1. TeamSTEPPS ® Primary Care Module Richard Ricciardi, PhD, NP Agency for Healthcare Research and Quality Center for Primary Care, Prevention and Clinical Partnerships September 10, 2012

2. T EAM STEPPS 05.2 Mod 1 05.2 Page 2 TeamSTEPPS Acknowledgement Deborah A. Milne, RN MPA American Institutes for Research

3. T EAM STEPPS 05.2 Mod 1 05.2 Page 3 TeamSTEPPS First Step Convened Technical Expert Panel (TEP) December 2010 Representatives from AHRQ and DoD Experts in primary care and quality improvement Interprofessional primary health care providers

4. T EAM STEPPS 05.2 Mod 1 05.2 Page 4 TeamSTEPPS Laying the Groundwork Defined the “team” Identified the “system” Evaluated the challenges Decided areas of focus

5. T EAM STEPPS 05.2 Mod 1 05.2 Page 5 TeamSTEPPS Primary Care Office (PCO) Team Technical Expert Panel defined the scope of “team” for purpose of this project Focus of the project was intended to be on optimizing teamwork within the medical office Caveat - it was noted that external care coordination is of extreme importance for future work

6. T EAM STEPPS 05.2 Mod 1 05.2 Page 6 TeamSTEPPS Primary Care Team Structure

7. T EAM STEPPS 05.2 Mod 1 05.2 Page 7 TeamSTEPPS Primary Care Office Environment

8. T EAM STEPPS 05.2 Mod 1 05.2 Page 8 TeamSTEPPS Some of the Inputs Patient phone calls/emails Scheduling Medication refills Interruption of patient flow Walk-ins, lab results Formulary questions Missed appointments Population data management Information from insurers Urgent appointments Calls from consultants/external providers Personnel transitions

9. T EAM STEPPS 05.2 Mod 1 05.2 Page 9 TeamSTEPPS Challenges to Teamwork in Primary Care Offices Quality Measures (Process and Outcome) Standardization Definitions Role Ambiguity Non – linear work flow Assumptions/Habits/Change

10. T EAM STEPPS 05.2 Mod 1 05.2 Page 10 TeamSTEPPS Curriculum Training Structure When training teams to implement TeamSTEPPS: Developed to be taught in conjunction with TeamSTEPPS Essentials OR When training Master Trainers: To be taught as an addition to TeamSTEPPS Fundamentals

11. T EAM STEPPS 05.2 Mod 1 05.2 Page 11 TeamSTEPPS Next Steps Literature review Curriculum design guide development Developed draft curriculum slides and instructor guide Begin preliminary scripts for video vignettes We asked all TEP members to send us brief “stories” that represented actual scenarios they had experienced

12. T EAM STEPPS 05.2 Mod 1 05.2 Page 12 TeamSTEPPS Field Testing Two sites TeamSTEPPS essentials followed by Primary Care Office Module Data collection

13. T EAM STEPPS 05.2 Mod 1 05.2 Page 13 TeamSTEPPS Highlights of Field Testing Focus Groups “What parts of the module are most relevant to primary care?” Patient advocacy and communication Conflict resolution Situation monitoring Debriefing

14. T EAM STEPPS 05.2 Mod 1 05.2 Page 14 TeamSTEPPS Highlights of Field Testing Focus Groups “What improvements could be made to the module?” More emphasis on roles of non-clinical staff in the care team More case-based scenarios, especially across team roles Non clinical staff felt that they often had important information to communicate but no process to do so Quote: “Little bits that you don’t automatically put into the records as a formal thing are so important.” Resulting module change: Included 4 scenarios in module that emphasize non-clinical staff

15. T EAM STEPPS 05.2 Mod 1 05.2 Page 15 TeamSTEPPS Highlights, cont… “What parts of the module do not make sense?” Definitions of “Huddles” and “Briefs” conflicts with NCQA Primary Care Medical Home (PCMH) language Quote: “PCMH designates the TeamSTEPPS Brief as a Huddle. We all need to know what we mean in terms of what we’re doing.” Resulting module change: More emphasis on flexibility/customizability throughout the curriculum, as long as each team member shares the same mental model.

16. T EAM STEPPS 05.2 Mod 1 05.2 Page 16 TeamSTEPPS Video Production Scenario video production – 4 paired scenarios (right way and wrong way) Script changes influenced by field testing results Each based on an actual event Leadership, Communication, Mutual Support, Situation Monitoring

17. T EAM STEPPS 05.2 Mod 1 05.2 Page 17 TeamSTEPPS Leadership in the Primary Care Medical Office Let’s watch the primary care team demonstrate proper team leadership.

18. T EAM STEPPS 05.2 Mod 1 05.2 Page 18 TeamSTEPPS Questions?