1. Including TeamSTEPPS in Hospital Engagement Network Planning

2. What the HEN Program Is Background: Key part of HHS Partnership for Patients Parameters: 2-3 years, 3,000+ participating hospitals, 26 HEN contractors, $218M in funding from CMS to HENs Focus: Adverse drug events, catheter-associated urinary tract infections, central line-associated blood stream infections, injuries from falls and immobility, obstetrical adverse events, pressure ulcers, surgical site infections, venous thromboembolism, ventilator-associated pneumonia & preventable readmissions Goals: 40% reduction in healthcare acquired conditions & 20% reduction in preventable readmissions

3. HENS and TeamSTEPPS HENs must address three cross-cutting issues: leadership, safety culture, teamwork, etc. TeamSTEPPS helps: – Provide resources for engaging leaders – Create a culture of safety within hospitals – Improve teamwork in units and facilities – Equip hospital staff working to address all 10 areas HENS are targeting

4. Session Goals Expose attendees to range of approaches for using TeamSTEPPS to reinforce HEN activities – Training entire facilities to use TS for all aspects of their work – Introducing specific tools from TS to help staff in hospitals or units address specific challenges – Embedding TS tools or resources into HEN topic-specific change packages Learn challenges facing four separate HENS using TS and how they are overcoming them Foster dialogue with presenters and audience members about how TS can contribute to efforts by HENS and other groups to improve substantial quality improvement

5. Presenter Introductions All presenters: – Are representatives from HENS – Are incorporating TS into their Nancy Landor, RN, MS, CPHQ (HANYS) Betsy Lee, RN, BSN, MSPH (IN Hospital Assoc) Patricia Noga, RN, PhD, MBA (MA Hospital Assoc) Darlene Swart, RN, BSN, MS (TN Hospital Assoc) Sheri Winsper, RN, MSN, MSHA (HRET)

6. A partnership of the Healthcare Association of New York State and the Greater New York Hospital Association TeamSTEPPS National Conference Nashville, Tennessee

7. NYS PARTNERSHIP FOR PATIENTS Multi-Prong Approach 7

8. NYS PARTNERSHIP FOR PATIENTS AHRQ o Culture of Safety Survey > 40% response rate (> 43,000 surveys) o Readiness for Change Participation (NYSPFP n=173 hospital sites)RFC AHRQ COS Team STEPPS Exclusive through the NYSPFP62%60%66% Total -Submitted current survey results into the NYSPFP -System or Hospital currently has hospital-wide CRM Program 87%80%

9. NYS PARTNERSHIP FOR PATIENTS NYSPFP TeamSTEPPS Phase One: Executive Coaching Training Phase Two: Hospital Master Training Phase Three: Individualized Hospital TeamSTEPPS Strategic Roll-out Plans

10. NYS PARTNERSHIP FOR PATIENTS Phase One: Executive Coaching Training For NYSPFP Project Managers 5/12

11. NYS PARTNERSHIP FOR PATIENTS Phase Two: Regional Master Trainer Programs Two day Training (Lesson Learned: Modified from 3 to 2 days after 1 st Session) Project Managers coach on Day II - Hospital Action Plans Mid-May through Mid-July One lead staff per hospital (Lesson Learned: Open up to more than one per hospital) NYSPFP

12. NYS PARTNERSHIP FOR PATIENTS Phase Three: Hospital Level TeamSTEPPS Roll-Out Plan: Hold two-day sessions at each participating hospital Hospital Lead Master Trainer Hospital NYSPFP Project Manager NYSPFP Experienced Faculty Lesson Learned - Current Status Expert consensus Issue on one or two day Master Training Variation per Hospital on preference for educational TeamSTEPPS roll-out Currently adjusting planning and curriculum to meet multiple needs, approaches, and tactics Lesson Learned - Current Status Expert consensus Issue on one or two day Master Training Variation per Hospital on preference for educational TeamSTEPPS roll-out Currently adjusting planning and curriculum to meet multiple needs, approaches, and tactics

13. NYS PARTNERSHIP FOR PATIENTS Hospital Action Plans o Roll-out in Key Service Areas (OB, OR) o Roll-out in NYSPFP HAC Initiative Teams o Roll-out top 4-6 TeamSTEPPS tools from Board to Floor o Hybrid of Above

14. NYS PARTNERSHIP FOR PATIENTS NYSPFP NYSPFP Response to Hospital TeamSTEPPS o Two-day hospital – based programs o One-day hospital – based programs o Additional regional programs (mainly in NYC) o Specialty programs for key areas OB, Critical Care Anticipate prior to (as able) or if we go to Year III o One-two hour frontline and physician staff program o Individualize hospital programs Utilizing hospital trained staff and NYSPFP project managers

15. Indiana Coalition for Care: Integrating TeamSTEPPS Betsy Lee, RN, MSPH Director, Indiana Patient Safety Center

16. Indiana’s Bold Aim: To make Indiana the safest place to receive health care in the United States, if not the world Inaugural Indiana Patient Safety Summit - March 2010 16

17. How Might We Do This? Transform cultures to promote safe care Embrace both the personal and collective nature of change Drive out fear in our organizations Recognize the difference between system error and human error Practice human-centered design Improve communications at handovers 17

18. TeamSTEPPS History in Indiana Patient Safety Improvement Corps – TeamSTEPPS Master Training (2007-08) Two one-day TeamSTEPPS educational sessions (SSM trainer) – 2008 Elements integrated into IHI TCAB Teamwork and Vitality content and How-to Guide for Optimizing Teamwork and Communications Select Indiana hospitals implemented TeamSTEPPs – not widespread

19. Ten regional coalitions cover Indiana Members agree not to compete on patient safety Create layered model of regional coalitions and affinity groups – Indiana’s “transformation grid” to support dissemination Benefits: Innovate at the front lines Align with state and national efforts, and standardize when beneficial Model builds local and hospital-specific capacity for improvement and innovation Encourages safety leadership at all levels across multiple professions 19

20. Assessing and Organizing Individual hospital plan based on the needs assessment Safety Coalition and affinity group support HRET content offerings IHA/Purdue coaching Joint programs with Health Care Excel and other HENs Building Lasting Capacity / T Medication Safety Web- based CEU/certification (10 per hospital) Lean executive overview (5 per hospital) Lean Six Sigma certification (2 green belts, 1 black belt per hospital) Innovation and Transforming Care Leadership for Safety (CEOs, Trustee, and Safety Leaders) Driving Improvement HAI Focus (CLABSI, CAUTI, SSI, VAP) IHA – Sepsis mortality Obstetric Adverse Events (IHA/ISDH/FSSA/March of Dimes – with IHI support) Transforming Care at the Bedside – Pressure Ulcers, Falls, Teamwork) Medication Adverse Events and Readmissions Culture/Leadership/TeamSTEPP S/ Patient & Family Centered Care All Cause Harm + Leading Transformation in Indiana Leadership Transformation in Indiana

21. Capacity Building (Purdue Healthcare TAP) Lean Six Sigma Certification & Training: Executive Training ( up to 5 people per hospital) – 2 days Hospitals will identify 3 project areas from 10 HAC’s Black Belt Training (up to 1 person per hospital) Green Belt (up to 2 people per hospital) Plan to integrate TeamSTEPPS elements Medication Safety On-line course (10 people per hospital) Encourage inter-professional team

23. AHRQ Hospital Survey on Patient Safety Culture Offered to Indiana hospitals for free since 2007 through Georgia Hospital Association Over 75,000 employee responses from about 90 hospitals in 5 years Biggest opportunities for improvement: –Non-punitive response to error –Handoffs and transitions

24. Designing for Results Regionalize technical assistance and education Align measures to mark progress Utilize Lean/Six Sigma training to drive results in topic areas Build teamwork and communication competencies Focus on patients and families Make it personal

25. Contacts Betsy Lee, RN, MSPH Director, Indiana Patient Safety Coalition Indiana Hospital Association blee@ihaconnect.org (317) 423-7795 Kathy Wallace Director, Performance Improvement Indiana Hospital Association kwallace@ihaconnect.org (317) 423-7740 25

26. Implementation of TeamSTEPPS June 21, 2012

27. Massachusetts Hospital Engagement Network with Advisory Group Partners - MA Coalition, Masspro, MA DPH BORM QPSD, IHI, MA Senior Care Association

28. HEN Goals The 40/20 Goal Keep patients from getting injured or sicker. Reduce preventable hospital-acquired conditions by 40%. 1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years. Help patients heal without complication. Reduce hospital readmissions by 20%. 1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

29. Opportunity for MA Hospitals “The 40/20 Goal” Leverage local expertise and national resources Target improvements towards common goals (reduce harm and readmissions) Coordinate patient safety efforts with statewide partners Accelerate the adoption of best practices through peer learning networks Build capacity for creating a culture of patient safety

30. Massachusetts HEN - 31 Teams 18 Community Hospitals 4 Long Term Acute Care Hospitals 4 Rehabilitation Hospitals 3 Rural Hospitals 2 Specialty Hospitals

31. MHA HEN Approach Network Model: peer-to-peer learning Learning Events: collaboratives, webinars, training sessions, conferences, forums Hospital Affinity Peer Networks: affinity groups for sharing best practices on patient safety focus areas and improving transitions in care Safety Culture: series of events and training opportunities to highlight system improvements for patient safety Technical Assistance: coaching, peer mentoring, and site visits (peers and coaches) Measurement: hospitals track aggregate results on 40/20 scale to benchmark performance and identify best practices Network Model: peer-to-peer learning Learning Events: collaboratives, webinars, training sessions, conferences, forums Hospital Affinity Peer Networks: affinity groups for sharing best practices on patient safety focus areas and improving transitions in care Safety Culture: series of events and training opportunities to highlight system improvements for patient safety Technical Assistance: coaching, peer mentoring, and site visits (peers and coaches) Measurement: hospitals track aggregate results on 40/20 scale to benchmark performance and identify best practices

32. AIM Aim: Provide an integrated approach for hospitals to work together in multiple forums and structured programs to improve performance and create a culture of patient safety within facilities and across the transitions of care. Learning Collaboratives Webinar Series Hospital Affinity Peer Networks Safety Culture Forums Learning-in-Network

33. Learning Collaboratives Collaborative Learning Events using a combination of in-person meetings, regional events, and distance learning technologies to support shared learning on the science of improvement and the application of evidence-based practices Avoidable Readmissions MHA/Mass Coalition/DPH/MMS CUSP/CAUTI MHA/AHRQ CUSP/CLABSI MHA/Mass Coalition/AHRQ SUSP (SSI) AHRQ OB Collaborative MOD/DPH Pressure Ulcer Collaborative MHA/MSC/HCA/ Masspro

34. Webinar Series Learning Programs and Events highlighting successful practices for implementing evidence-based change strategies and rapid action cycles for improvement ADE Webinar Series Masspro/MHA Falls Collaborative DPH/MSC/HCA/M HA VTE Webinar Series MHA VAP Webinar Series MHA

35. Leadership Affinity Networks Affinity groups representing leadership from peer organizations to share best practices and highlight opportunities for improving the culture of patient safety Avoidable Readmission Hospitals Community Hospitals Post-Acute Care Facilities Rural Hospitals Specialty Care Facilities

36. Safety Culture Forums Training and events designed to introduce strategic initiatives and system improvements for creating a culture of patient safety Patient Safety Toolkit TeamSTEPPS Training Learning from Defects Events Just Culture Training

37. MA HEN Approach Educate Master Trainer – State Lead Educate Master Trainers – HEN Coaches Educate Master Trainer for each hospital Incorporate TeamSTEPPS training concepts and components into HEN programs – Patient Safety Topic Areas – Safety Culture Forums Educate Master Trainer – State Lead Educate Master Trainers – HEN Coaches Educate Master Trainer for each hospital Incorporate TeamSTEPPS training concepts and components into HEN programs – Patient Safety Topic Areas – Safety Culture Forums

38. MA HEN Timeline & Plan Complete Master Training by State Lead Assess Need for Training among Hospital Leads and Teams Plan for 2 Hospital Master Training Sessions during December 2012 and January 2013 Provide technical assistance and mentoring to teams re: TeamSTEPPs Complete Master Training by State Lead Assess Need for Training among Hospital Leads and Teams Plan for 2 Hospital Master Training Sessions during December 2012 and January 2013 Provide technical assistance and mentoring to teams re: TeamSTEPPs

39. MA HEN Challenges How to effectively train in TeamSTEPPS and facilitate culture change – – Diverse culture & focus of HEN hospitals – Delivery of effective TeamSTEPPS programming & mentoring – Many learning programs and events – Short timeline of HEN initiative How to effectively train in TeamSTEPPS and facilitate culture change – – Diverse culture & focus of HEN hospitals – Delivery of effective TeamSTEPPS programming & mentoring – Many learning programs and events – Short timeline of HEN initiative

40. Thank you

41. Tennessee Hospital Association Hospital Engagement Network (THA HEN) The THA HEN program activities are carried out through THAs Tennessee Center for Patient Safety (TCPS), established in 2007. The THA HEN has 66 member hospitals enrolled in the program.

42. Tennessee Hospital Association Hospital Engagement Network (THA HEN) The THA HEN will roll out TeamSTEPPS ® to the 66 member hospitals. We will provide the “Train the Trainer” program regionally. 10 hospitals have already shown interest in implementing TeamSTEPPS ® training.

43. Tennessee Hospital Association Hospital Engagement Network (THA HEN) Challenges: Initiative overload Successes: TCPS has offered, free of charge, the AHRQ Hospital Survey on Patient Safety (HSOPS) to our 122 safety partners since 2008. The TCPS has been collecting data since 2008 on CLABSI, MRSA and SCIP.

44. MDROs MRSA CDI Tennessee Center for Patient Safety THA Board Aim: Zero Preventable Harm Partnership for Patient Goals:  Decrease hospital-acquired conditions by 40%  Reduce hospital readmissions by 20% SSI HAIHAC CLABSI CAUTI VTE ADEFALLS PU OB HEN TOPICS TCPS State Initiatives VAP Leadership Culture HEN – Hospital Engagement Network HAI – Healthcare-Associated Infection HAC – Hospital-Acquired Condition MDRO – Multi-Drug Resistant Organism MRSA – Methicillin-Resistant Staphylococcus aureus CDI – Clostridium Difficile SSI – Surgical-Site Infection CLABSI – Central Line-Associated Bloodstream Infection CAUTI – Catheter-Associated Urinary Tract Infection VAP – Ventilator Associated Pneumonia VTE – Venous Thromboembolism PU – Pressure Ulcer ADE – Adverse Drug Event OB – Obstetrical Adverse Event Readmissions

45. THA HEN/TCPS Staff Chris Clarke, Sr. VP, Clinical and Professional Practices Darlene Swart, VP, Clinical Director Patrice Mayo, VP, Operations Director Larissa Lee, Project and Data Manager Angela O’Neal, Executive Assistant Mary Ellen Mooney, Clinical Director, PSO Rebecca Carroll, Executive Assistant and Project Coordinator, PSO and TSQC Lin Keyes, Data Quality Control Assistant Jackie Moreland, Clinical Quality Improvement Specialist

46. Contact Information Darlene Swart, VP, Clinical Director Phone: (615) 401-7460 Email: dswart@tha.comdswart@tha.com Website: www.TNPatientSafety.comwww.TNPatientSafety.com

47. QUESTION & ANSWER PERIOD