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Bree Watzak PharmD, BCPS Carly McCord Ph.D. Elizabeth Dickey
TeamSTEPPS from the basics to a model of interprofessional team collaboration: the Health For All huddle Bree Watzak PharmD, BCPS Carly McCord Ph.D. Elizabeth Dickey
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Objectives Describe the TeamSTEPPS framework
Identify TeamSTEPPS tools and strategies that can improve team communication Describe a best practice that utilizes interprofessional huddles Identify unique ways to integrate behavioral health into a primary care clinic using telehealth and interprofessional meeting time
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TeamSTEPPS National Implementation Program
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Teamwork Exercise Setting the Stage Think of a team you have been on that was high-functioning. What were the characteristics of that team?
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Interprofessional Healthcare Teams
The pace of discovery is accelerating 25,000 new clinical trials published each year Complexity of the modern patient is increasing Bottom line = Safe, effective patient care can not be done by an individual. Interprofessional teams offer the benefit of diverse knowledge and experience = improved patient outcomes Used to have health care in silos. Doctor as solo provider/decision maker, nurse as patient care giver, and pharmacists provided meds as ordered by MD and given by RN. So each had a role but it was not a team. Seeing more emphasis on team based care now in light of changes in health care. Better communication, better relationships = better care IOM 2012
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Core Teamwork Skills
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Just a Routine Operation
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Video Discussion What breakdowns in teamwork did you observe in the stories? How can we prevent medical errors? How can we continue to improve communication with all those we work with?
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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 followup Distractions Fatigue Workload Misinterpretation of cues Lack of role clarity
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Patient Safety Movement & Team Training
TeamSTEPPS® Centers for Medicare & Medicaid Services Partnership for Patients Campaign TeamSTEPPS Released to the Public JCAHO National Patient Safety Goals “To Err Is Human” IOM Report TeamSTEPPS National Implementation Program Began Institute for Healthcare Improvement 100K lives Campaign Patient Safety and Quality Improvement Act of 2005 DoD MedTeams® ED Study Executive Memo from President National Implementation of CUSP 1995 1999 2001 2003 2004 2005 2006 2007 2008 2011 Medical Team Training
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Team Strategies & Tools to Enhance Performance & Patient Safety
Based on more than 30 years of research and evidence Team training programs have been shown to improve attitudes, increase knowledge, and improve behavioral skills Salas, et al. (2008) meta-analysis provided evidence that team training had a moderate, positive effect on team outcomes (ρ = .38)
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Outcomes of Team Competencies
Knowledge Shared Mental Model Attitudes Mutual Trust Team Orientation Performance Adaptability Accuracy Productivity Efficiency Safety
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Evidence That TeamSTEPPS Works
Capella, et al. (2010) Trauma resuscitation team implementation Pre- and post-TeamSTEPPS training results: Team performance improved across all teamwork skills: Leadership, Situation Monitoring, Mutual Support, Communication Significantly decreased times from arrival to CT scanner, endotracheal intubation, and operating room Thomas & Galla (2013) Systemwide implementation Pre- and post-TeamSTEPPS training results: Significant improvement in HSOPS scores on Feedback and Communication About Error, Frequency of Events Reported, Hospital Handoffs and Transitions, and Teamwork Across Units Incremental changes evident through reduction of nosocomial infections, falls, birth trauma, and other incidents
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Team Structure, Leadership, & Communication
NEXT:
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Team Structure Teamwork cannot occur in the absence of a clearly defined team Understanding a team’s structure and how multiple teams interact is critical for implementation planning
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What Defines a Team? Two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and may have a time-limited membership A team is different from a group. A group can achieve its goal through independent individual contributions. Real-time coordination of tasks between individuals is not required. A team, however, consists of 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. During the temporal life of a team, the team’s mission is of greater value than the goals of the individual members
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Partnering With the Patient
Strategies for involving patients in their care Include patients in bedside rounds Conduct handoffs at the patient’s bedside Provide patients with tools for communicating with their care team Involve patients in key committees Actively enlist patient participation TeamSTEPPS revolves around patient safety and so they put patient in the center. But you can adapt this to partner with your customer and use the tools we’ll discuss to improve communications that way.
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Clinical Team Responsibilities
Embrace patients and their families as valuable and contributing partners in patient care Listen to patients and their families Assess patients’ preference regarding involvement Ask patients about their concerns Speak to them in lay terms Allow time for patients and families to ask questions Ask for their feedback Give them access to relevant information Encourage patients and their families to proactively participate in patient care
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Patient and Family Responsibilities
Provide accurate patient information Comply with the prescribed plan of care (e.g., schedule and attend appointments as directed) Ask questions and/or voice any concerns regarding the plan of care Monitor and report changes in the patient’s condition Manage family members Follow instructions of the clinical team Communication is a 2 way street so can’t just be you “talking to a person” they have to add content as well.
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Multi-Team System (MTS) for Patient Care
Patient can = customer for RCHI purposes
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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 Patient can = customer. So here a Core Team may be the KSTAR physician Assessment team. A core team is a small team but it does have a leader. We also have core teams for Dads, DSHS, the Regional Extension Center. Core Team members have the closest contact with the patient!
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A Contingency Team is… A time-limited team formed
for emergent or specific events and composed of members from various teams A contingency team don’t typically spend much time working together as a team but they come to help the core team when the core team needs resources they don’t have. An example in the hospital is a code blue team. The best example I can think of at RCHI is when we pulled people in to help submit my Opioid Grant. The core team was Misti and me but then we pulled in Jettie and Dr. Dickey and Dr. Steele and needed Sherry to help with financials and pulled in the students to help with some tasks and it was a time limited team (we had a deadline) formed for a specific and emergent event (Hope & Cope Grant).
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A Coordinating Team is…
A team comprising those work area members who are responsible for managing the operational environment that supports the Core Team Joan, Carina, Charlotte, Robin, Tracy, Sherry, Angie, and Susan = RCHI coordinating team. They make sure that conference rooms are set up, conference calls are set up, visitors are shown into offices, travel arrangements are made. The coordinating team manages the environment so that the core team can focus on the patient/customer. It allows core team to focus and not be distracted by details that can be managed by the coordinating team.
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Ancillary & Support Services
Ancillary Services provide direct, task-specific, time- limited care to patients. Support Services provide indirect service-focused tasks which help to facilitate the optimal health care experience for patients and their families. Housekeeping is a support service – if the doors aren’t locked when they leave all our PHI is at risk. If the offices aren’t cleaned we can’t put on our best face when people come to visit. Building services is also a support service – the temperature of your office makes a difference in your day.
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The Role of Administration is to…
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 Dr. Dickey, Dr. Steele, Jettie, Tammy Wagner and Peter are our leadership team. They have 24 hour 100% accountability for the management of RCHI – they need to make sure each core team understands its role AND has access to the resources they need to succeed.
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Team Structure Video
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Team Structure Video Analysis
What breakdowns could occur between the components of this multi-team system? What could have been done to ensure a positive outcome? Do you see a team leader? Did anybody establish a vision for a successful outcome?
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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) You saw this slide in the introduction and the video was not a high performing team. No shared mental model, no clear roles, no clear vision, didn’t see leadership, did not optimize performance outcomes…..
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Communication Communication is a critical skill required for effective teamwork! Assumptions Fatigue Distractions HIPAA
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Lost in Translation
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Communication Effective communication skills are vital for patient safety Enables team members to effectively relay information The mode by which most TeamSTEPPS strategies and tools are executed
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Importance of Communication
Joint Commission data continues to demonstrate the importance of communication in patient safety : Ineffective communication identified as root cause for nearly 66 percent of all reported sentinel events* : Ineffective communication among top 3 root causes of sentinel events reported** * (JC Root Causes and Percentages for Sentinel Events (All Categories) January 1995−December 2005) ** (JC Sentinel Event Data (Root Causes by Event Type) )
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Communication is… Shared understanding
The process by which information is exchanged The lifeline of the Core Team Effective when it permeates every aspect of an organization Assumptions Fatigue Distractions HIPAA
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Shared understanding?
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Non-verbal Communication
Body Language In face-to-face communication: Words: 7% of meaning Tone of voice: 38% Body language: 55% Visual Cues Such as color coding
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Brief Clear Timely
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Communication Challenges
Language barrier Distractions Physical proximity Personalities Workload Varying communication styles Conflict Lack of information verification Shift change Any epic fail stories to share???
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Four Information Exchange Strategies
Situation – Background – Assessment – Recommendation (SBAR) Call-Out Check-Back Handoffs
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#1: SBAR Provides… A framework for team members to effectively communicate information to one another Communicate the following information: Situation―What is going on? Background―What is the background or context? Assessment―What do I think the problem is? Recommendation―What would I recommend? SBAR is just a tool to frame a conversation.
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#2: Call-Out is… A strategy used to communicate important or critical information It informs all team members simultaneously during emergency situations It helps team members anticipate next steps Joan does call outs during our torrential rains so we all know when to move our cars out of the flood plain in back
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#3: Check-Back is… Closed loop communication as demonstrated with Check Back – is the process of confirming and cross checking info for accuracy. It increases the ability of the entire team to share goals, expectations, awareness, and plan execution. Hospital, used frequently in code situations but also has a role in other situations.
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Check Back https://www.youtube.com/watch?v=mLFZTzR5u84
Check back – critical information exchanged here and closed loop demonstrated.
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#4: Handoff is… The transfer of information during transitions in responsibility across the continuum Includes an opportunity to ask questions, clarify, and confirm 43
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Handoff Consists of… Transfer of responsibility and accountability
Clarity of information Verbal communication of information Acknowledgment by receiver Opportunity to review Misti does this during our Grant huddles. We come together as a core team, we decide what needs to be done. Then Misti summarizes our meetings and does a Handoff – Robin/Dr. Dickey are responsible for contacting 2 CEOs and doing an interview, I have to write up a pharmacy piece based on the information Abeer researched. Misti transfers the info, we verify it was clear and acknowledge we own it now. 44
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When to share information
Brief: short session before you start to share the plan Huddle: ad hoc meeting to monitor & modify the plan Debrief: after you are done, informal session to review team performance. What went well and what can we do better next time. NOT a vent session More tools to help share information. These are gatherings with the purpose of sharing information . Brief: short session before you start to share the plan, discuss team formation, assign roles and responsibilities, establish expectations & climate, anticipate outcomes, and make contingency plans.
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When and How to Share information?
Briefs Huddles Debriefs How: SBAR Call-outs Check-backs
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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 OUTCOMES Shared Mental Model Adaptability Team Orientation Mutual Trust Team Performance Patient Safety!!
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Questions? https://www.ahrq.gov/teamstepps/index.html
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