1. Mutual Support

2. Objectives
Describe how mutual support affects team processes and outcomes
Discuss specific strategies to foster mutual support (e.g., task assistance, feedback)
Identify specific tools to facilitate mutual support
Describe conflict resolution strategies

3. Mutual Support Mutual support involves team members:
Assisting each other
Providing and receiving feedback
Exerting assertive and advocacy behaviors when patient safety is threatened
Bold a few words and pause and emphasize that this is hard?

4. Mutual Support
Dependent upon information gathered through situation monitoring
Moderated by the communication of information
Enhanced by leaders who encourage and role model mutual support behaviors

5. Task Assistance
Team members foster a climate in which it is expected that assistance will be actively sought and offered as a method for reducing the occurrence of error.

6. Task Assistance Example
Two members of the GI Laboratory are assessing an elderly patient who has just had conscious sedation for a colonoscopy. The monitor shows SVT (an abnormal rhythm that would be unexpected and may be a significant emergency) at a rate of 150 and a BP of 76/48. The nurse calls out the vital signs while the physician continues to monitor the rhythm. A nurse passing by the room overhears the interaction.
Added explaination and clarified wording here … in this case the nurse walking by might offer assistance

7. What Is Feedback?
Feedback is information provided for the purpose of improving team performance

8. Types of Feedback Formal
Retrospective and typically scheduled in advance
Has an evaluative quality
Examples: Collaborative discussions, case conferences, individual performance reviews
Informal
Typically in real time
Provided on an ongoing basis
Focuses on knowledge and practical skills development
Examples: Huddles, debriefs
Informal is what we are talking about today….

9. Characteristics of Effective Feedback
Effective feedback is—
Timely
Respectful
Specific
Directed toward improvement (or reinforcement)
Helps prevent the same problem from occurring in the future
Considerate
I added reinforcement

10. How would you provide effective feedback?
Feedback Exercise
You are supervising a student. They seem to be really trying to do a good job, but are using language with a patient that is very technical and the patient looks really confused and anxious.
How would you provide effective feedback?

11. How would you provide effective feedback?
Feedback Exercise
You are assisting a senior member of your group as they care for a patient. The practitioner is highly skilled but isn’t exactly known for his people skills. He is using language with a patient that is very technical and the patient looks really confused and anxious.
How would you provide effective feedback?
Consider that they may not have complete information
Show the video from IPASS??

12. Advocacy and Assertion
Advocate for the patient
Invoked when team members’ viewpoints don’t coincide with that of a decision maker
Assert a corrective action in a firm and respectful manner
Sometimes this becomes a safety issue

13. The Assertive Statement
Respectful and supportive of authority
Clearly asserts concerns and suggestions
Is nonthreatening and ensures that critical information is addressed
Five-Step Process:
Open the discussion
State the concern
State the problem—real or perceived
Offer a solution
Obtain an agreement
You have to find your own style in this…. Can feel confrontational or argumentative.

14. Suggested conversation starters
“ I am curious…”
“Help me understand…”
“Let me see if I understand your
reasoning…”
“Help me think through my options…”
“What do you think I could be missing…”
“In your experience….”
“Could we take a quick time out?”
Here are some suggested approaches…

15. Two-Challenge Rule Invoked when an initial assertion is ignored…
It is your responsibility to assertively voice your concern at least two times to ensure that it has been heard
The member being challenged must acknowledge
If the outcome is still not acceptable
Take a stronger course of action
Use supervisor or chain of command

16. Two-Challenge Rule
Empower any team member to “stop the line” if he or she senses or discovers a breach of safety.
This is an action never to be taken lightly, but it requires immediate cessation of the process and resolution of the safety issue.
This is a standard in some, though not all, healthcare settings, but a useful touchpoint regardless, especially in high-risk situations

17. Stop-the-Line Concern for wrong site or wrong patient surgery
Concern for retained foreign body
Lack of consent documentation in elective surgery
Concern for impaired practitioner

18. Please Use CUS Words but only when appropriate!

19. Advocacy and Assertion Scenario
You are working in the ER. An infant has symptoms of severely low calcium levels, a medical emergency, and needs IV calcium.
You know that dosing calcium is tricky. There are several mathematical steps, and this hospital stocks multiple types and concentrations of calcium. You also know an overdose can be fatal.
The fellow and attending discuss the dose. They both have significant accents and you have trouble following the conversation. You are not sure they are discussing the same form of calcium. They agree on a dose and ask you to enter the order. You think that they are asking you to enter a 10-fold overdose of the medication.
What do you say?

20. Advocacy and Assertion Scenario
You and the pediatric attending are seeing a patient with abdominal pain. His ultrasound is inconclusive for appendicitis, his white blood cell count is only slightly abnormal, and he feels better. The surgeons rounded earlier and recommended discharge. Your attending agrees after noting he is well appearing, eating a cheeseburger, and has a normal abdominal exam. You are uncomfortable with this, as his imaging and labs are not really reassuring. When you examined him earlier, his abdominal exam was abnormal and from what you have read, classic for appendicitis. What do you say?

21. Applying TeamSTEPPS Exercise
Have you been in a situation where mutual support was displayed?
How was it received?
Have you been in a situation where you should have provided mutual support or feedback?

22. Tools & Strategies Summary
BARRIERS
Inconsistency in Team Membership
Lack of Time
Lack of Information Sharing
Hierarchy
Defensiveness
Conventional Thinking
Complacency
Varying Communication Styles
Conflict
Lack of Coordination and Followup With Coworkers
Distractions
Fatigue
Workload
Misinterpretation of Cues
Lack of Role Clarity
TOOLS and STRATEGIES
Communication
SBAR
Call-Out
Check-Back
Handoff
Leading Teams
Brief
Huddle
Debrief
Situation Monitoring
STEP
I’M SAFE
Mutual Support
Task Assistance
Feedback
Assertive Statement
Two-Challenge Rule
CUS
DESC Script
OUTCOMES
Shared Mental Model
Adaptability
Team Orientation
Mutual Trust
Team Performance
Patient Safety!!
This just shows where you are in this overview… after a brief break we will move onto the shared mental model.

23. Questions?

24. Slide purgatory

25. Insert video from I PASS here?

26. Conflict in Teams Interpersonal Conflict
(Hostile and harassing behavior)
DESC Script
Informational Conflict
(We have different information!)
Two-Challenge Rule
I cut these…interesting but not the key points….

27. Conflict Resolution DESC Script
A constructive approach for managing and resolving conflict
D—Describe the specific situation
E—Express your concerns about the action
S—Suggest other alternatives
C—Consequences should be stated

28. DESC-It Let’s “DESC-It!” Have timely discussion Work on win-win
Frame problem in terms of your own experience
Choose a private location
Use “I” statements; avoid blaming statements
Critique is not criticism
Focus on what is right, not who is right

29. A DESC Scenario
A nurse feels that a patient has abdominal distension and pain secondary to a distended bladder and needs a Foley catheter. The nurse receives the order from the resident on call. When the attending later realizes that the order was given without his consent, he raises his voice to the resident in front of staff and the patient.

30. Applying TeamSTEPPS Exercise
Is your teamwork issue related to mutual support?
If yes, what is the mutual support issue?
Which mutual support tools or strategies might you consider implementing to address the issue?

32. To do
Add LP video from IPASS to/after slide 11….