1. Clarifying
Key
Concepts

2. Objective
To clarify key concepts that a majority did not know the answer for on the knowledge test taken at the end of the training
The components of an effective team structure
Designated and situational leaders
The role of a structured framework in information exchange
What makes handoffs different from other communication?
What is a shared mental model?
What is mutual support?

3. TeamSTEPPS is composed of four teachable/learnable skills
Leadership
Situation Monitoring
Mutual Support
Communication
Skills are supported by team structure
…team performance is a science…consequences of errors are great…

4. Components of Effective Team Structure
A team is composed of two or more people who…
Interact interdependently and adaptively
Have complementary skills
Have effective leadership
Work toward a common goal… this is the MOST important component of team structure…knowledge of the common goal accounted for 14% of the difference in team function
Have clear roles and responsibilities…second most important component of team structure…accounted for 12% of the difference in team function
Hold them selves mutually accountable for achieving the goal
Salas et al. Does team training work? Principles for health care. Acad Emerg Med :1-8.

5. Designated and Situational Leaders
Leadership is one of the four key teachable/learnable TeamSTEPPS strategies
There are two type of leaders
Designated leader is assigned to lead and organize a designated core team by
Establishing clear goals
Facilitating open communication, information, and mutual support sharing through briefs, huddles, debriefs
Resolving conflict
Situational leader is any team member who steps forward because they have the skills/knowledge to manage the situation-at-hand; situational leader may step forward during a brief or debrief or they may call a huddle

6. Information Exchange
Communication contributes to nearly 2/3 of sentinel events because effective communication does not come naturally

7. Information Exchange
Effective communication is the exchange of information between a sender and a receiver…and it is
Complete
Brief
Clear
Timely
Closed loop by asking for confirmation and providing time for follow up questions
Structured communication strategies such as SBAR, Call-Out, Check-Back, and Handoffs decrease errors by setting expectation for what will be communicated

8. What makes Handoffs Different?
A handoff involves the transfer of information—along with authority and responsibility—during transitions in care across the continuum;
Because authority and responsibility are being transferred, the handoff must include opportunity to address
Safety concerns
Background…what are the co-morbidities, medications, history
Actions…what has already been done?
Timing…how urgent, what should be done first:
Ownership…who is responsible for what?
Next…what will happen next?
Which is why SBAR may not be the best tool for a handoff across shifts or levels of care unless it is modified

9. Question, Clarify, and Confirm
“I PASS THE BATON”
Introduction: Introduce yourself and your role/job (include patient)
Patient: Identifiers, age, sex, location
Assessment: Present chief complaint, vital signs, symptoms, and diagnosis
Situation: Current status/circumstances, including code status, level of uncertainty, recent changes, and response to treatment
Safety: Critical lab values/reports, socio-economic factors, allergies, and alerts (falls, isolation, etc.)
THE
Background: Co-morbidities, previous episodes, current medications, and family history
Actions: What actions were taken or are required? Provide brief rationale
Timing: Level of urgency and explicit timing and prioritization of actions
Ownership: Who is responsible (nurse/doctor/team)? Include patient/family responsibilities
Next: What will happen next? Anticipated changes? What is the plan? Are there contingency plans?
Question, Clarify, and Confirm

10. What is a Shared Mental Model?
A shared mental model is the perception of, understanding of, or knowledge about a situation or process that is shared among team members through communication
Shared mental models require individuals to monitor what is going on around them and share that information during briefs, huddles, and debriefs
Situation Monitoring (Individual Skill)
Situation Awareness (Individual Outcome)
Shared Mental Model (Team Outcome)

11. What is a Mutual Support?
Mutual support is one of the four key skills or team strategies taught in TeamSTEPPS; the other three are leadership, situation monitoring and communication
Mutual support is “back up behavior” in which team members provide a safety net for each other to prevent errors
Task Assistance
can prevent
work overload
Feedback focuses
on behaviors and
is needed to
improve team
performance
Patient Safety
I must advocate
for my patient;
others may not
have the same
information
I’m Concerned,
I’m Uncomfortable,
this is a Safety
issue!

12. What is a Mutual Support?
Mutual support has the most tools of the four key strategies
Task assistance
Feedback
Advocacy and Assertion
Two Challenge Rule
CUS (resolve information conflict)
DESC Script (resolve personal conflict)
Advocating for patients may lead to conflict when decision makers don’t have the same information (shared mental model) or there is a personality conflict
Assertion is NOT aggressive; it does not undermine authority, attack the decision maker, or question a decision without reason
Information
Conflict
Personal
Conflict

13. Summary
Teams provide organizations with a greater ability to adapt and learn than do individuals. However, just because groups of people call themselves a team doesn’t mean that they are truly a team. Based on an extensive review of the literature, Eduardo Salas and colleagues published the theoretical model on the next slide in This framework is called the big 5 of teamwork. The purpose of the model is to identify the core concepts that enable groups of people to work together, to collaborate, to adapt to changing circumstances, and effectively work toward a common goal. The diagram illustrates that when team leaders direct and coordinate the activities of other team members by clarifying roles, establishing goals & expectations, and organizing meetings for planning and feedback, they provide the opportunity for team members to communicate, collaborate, and cooperate. It is during these meetings—briefs, huddles, and debrief—that team members communicate what they have learned by monitoring others, a new shared mental model of how to reach a goal emerges, and team members offer back up or mutual support to achieve that goal. When team members trust each other, value team goals above individual goals, and use closed loop communication, they have the ability to be adapt, manage complex systems and complex patients and learn from experience.

14. The Theory Effectiveness Salas, Sims, Burke. Is there
Team
Leadership
Orientation
Mutual
Performance
Monitoring
Back-up
Behavior
Adaptability
Shared Mental
Models
Trust
Effectiveness
Closed Loop
Communication
Salas, Sims, Burke. Is there
a “Big Five” in teamwork?
Small Group Research. 2005; 36:
Big 5
Coord.
Mechanism
Teams provide organizations with a greater ability to adapt and learn than do individuals. However, just because groups of people call themselves a team doesn’t mean that they are truly a team. Based on an extensive review of the literature, Eduardo Salas and colleagues published this framework/model —called the big 5 of teamwork—in The purpose of the model is to identify the core concepts that enable groups of people to work together, to collaborate, to adapt to changing circumstances, and effectively work toward a common goal. The diagram illustrates that when team leaders direct and coordinate the activities of other team members by clarifying roles, establishing goals & expectations, and organizing meetings for planning and feedback, they provide the opportunity for team members to communicate, collaborate, and cooperate. It is during these meetings—in TS we learned to call them briefs, huddles, and debrief—that team members communicate what they have learned by monitoring others, a new shared mental model of how to reach a goal emerges, and team members offer back up or mutual support to achieve that goal. When team members trust each other, value team goals above individual goals, and use closed loop communication, they have the ability to be adapt, manage complex systems & patients and learn from experience.

15. Summary
Impact of errors…patients are harmed, non-clinical teams do not achieve goals
TeamSTEPPS Framework
Safety net for fallible human beings
TeamSTEPPS training meets a need
Diffuse evidence-based training program nationally and internationally
Outcomes of TeamSTEPPS
Shared Mental Model Adaptability Team Orientation Mutual Trust Team Performance Patient Safety!!