1. Teamwork Across Units
Armstrong Institute for Patient Safety and Quality
Presented by: Jill A. Marsteller

2. Motivation
Feeling that “I’m done” when the patient leaves my area (must turn to next patient)(out of sight, out of mind)
Lack of understanding across and between clinical areas/units (what, how, why, who)
In-group and out-group (Halo and Horns effects)
Cross-unit communications may lack explicit tools, vehicles for communication
Leads to duplication; missed items; failure to interact; low inter-unit respect/ collegiality

3. Motivation Interactions among units can be strained
CUSP is challenging to implement, units can support each other
Some issues differ across units and others are common
Consolidating effort in QI/PS may lead to better results (fragmented efforts less payoff)
BRIEFLY

4. Elizabeth Dayton et al., Joint Commission Journal, Jan. 2007

5. Figure 2: Stages of communication, common problems and solutions
Stage 5: Escalate
Stage 1: Decide on message
Stage 2: Encode
Stage3: Decode
Stage 4: Negotiate
Groupthink, tunnel vision, low input
Problems:
Solutions: Psychological safety, pause points, diversity, situational awareness
Ambiguous language
Solutions: Structured communication tools such as SBAR
Fatigue, distraction, noise, closed culture
Solutions:
Read back
Failure to speak up, bullying, judging
Assertive communication, role playing
Failure to seek mediation
Solutions: Set up clear chain of command and expectations for use

6. Aim For Cross-Unit Teamwork
To facilitate and improve teamwork, communication, and coordination of quality improvement and patient safety activities across the CUSP teams working in the three clinical areas/units.

7. Improved understanding and interactions across units within a hospital
Goals
Thinking about keeping patients safe during entire episode of inpatient care
Increased cross-unit interactions would encourage shared goals and problem-solving with respect to quality and safety issues/ initiatives across units within a hospital
Improved understanding and interactions across units within a hospital
We already spend an hour in the morning

8. Conceptual Supports Improvement of relationships due to:
Work on common topics
Increased exposure to problems/ successes of other units
Shared problem-solving
Creation of a super-ordinate identity
Faster/ greater improvement in QI/PS issues due to:
Increased availability of information/ ideas
Benefits of multiple perspectives
Coordinated approach across units with common issues

9. Interventions Meetings of an All-unit CUSP team
Sharing local safety assessment and LFD results
Joint LFD investigations of common safety issues
Joint designation/development of new QI initiatives
Cross-unit Shadowing

10. Cross-unit Shadowing
What happened during the shadowing exercise that involved multiple practice domains?
Were any health care providers difficult to approach? Did one provider get approached more often for patient issues?
Did you observe any errors in transcription, interpretation, delivery of orders/ other processes?
Were patient problems identified quickly? Were they handled as you would have handled them? Why/ why not? What obstacles were faced?
Any suggestions for the shadowed unit to consider?

11. The hard question
What could my unit/area do to help care go more smoothly in the shadowed unit?

12. Outcomes/Results
We hypothesize that providers will note increased frequency of communication and better problem-solving interactions, higher ratings of shared goals, knowledge, and mutual respect across units at time 2 compared to time 1
Shared QI programs/ strategies will be observed at time 2 that were not present at time 1