1. TeamSTEPPS Master Training Webinar October 8, 2013 1

2. Webinar Agenda Overview & Introductions – Betsy Lee TeamSTEPPS Master Training– Karyn Baum, M.D., M.S.Ed. Wrap-up/Questions – Betsy Lee 2

3. Evaluation Webinar funded by CMS through the Partnership for Patients CMS reviews results and wants 80% of participants to evaluate educational sessions Please complete the simple three question evaluation by Oct. 15, 2013: https://www.surveymonkey.com/s/20131008TeamSTEPPSWebinar https://www.surveymonkey.com/s/20131008TeamSTEPPSWebinar 3

4. TeamSTEPPS Master Training Webinar October 8, 2013

5. T EAM STEPPS 05.2 06.1 Page 5 Webinar Instructor Karyn Baum, M.D., M.S.Ed., Professor of Medicine and Associate Chair for Clinical Improvement, University of Minnesota

6. T EAM STEPPS 05.2 06.1 Page 6 Webinar TeamSTEPPS Master Training Train-the-trainer approach Prepares you to serve as a TeamSTEPPS Master Trainer by: Providing instruction on TeamSTEPPS tools and strategies Providing guidance on how to teach TeamSTEPPS to others in your organization Prepares you to serve as a leader for implementing TeamSTEPPS within your organization

7. T EAM STEPPS 05.2 06.1 Page 7 Webinar Rationale for This Course Meet demand for TeamSTEPPS training Considering time demands Strategy Mixture of webinar and in-person Maintain equivalence to the two-day in-person training 7

8. T EAM STEPPS 05.2 06.1 Page 8 Webinar Materials 8 Webinar (October 8) Ppt Slides Slides will be posted later; session recorded In-Person Training (3 dates) TeamSTEPPS Instructors Guide TeamSTEPPS CD and DVD Other

9. Strategies and Tools to Enhance Performance and Patient Safety MODULE 1. Introduction

10. T EAM STEPPS 05.2 06.1 Page 10 Webinar 10 Ice Breaker NOTE: Will do this at the in-person training!

11. T EAM STEPPS 05.2 06.1 Page 11 Webinar 11 Sue Sheridan Video

12. T EAM STEPPS 05.2 06.1 Page 12 Webinar 12 Video Discussion Why to errors occur? How can we prevent medical errors? What are the solutions? …Improved teamwork and communications… Ultimately, a culture of safety

13. T EAM STEPPS 05.2 06.1 Page 13 Webinar 13 Objectives Describe the impact of errors and why they occur Describe the TeamSTEPPS training initiative Describe the TeamSTEPPS framework List outcomes of the TeamSTEPPS framework

14. T EAM STEPPS 05.2 06.1 Page 14 Webinar 14 Teamwork Is All Around Us

15. T EAM STEPPS 05.2 06.1 Page 15 Webinar 15 (Mann, 2006) Beth Israel Deaconess Medical Center Contemporary OB/GYN (Sexton, 2006) Johns Hopkins (Pronovost, 2003) Johns Hopkins Journal of Critical Care Medicine

16. T EAM STEPPS 05.2 06.1 Page 16 Webinar 16 Introduction Evolution of TeamSTEPPS Curriculum Contributors Department of Defense Agency for Healthcare Research and Quality Research Organizations Universities Medical and Business Schools Hospitals—Military and Civilian, Teaching and Community-Based Healthcare Foundations Private Companies Subject Matter Experts in Teamwork, Human Factors, and Crew Resource Management (CRM)

17. T EAM STEPPS 05.2 06.1 Page 17 Webinar 17 “Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military, aviation, nuclear power, business and industry…to acquire team competencies” Team Strategies & Tools to Enhance Performance & Patient Safety

18. T EAM STEPPS 05.2 06.1 Page 18 Webinar 18 The Components of a Patient Safety Program

19. T EAM STEPPS 05.2 06.1 Page 19 Webinar 19 Course Agenda Module 1—Introduction Module 2—Team Structure Module 3—Leadership Module 4—Situation Monitoring Module 5—Mutual Support Module 6—Communication Module 7—Summary—Pulling It All Together

20. T EAM STEPPS 05.2 06.1 Page 20 Webinar 20 If I had a “Magic Wand” and could make changes within my unit or facility in the areas of patient quality and safety… Introductions and Exercise: Magic Wand

21. T EAM STEPPS 05.2 06.1 Page 21 Webinar 21 Why Do Errors Occur—Some Obstacles Workload fluctuations Interruptions Fatigue Multi-tasking Failure to follow up Poor handoffs Ineffective communication Not following protocol Excessive professional courtesy Halo effect Passenger syndrome Hidden agenda Complacency High-risk phase Strength of an idea Task (target) fixation

22. T EAM STEPPS 05.2 06.1 Page 22 Webinar 22 Institute of Medicine Report Impact of Error: 44,000–98,000 annual deaths occur as a result of errors Medical errors are the leading cause, followed by surgical mistakes and complications More Americans die from medical errors than from breast cancer, AIDS, or car accidents 7% of hospital patients experience a serious medication error Cost associated with medical errors is $8–29 billion annually. Federal Action: By 5 years;  medical errors by 50%,  nosocomial by 90%; and eliminate “never-events” (such as wrong-site surgery)

23. T EAM STEPPS 05.2 06.1 Page 23 Webinar 23 JCAHO Sentinel Events

24. T EAM STEPPS 05.2 06.1 Page 24 Webinar 24 What Comprises Team Performance? Knowledge Cognitions “Think” …team performance is a science…consequences of errors are great… Attitudes Affect “Feel” Skills Behaviors “Do”

25. T EAM STEPPS 05.2 06.1 Page 25 Webinar 25 Outcomes of Team Competencies Knowledge Shared Mental Model Attitudes Mutual Trust Team Orientation Performance Adaptability Accuracy Productivity Efficiency Safety

26. T EAM STEPPS 05.2 06.1 Page 26 Webinar Swiss cheese model of errors

27. Team Structure The ratio of We’s to I’s is the best indicator of the development of a team. –Lewis B. Ergen NEXT:

28. T EAM STEPPS 05.2 06.1 Page 28 Webinar 28 Objectives Identify the characteristics of high-performing teams Discuss benefits of teamwork and team structure Describe components and composition of a multi-team system (e.g., Core Team, Coordinating Team, Contingency Team, Ancillary Services, and Administration) Understand what defines a team Define the roles and effectiveness of team members

29. T EAM STEPPS 05.2 06.1 Page 29 Webinar 29

30. T EAM STEPPS 05.2 06.1 Page 30 Webinar 30 Partnering with the Patient Embrace patients as valuable and contributing partners in patient care Learn to listen to patients Assess patients’ preference regarding involvement Ask patients about their concerns Speak to them in lay terms Ask for their feedback Give them access to relevant information Encourage patients and their families to proactively participate in patient care

31. T EAM STEPPS 05.2 06.1 Page 31 Webinar 31 Why Teamwork? Reduce clinical errors Improve patient outcomes Improve process outcomes Increase patient satisfaction Increase staff satisfaction Reduce malpractice claims

32. T EAM STEPPS 05.2 06.1 Page 32 Webinar 32 High-Performing Teams Teams that perform well: Hold shared mental models Have clear roles and responsibilities Have clear, valued, and shared vision Optimize resources Have strong team leadership Engage in a regular discipline of feedback Develop a strong sense of collective trust and confidence Create mechanisms to cooperate and coordinate Manage and optimize performance outcomes (Salas et al., 2004)

33. T EAM STEPPS 05.2 06.1 Page 33 Webinar 33 Barriers to Team Performance Inconsistency in team membership Lack of time Lack of information sharing Hierarchy Defensiveness Conventional thinking Varying communication styles Conflict Lack of coordination and follow-up Distractions Fatigue Workload Misinterpretation of cues Lack of role clarity

34. T EAM STEPPS 05.2 06.1 Page 34 Webinar 34 Exercise: Teams and Teamwork Write down the names (or positions) of the people in your immediate work area or unit who contribute to successful patient care.

35. T EAM STEPPS 05.2 06.1 Page 35 Webinar 35 Multi-Team System (MTS) for Patient Care

36. T EAM STEPPS 05.2 06.1 Page 36 Webinar 36 Core Team members have the closest contact with the patient! A Core Team is… A group of care providers who work interdependently to manage a set of assigned patients from point of assessment to disposition

37. T EAM STEPPS 05.2 06.1 Page 37 Webinar 37 A team comprising those work area members who are responsible for managing the operational environment that supports the Core Team A Coordinating Team is…

38. T EAM STEPPS 05.2 06.1 Page 38 Webinar 38 A time-limited team formed for emergent or specific events and composed of members from various teams A Contingency Team is…

39. T EAM STEPPS 05.2 06.1 Page 39 Webinar 39 Ancillary Services provide direct, task-specific, time- limited care to patients. Support Services provide indirect service-focused tasks which help to facilitate the optimal healthcare experience for patients and their families. Ancillary & Support Services Provide…

40. T EAM STEPPS 05.2 06.1 Page 40 Webinar 40 Establish and communicate vision Develop policies and set expectations for staff related to teamwork Support and encourage staff during implementation and culture change Hold teams accountable for team performance Define the culture of the organization The Role of Administration is to…

41. T EAM STEPPS 05.2 06.1 Page 41 Webinar 41 Example: A Multi-Team System in the OR

42. T EAM STEPPS 05.2 06.1 Page 42 Webinar 42 Exercise: Your Multi-Team System ? ?

43. Team Member Characteristics

44. T EAM STEPPS 05.2 06.1 Page 44 Webinar 44 Team Failure Video

45. T EAM STEPPS 05.2 06.1 Page 45 Webinar 45 Two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and have a time-limited membership What Defines a Team?

46. T EAM STEPPS 05.2 06.1 Page 46 Webinar 46 Paradigm Shift to Team System Approach Dual focus (clinical and team skills) Team performance Informed decision-making Clear understanding of teamwork Managed workload Sharing information Mutual support Team improvement Team efficiency Single focus (clinical skills) Individual performance Under-informed decision-making Loose concept of teamwork Unbalanced workload Having information Self-advocacy Self-improvement Individual efficiency

47. T EAM STEPPS 05.2 06.1 Page 47 Webinar 47 Are better able to predict the needs of other team members Provide quality information and feedback Engage in higher level decision-making Manage conflict skillfully Understand their roles and responsibilities Reduce stress on the team as a whole through better performance “Achieve a mutual goal through interdependent and adaptive actions” Effective Team Members

48. T EAM STEPPS 05.2 06.1 Page 48 Webinar 48 Teamwork Actions Assemble a team Establish a leader Identify the team’s goals and vision Assign roles and responsibilities Hold team members accountable Actively share information among team members Provide feedback “Individual commitment to a group effort—that is what makes a team work, a company work, a society work, a civilization work.” –Vince Lombardi

49. CHANGE MANAGEMENT: HOW TO ACHIEVE A CULTURE OF SAFETY

50. T EAM STEPPS 05.2 06.1 Page 50 Webinar John Kotter 8 Steps of Change

51. T EAM STEPPS 05.2 06.1 Page 51 Webinar Set the Stage and Create a Sense of Urgency Get people’s attention! Sell the need for change … sell the pain and the consequences of not changing Discuss ways to solve the problems people identify with the change Empower people to solve the “problem”

52. T EAM STEPPS 05.2 06.1 Page 52 Webinar Pull Together the Guiding Team Choose key players, especially staff-level managers Multidisciplinary Goal is informed; intelligent decisions are being made Credibility and integrity of change leaders Choose proven leaders who can drive the change process Strong position power, broad expertise, and high credibility Need both management and leadership skills Management skills control the process Leadership skills drive the change …TeamSTEPPS initiative should have a designated executive sponsor

53. T EAM STEPPS 05.2 06.1 Page 53 Webinar Develop the Change Vision and Strategy Senior Leadership is responsible for: Establishing the definition of a “culture of safety” aligned with expectations, core values, and shared beliefs Informing the organization of these values and evaluating the culture; communication Leading the process of: Translating values into expected behaviors Establishing trust and accountability

54. T EAM STEPPS 05.2 06.1 Page 54 Webinar Communicate for Understanding and Buy-In Provide supportive actions for fear, anger, and resistance Encourage discussion, dissent, disagreement, debate … keep people talking Tell people what you know―and what you don’t know Acknowledge people’s pain, perceived losses, and anger Value resisters They clarify the problem and identify other problems that need to be solved first Their tough questions can strengthen and improve the change They may be right―it is a dumb idea! …communicate, communicate, communicate…

55. T EAM STEPPS 05.2 06.1 Page 55 Webinar Empower Others to Act Develop a shared sense of purpose Align structures with vision and goals Train employees so they have the desired skills and attitudes Confront high-level resisters An organization cannot be improved from the top only

56. T EAM STEPPS 05.2 06.1 Page 56 Webinar Produce Short-Term Wins Provide positive feedback Further builds morale and motivation Lessons learned help Greater difficulty for resisters to block Provide leadership with evidence of success Build momentum

57. T EAM STEPPS 05.2 06.1 Page 57 Webinar Don’t Let Up Acknowledge hard work Celebrate successes and accomplishments Reaffirm the vision Bring people together toward the vision Develop long-term goals and plans Provide tools and training to reinforce new behaviors Reinforce and reward the new behaviors Prepare people for the next change

58. T EAM STEPPS 05.2 06.1 Page 58 Webinar Create a New Culture Develop action steps for stabilizing, reinforcing, and sustaining the change: Give people time to mourn their actual losses Provide skill and knowledge training Revise job descriptions Develop new reward systems Strengthen social connections and relationships Recognize and celebrate accomplishments Develop performance measures to continually monitor the results from the change and to identify opportunities for further improvements Make adjustments to the change vision and strategy to reflect new learning and insights

59. T EAM STEPPS 05.2 06.1 Page 59 Webinar Culture Change Comes Last, Not First! Most alterations in norms and shared values come at the end of the transformation process New approaches sink in after success has been proven Feedback and reinforcement are crucial to buy-in Sometimes the only way to change culture is to change key people Individuals in leadership positions need to be on board Otherwise, the old culture will reassert itself …Reculturing takes time and it really never ends

60. T EAM STEPPS 05.2 06.1 Page 60 Webinar Sizing Up The Culture Readiness assessment Read through and answer the questions on the “Sizing Up the Culture Exercise Sheet” Before we meet in person As you answer the questions, consider the state of your current organization and the current safety climate.

61. T EAM STEPPS 05.2 06.1 Page 61 Webinar Identify Specific Areas for Improvement Define the Need that is Driving Your Organization to Consider TeamSTEPPS What are the areas for improvement? In which units/organizations are the improvements needed? Determine Whether Stronger Teamwork and Safety Culture is an Appropriate Strategy for Addressing Your Organization’s Needs

62. T EAM STEPPS 05.2 06.1 Page 62 Webinar Learn About Other TeamSTEPPS Efforts in Your Organization Gather Knowledge Related to Other Uses of TeamSTEPPS within Your Organization Has leadership already been involved in any TeamSTEPPS efforts? Have other units/areas of your hospital already implemented aspects of TeamSTEPPS? If so, which ones, and were they successful? Are there TeamSTEPPS tools and/or strategies your organization already knows and/or uses?

63. T EAM STEPPS 05.2 06.1 Page 63 Webinar Determine Readiness Factors for Consideration Which units/areas are most ready for and in need of TeamSTEPPS? Is/are there any unit(s) in which TeamSTEPPS can be implemented now? Is the timing right in terms of avoiding competition with other major initiatives or changes? In which units/areas can success be expected, and later used as an example for spreading TeamSTEPPS in the organization?

64. T EAM STEPPS 05.2 06.1 Page 64 Webinar Questions and Answers 64

65. T EAM STEPPS 05.2 06.1 Page 65 Webinar Thank You! For more information, please contact our team at: Karyn Baum kbaum@umn.edukbaum@umn.edu 65

66. TeamSTEPPS Master Training Offered as a part of the IHA Coalition for Care Three one-day training sessions will be offered Oct. 24Courtyard Fort Wayne, Fort Wayne Nov. 13Marten House, Indianapolis Nov. 14 Comfort Inn, Columbus 7:30 am - registration begins 8:00 am - meeting starts 12:15 - 1 pm - lunch, on your own 5:00 pm - meeting concludes 66

67. TeamSTEPPS Master Training Pre-conference webinar: Oct. 8, 2-4 pm ET –Required for all participants; recording available for those not able to attend Space is limited at each location. Only IHA Coalition for Care hospitals may register. IHA is not limiting the number of registrations per hospital at this time. –Adjustments may be necessary for hospitals with multiple registrations to accommodate additional participating hospitals. Registration: www.regonline.com/2013teamSTEPPS www.regonline.com/2013teamSTEPPS IHA TeamSTEPPS Resources: https://www.ihaconnect.org/Quality-Patient-Safety/Pages/Team- STEPPS-Resources.aspx 67

68. Evaluation Webinar funded by CMS through the Partnership for Patients CMS reviews results and wants 80% of participants to evaluate educational sessions Please complete the simple three question evaluation by Oct. 15, 2013: https://www.surveymonkey.com/s/20131008TeamSTEPPSWebinar https://www.surveymonkey.com/s/20131008TeamSTEPPSWebinar 68

69. Thank you 69