1. for OFFICE-BASED CARE Summary: Putting It All Together ®

2. TeamSTEPPS | Office-Based Care Summary Slide 1 1 INTRODUCTION SAY: The purpose of this summary module is to pull together everything you have learned in the opening, Fundamentals modules of TeamSTEPPS for Office-Based Care. In addition, you will be introduced to the practice facilitator model and how it can help you begin to think about weaving TeamSTEPPS into quality improvement initiatives. We’ll begin by reviewing some of the material you have studied in the previous modules. MODULE TIME: 60 minutes MATERIALS: Starting a TeamSTEPPS Program (video) AHRQ Practice Facilitation Handbook (optional) – available at AHRQ Practice Facilitation Handbook Web Link AHRQ Practice Facilitation Handbook Web Link

3. Slide 2 2 TeamSTEPPS | Office-Based Care Summary LEARNING OBJECTIVES SAY: During this module, you will: Review the tools and principles of TeamSTEPPS that you have been introduced to during the previous modules. Review the role of practice facilitators and the change team in introducing TeamSTEPPS in an office-based care setting. We will quickly review what TeamSTEPPS is all about as well as your role in the rollout of TeamSTEPPS in your institution.

4. TeamSTEPPS | Office-Based Care Summary Slide 3 3 CORE PRINCIPLES OF TEAMSTEPPS SAY: By now, this triangle should be very familiar to you. It represents the core principles of TeamSTEPPS: Communication Leading Teams Situation Monitoring Mutual Support These core principles represent the modules you have already reviewed. The tools that support these core principles are the tools that you will use to help improve the practice that you and your change team work in. The following slides will provide a brief review of each principle and the tools therein.

5. Slide 4 4 TeamSTEPPS | Office-Based Care Summary COMMUNICATION TOOLS SAY: Communication is the foundation of success for TeamSTEPPS. The communication tools help ensure that communication is both transmitted and received in a standardized and efficient way. Using these tools will improve communication and make handoffs and other events safer. DISCUSSION: Think back to your discussions you had on the communication tools. Which communications tools make sense and could work in your office? Which ones seem more difficult and might be harder to use effectively?

6. TeamSTEPPS | Office-Based Care Summary Slide 5 5 LEADING TEAMS TOOLS SAY: The leadership tools include briefs, huddles, and debriefs. These three events happen at the beginning, middle, and end of each event, shift, or even day. As you learned during the module itself, there are different ways to use these tools. Make sure, however, to always stay consistent in the way you name and present these tools. Checklists that accompany these tools help you to standardize each of these events so that individuals attending know what to expect from others in the meeting and what is expected of them. DISCUSSION: Recall your previous discussions with your team during the module on these tools. How useful did you think briefs, huddles, and debriefs would be? Was there any pushback from individuals on the team thinking that these would take too much time? If so, how did you respond?

7. Slide 6 6 TeamSTEPPS | Office-Based Care Summary SITUATION MONITORING TOOLS SAY: Situation monitoring tools are all useful in helping you scan and assess what is going on around you and with you. Cross- monitoring is a tool for watching others’ backs and the STEP checklist can help you monitor a situation or a patient. DISCUSSION: Recall your initial reaction to the situation monitoring tools in the accompanying module. What was your reaction to the idea of cross-monitoring? What benefits did you think improved situational awareness would have on your practices? In what specific situation did you feel you could use STEP? Are any of the team members worried that “watching each other’s backs” will be misconstrued as being too intrusive?

8. TeamSTEPPS | Office-Based Care Summary Slide 7 7 MUTUAL SUPPORT TOOLS SAY: The mutual support tools are a particularly rich set of tools that help you and your team to: Provide assistance to each other. Come together to overcome a problem. Challenge another person in the case of an unsafe and potentially dangerous situation. Work through conflict that can turn a relationship or work environment toxic. DISCUSSION: Mutual support tools such as the Two-Challenge Rule, CUS, and the DESC script might seem daunting at first glance. They might seem uncomfortable to implement. How have you thought about putting one of these tools in place?

9. Slide 8 8 TeamSTEPPS | Office-Based Care Summary TEAMSTEPPS OVERVIEW CHART SAY: This slide should be very familiar to you. It shows a list of barriers to team effectiveness and the tools and strategies that can be used to overcome those barriers. The positive outcomes to the successful use of those tools and strategies can be found in the final column. How then, do we get to the successful outcomes? Honestly, this doesn’t happen overnight. The successful implementation and sustainment of that implementation takes time and dedication. The rest of the material will focus on how you, the practice facilitator, can guide and support this change. TeamSTEPPS is culture change, pure and simple. This selection of tools and strategies helps achieve that goal of a new culture of teamwork, effectiveness, and communication.

10. TeamSTEPPS | Office-Based Care Summary Slide 9 9 WHAT IS PRACTICE FACILITATION? SAY: The TeamSTEPPS for Office-Based Care program uses a Practice Facilitator model. This person’s role is to learn about TeamSTEPPS and then spread it to office-based care settings that they influence. As you are fulfilling this role of Practice Facilitator it is important we have the same shared mental model of roles and responsibilities. Practice facilitation is a service provided to office-based care settings by an individual or individuals to help in the overall improvement of care delivery. Practice facilitators use principles from the following fields: Organizational development Project management Quality improvement By combining all of these skills together, the practice facilitator can serve as a long-term resource and as a change leader in a practice or collection of practices. One tool that a practice facilitator can use to drive the overall improvement of the practice is TeamSTEPPS.

11. Slide 10 10 TeamSTEPPS | Office-Based Care Summary WHO IS A PRACTICE FACILITATOR? SAY: Practice facilitators are individuals trained in or working for care improvement. They have the following competencies: Quality improvement Project management Team facilitation A practice facilitator’s background in team facilitation makes for a comfortable connection with the principles of TeamSTEPPS. Practice facilitators may be internal employees or external consultants. They may work in one practice or across many. It is important to note that you do not need to have the title of “Practice Facilitator” for your organization in order to lead a TeamSTEPPS intervention. What is important and necessary is that you are familiar with the knowledge, skills, and attitudes of one. This will undoubtedly help you to coordinate the training of others and to run the implementation program from start to finish. The AHRQ Practice Facilitation Handbook found at http://www.ahrq.gov/professionals/prevention-chronic- care/improve/system/pfhandbook/index.html can help you understand the basic knowledge, skills, and attitudes needed to be a successful practice facilitator. http://www.ahrq.gov/professionals/prevention-chronic- care/improve/system/pfhandbook/index.html

12. TeamSTEPPS | Office-Based Care Summary Slide 11 11 PRACTICE FACILITATOR MODEL FOR TEAMSTEPPS INSTRUCTOR NOTE: This model of practice facilitation is the most likely model for TeamSTEPPS implementation in the office-based care setting. However, make sure that you review the attendees of your course to ensure this model makes sense. A second possible model is described on the next slide and page of this instructor guide. SAY: The practice facilitator can serve as the master trainer for the whole staff. You can train staff using the Fundamentals course of this material. This is the material from which you learned during the previous weeks in the recorded presentations you viewed. You also train with a change team, many of whom may be coaches who will serve as frontline champions for TeamSTEPPS. These coaches on the change team are people who understand how TeamSTEPPS tools can be used on a daily basis in different situations. More information on how to train coaches will be shared later in this course.

13. Slide 12 12 TeamSTEPPS | Office-Based Care Summary EXTERNAL MODEL OF PRACTICE FACILITATION INSTRUCTOR NOTE: The external model of practice facilitation will not be as common as the model on the previous page of this instructor guide. In it, the practice facilitator is at a remove. This individual will want to train office champions in each location whose job will be to then train a change team of coaches who can support the entire staff. SAY: The external model of practice facilitation is different in its approach to how a practice facilitator spreads TeamSTEPPS. In it, one individual works to spread the principles across multiple sites. The practice facilitator teaches the entire material of this course to one office champion master trainer for each site. As a practice facilitator you would do this by providing training using all of the sections of this toolkit. In effect, you would be serving the same role as the faculty of this course. The office champion would then train the change team as coaches and the entire staff using the Fundamentals material that you have already used in the recorded portions of this course.

14. TeamSTEPPS | Office-Based Care Summary Slide 13 13 BEGINNING YOUR JOURNEY INSTRUCTOR NOTE: So much of the theory behind the practice facilitator is inherent in the TeamSTEPPS material. The sections on measurement, implementation, and spread and sustainment parallel this practice facilitator model. It is important to approach TeamSTEPPS as not another separate program but as a complementary piece to other work your practice is already doing to improve patient safety. SAY: This video illustrates the beginnings of a TeamSTEPPS program started in one medical office. In the clip, Valerie has received TeamSTEPPS training from an external practice facilitator. She is not a Practice Facilitator herself, but she is the office champion. DO: Watch the video clip entitled Beginning the TeamSTEPPS Journey. DISCUSSION: How has Valerie combined her knowledge of performance improvement methodology with her TeamSTEPPS initiative? VIDEO TIME: 6:43 minutes MATERIALS: Video