teamwork Exercise Cross-unit Shadowing All-unit Joint CUSP team meeting (regular) Own unit CUSP Team Joint CUSP team selects an issue Use LFD process (investigate, generate, evaluate) All staff Use BIM to assess barriers Develop handoff tools Sr Exec Partner Assess current handoffs

Cross-unit Shadowing Spend 2+ hours observing a role or process in another unit Write down answers to the shadowing questions Debrief with own unit CUSP team Report to Joint CUSP team, CUSP team for the shadowed unit

Cross-unit Shadowing Questions 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? What was going on at this time? Were issues or problems identified quickly? Were they handled as you would have expected? Why/ why not? What obstacles were faced? What did you learn about the other unit? Any suggestions for the shadowed unit to consider? What could my unit/area do to help care go more smoothly in the shadowed unit?

Cross-Unit Teamwork Needs Assessment Exercise Armstrong Institute for Patient Safety and Quality 11

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 10 Barrier Themes defined

Teamwork Across Units Activity Results - Barrier Themes Armstrong Institute for Patient Safety and Quality 14

Teamwork Across Units Activity Barrier Themes, cont. Armstrong Institute for Patient Safety and Quality 15

Teamwork Across Units Activity Barrier Themes, cont. Armstrong Institute for Patient Safety and Quality 16

Teamwork Across Units Activity Results

Conclusion Re-orient thoughts to protecting patients for their entire stay for patients Improve efficiency and experience for patient Make own lives easier by working together with other units Armstrong Institute for Patient Safety and Quality 18