1. TeamSTEPPS for Patients: A Pilot Test in Labor and Delivery December 17, 2014

2. T EAM STEPPS 05.2 Mod 1 05.2 Page 2 TeamSTEPPS ® TeamSTEPPS for Patients Slide 2 Acknowledgements Project Sponsors Jim Battles, PhD (AHRQ) Heidi King, MS (DoD) Project Team Health Research & Educational Trust (HRET) Barb Edson (Project Director) Chris Hund (Project Manager) IMPAQ International David Baker (Team Lead)

3. T EAM STEPPS 05.2 Mod 1 05.2 Page 3 TeamSTEPPS ® TeamSTEPPS for Patients Slide 3 TeamSTEPPS Master Training Two-day training course Train-the-trainer approach Prepares you to serve as a TeamSTEPPS Master Trainer by Providing instruction on TeamSTEPPS tools and strategies Providing an opportunity to develop and plan your TeamSTEPPS implementation Prepares you to serve as a leader for implementing TeamSTEPPS within your organization

4. T EAM STEPPS 05.2 Mod 1 05.2 Page 4 TeamSTEPPS ® TeamSTEPPS for Patients Slide 4 Help Line (312) 422-2609 Or email: AHRQTeamSTEPPS@aha.orgAHRQTeamSTEPPS@aha.org

5. T EAM STEPPS 05.2 Mod 1 05.2 Page 5 TeamSTEPPS ® TeamSTEPPS for Patients Slide 5 Rules of Engagement A Q&A session will be held at the end of the presentation Written questions are encouraged throughout the presentation and will be answered during the Q&A session To submit a written question, type it into the Discussion Area at the top left of your screen and send it at any time during the presentation The lines may open for call-in questions during the Q&A session

6. T EAM STEPPS 05.2 Mod 1 05.2 Page 6 TeamSTEPPS ® TeamSTEPPS for Patients Slide 6 Today’s Presenter David P. Baker, PhD IMPAQ International Chief Program Officer Involved with TeamSTEPPS since the beginning Director, Health Services Research Institute, Carilion Clinic (2007-2010) Associate Professor, Virginia Tech Carilion School of Medicine, IPE Block Design Team

7. T EAM STEPPS 05.2 Mod 1 05.2 Page 7 TeamSTEPPS ® TeamSTEPPS for Patients Slide 7 Objectives Describe the development of a TeamSTEPPS curriculum for patients and their family members Provide an overview of methods used to pilot test the curriculum Present the results and implications of the pilot test

8. T EAM STEPPS 05.2 Mod 1 05.2 Page 8 TeamSTEPPS ® TeamSTEPPS for Patients Slide 8 Project Background Work funded under an AHRQ Demonstration Grant (R21) Grant program focused on Risk and Litigation Work done at Carilion Clinic Research Team David P. Baker, PhD (Principal Investigator) Patrice Weiss, MD (Co-Investigator) Laurie Spotswood, MSEd, CLS (Research Specialist) Anthony Slonim, MD, DPH (Co-Investigator)

9. T EAM STEPPS 05.2 Mod 1 05.2 Page 9 TeamSTEPPS ® TeamSTEPPS for Patients Slide 9 Research Background Patients and family members are core members of the care team Studies have shown increases in patient satisfaction and self-efficacy when patients/families are included in the care team (Dunst et al., 2007) Including patients and their family members in the care team should: Yield better communication between providers and patients/families (As a result) Mitigate risk and reduce liability claims Could patients and family members benefit from TeamSTEPPS training?

10. T EAM STEPPS 05.2 Mod 1 05.2 Page 10 TeamSTEPPS ® TeamSTEPPS for Patients Slide 10 Research Background (Cont’d) Little research to-date on how to: Include patients and their family members as part of the care team Train patients and their family members to be effective team members (including what training should consist of, when it should occur, and its results)

11. T EAM STEPPS 05.2 Mod 1 05.2 Page 11 TeamSTEPPS ® TeamSTEPPS for Patients Slide 11 Project Purpose To understand patient and family responsibilities within the care team To develop and pilot test a shortened version of the TeamSTEPPS curriculum that: Teaches patients/families how to be members of the care team Enhances communication between patients/families and providers

12. T EAM STEPPS 05.2 Mod 1 05.2 Page 12 TeamSTEPPS ® TeamSTEPPS for Patients Slide 12 Research Aims 1. Identify L&D events that vary in terms of risk and liability and require teamwork 2. Identify the root causes of each event 3. Conduct patient/family focus groups –team member responsibilities and useful TeamSTEPPS tools 4. Develop and test a module for teaching TeamSTEPPS tools to patients/family members

13. T EAM STEPPS 05.2 Mod 1 05.2 Page 13 TeamSTEPPS ® TeamSTEPPS for Patients Slide 13 Patient/Family Focus Groups 47 total patients/family members 18 pregnant 28 had experienced a medical error 9 healthcare workers Focus groups were two hours long Discussed patient/family responsibilities Discussed patient/family-provider communication Discussed disclosure Reviewed TeamSTEPPS tools

14. T EAM STEPPS 05.2 Mod 1 05.2 Page 14 TeamSTEPPS ® TeamSTEPPS for Patients Slide 14 Focus Group Approach Introductions, Informed Consent, and Housekeeping Purpose of this Research Review Outcome and Discuss Patient and Family Responsibilities Review and Discuss Possible Breakdowns in Care Short Survey Doctor and Patient Communication

15. T EAM STEPPS 05.2 Mod 1 05.2 Page 15 TeamSTEPPS ® TeamSTEPPS for Patients Slide 15 Focus Group Approach Presented information on SBAR, Check-Back, Two-Challenge Rule, CUS, and Briefs, Huddles and Debriefs For each tool, participants were asked: Do you think the tool is clear and would be easy to use? Would you feel comfortable using the tool with doctors and nurses providing you care? Do you think it would be a good idea to provide training to patient/family members on the tool?

16. T EAM STEPPS 05.2 Mod 1 05.2 Page 16 TeamSTEPPS ® TeamSTEPPS for Patients Slide 16 Training Objectives Describe how the patient and family fits into the clinical team Describe the patient and family responsibilities as team members Describe the clinical team member roles and responsibilities Describe the core components of team leadership, assertion, and communication Describe TeamSTEPPS tools that can be used by patients Briefs, Huddles, and Debriefs Assertive Statement and Two-Challenge Rule SBAR and Check-Back

17. T EAM STEPPS 05.2 Mod 1 05.2 Page 17 TeamSTEPPS ® TeamSTEPPS for Patients Slide 17

18. T EAM STEPPS 05.2 Mod 1 05.2 Page 18 TeamSTEPPS ® TeamSTEPPS for Patients Slide 18 Pilot Test Included 28 participants Patients and family members who were receiving or had recently received L&D care Participants trained across three classes Collected data on participant reactions and learning

19. T EAM STEPPS 05.2 Mod 1 05.2 Page 19 TeamSTEPPS ® TeamSTEPPS for Patients Slide 19 Reactions Measure Assessed participant “reactions” to training at two levels: Did participants like the training (i.e., affective reactions)? Did the participants find the training useful (i.e., instrumentality)? Participants completed the reaction questionnaire post-training only

20. T EAM STEPPS 05.2 Mod 1 05.2 Page 20 TeamSTEPPS ® TeamSTEPPS for Patients Slide 20 Reactions Measure

21. T EAM STEPPS 05.2 Mod 1 05.2 Page 21 TeamSTEPPS ® TeamSTEPPS for Patients Slide 21 Participant Learning Learning is defined as changes in knowledge, skills, or attitudes Assessed participant learning in terms of: Participant attitudes toward teamwork TeamSTEPPS Teamwork Attitudes Questionnaire (T- TAQ) Knowledge of teamwork TeamSTEPPS Learning Benchmarks Both measures administered pre- and post- training

22. T EAM STEPPS 05.2 Mod 1 05.2 Page 22 TeamSTEPPS ® TeamSTEPPS for Patients Slide 22 T-TAQ Sample Items: It is important to ask patients and their families for feedback regarding patient care. (Team Structure) It is important for leaders to take time to discuss with their team members plans for each patient. (Leading Teams) Even individuals who are not part of the direct care team should be encouraged to scan for and report changes in patient status. (Situation Monitoring) It is appropriate to continue to assert a patient safety concern until you are certain that it has been heard. (Mutual Support) Adverse events may be reduced by maintaining an information exchange with patients and their families. (Communication) Participants indicate agreement on a Likert scale ranging from Strongly Disagree to Strongly Agree

23. T EAM STEPPS 05.2 Mod 1 05.2 Page 23 TeamSTEPPS ® TeamSTEPPS for Patients Slide 23 Sample TeamSTEPPS Learning Benchmarks Item 1.A nurse is called to the phone to receive a telephone order from the doctor about a patient she is taking care of today. After clearly establishing the patient and physician identities, the BEST procedure for the nurse would be A.Listening to the order, calling the pharmacist, writing the details on the order sheet, and bringing the drug to the bedside. B.Refusing to take this telephone order and indicating that she can't be sure of the physician's thought process C.Listening to the order, repeating back what the doctor said, and then writing it down in the patient's medical record. D.Listening to the order, asking the charge nurse how to spell the drug's name, asking the family member if that was in the plan for today and carrying out the order. E.Listening to the order, writing it on the order page, reading the order back to the physician and seeking his verification of the order's accuracy.

24. T EAM STEPPS 05.2 Mod 1 05.2 Page 24 TeamSTEPPS ® TeamSTEPPS for Patients Slide 24 Results: Reactions Overall mean rating was 4.18, on a 5-point scale “This training would be appropriate for patients in all care settings” “This training should be offered by …. in the future” Highest Rated Items This training would be appropriate for patients in all care settings This training should be offered by Carilion in the future Lowest Rated Item The tools appear easy to use

25. T EAM STEPPS 05.2 Mod 1 05.2 Page 25 TeamSTEPPS ® TeamSTEPPS for Patients Slide 25 Results: Learning Attitudes (T-TAQ) Pre-training Mean (4.51) Post-training Mean (4.55) Learning (Learning Benchmarks) Pre-training Mean (10.86 items correct) Post-training Mean (12.28 items correct)

26. T EAM STEPPS 05.2 Mod 1 05.2 Page 26 TeamSTEPPS ® TeamSTEPPS for Patients Slide 26 Discussion The results found that participants: Thought the training was useful Had very positive reactions to the curriculum and its potential future implementation and use Future research should consider: Larger demonstration and implementation of the training Measuring transfer of trained skills (Level III) Measure impact on quality of care and safety outcomes (Level IV)

27. T EAM STEPPS 05.2 Mod 1 05.2 Page 27 TeamSTEPPS ® TeamSTEPPS for Patients Slide 27 Conclusions Teaching patients/family members some core TeamSTEPPS tools has promise Labor and Delivery Chronic care A short curriculum enhanced patient/family member knowledge Curious if learning would transfer GBS positive Management of family members in the delivery room

28. T EAM STEPPS 05.2 Mod 1 05.2 Page 28 TeamSTEPPS ® TeamSTEPPS for Patients Slide 28 Questions and Answers

29. T EAM STEPPS 05.2 Mod 1 05.2 Page 29 TeamSTEPPS ® TeamSTEPPS for Patients Slide 29 Upcoming TeamSTEPPS Events Monthly Teleconferences Scheduled through September 2015 Topics, speakers, and registration information will be posted on the portal Annual Conference June 16-18, 2015 Denver, Colorado at the Westin Downtown Denver

30. T EAM STEPPS 05.2 Mod 1 05.2 Page 30 TeamSTEPPS ® TeamSTEPPS for Patients Slide 30 Thank You! For more information, please contact our team at: AHRQTeamSTEPPS@aha.org