1. Strategies and Tools for Patient Safety
“Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military, aviation, nuclear power, business and industry…to acquire team competencies”

2. TeamSTEPPS

3. Weathering a disaster is not a matter of luck

4. It’s a team process

5. Sue Sheridan Video
Play Video

6. Objectives Understand the role of communication in patient safety
Acknowledge that conflict creates significant risk for patients
Gain a basic understanding of TeamSTEPPS tools and incorporate into patient care
Support co-workers in utilizing TeamSTEPPS tools to enhance patient safety

7. INEFFECTIVE COMMUNICATION
Impact?

8. Joint Commission Sentinel Events
Targets for Teamwork

9. How Health Care Systems have measured success with TeamSTEPPS:
Length of Stay
Reduction in sentinel events
Quality Patient Indicators- Culture of safety
Staff retention
Event reporting (STARS)
Staff satisfaction
Patient satisfaction

10. Avg. Length of Stay (days)
Length of ICU Stay After Team Training 1
1.2
1.4
1.6
1.8 2
2.2
2.4
June
July
August
Sept
Oct
Nov
Dec
Jan
Feb
March
April
May
Avg. Length of Stay (days)
Length of ICU Stay After Team Training
50% Reduction
(Pronovost, 2003)
Johns Hopkins
Journal of Critical Care Medicine

11. OR Teamwork Climate and Postoperative Sepsis Rates
(per 1000 discharges)
(Sexton, 2006)
Johns Hopkins

12. Adverse Outcomes (Mann, 2006) Beth Israel Deaconess Medical Center
Contemporary OB/GYN

13. If you had the tools to cure a critical illness, wouldn’t you use them?

14. 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 have a time-limited membership
“Individual commitment to a group effort—that is what makes a team work, a company work, a society work, a civilization work.”
–Vince Lombardi

15. Team Structure
The ratio of We’s to I’s is the best indicator of the development of a team.
–Lewis B. Ergen

16. High-Performing Teams
Teams that perform well:
Have clear, valued, and shared vision
Engage in a regular discipline of feedback
Briefs, huddles, debriefs
Manage and optimize performance outcomes
Hold each other accountable
Give feedback and share information
(Salas et al. 2004)
“The trick is understanding that only a special type of teamwork and camaraderie can catch in time the types of medical errors a hospital will always generate.”
(Nance, 2009)
“Why Hospitals Should Fly”

17. Barriers to Team Performance
Lack of information sharing
Hierarchy
Defensiveness
Conflict
Distractions
Fatigue
Workload
Lack of role clarity
Lack of coordination and follow-up

18. 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.
“Teams that perform well hold shared mental models.”
(Rouse, Cannon-Bowers, and Salas 1992)

19. How Shared Mental Models Help Teams
Help ensure that teams know what to expect, so if necessary, can regroup to get on the “same page”
Foster communication to ensure care is synchronized
Ensure that everyone on the team has a picture of what it should look like
Enable team members to predict and anticipate better
Create commonality of effort and purpose
“ Shared mental models help teams avoid errors that place patients at risk.”

20. Eight Steps of Change Create sense of urgency Build the guiding team
Develop a change vision and strategy
Understanding and buy-in
Empower others
Short term wins
Don’t let up – Be relentless
Create a new culture

21. Leadership

22. Team Leader Two types of leaders:
Designated – The person assigned to lead and organize a designated core team, establish clear goals, and facilitate open communication and teamwork among team members
Situational – Any team member who has the skills to manage the situation-at-hand

23. Effective Team Leaders
Organize the team
Articulate clear goals
Make decisions through collective input of members
Empower members to speak up and challenge, when appropriate
Actively promote and facilitate good teamwork
Skillful at conflict resolution

24. Promoting & Modeling Teamwork
Effective leaders cultivate desired team behaviors and skills through:
Open sharing of information
Role modeling and effectively cueing team members to employ prescribed teamwork behaviors and skills
Constructive and timely feedback
Facilitation of briefs, huddles, debriefs, and conflict resolution

25. Communication
Assumptions
Fatigue
Distractions
HIPAA

26. Communication and Conflict Resolution Techniques
Communication is a skill
Communication starts with active listening
Conflict resolution is a higher level skill built on effective communication and active listening plus….

27. Communication 101
DEPERSONALIZE: The more inappropriate communication is, the less you have to own it!!!!”
“No one can make me feel inferior without my consent” Eleanor Roosevelt

28. Communication 101
Being able to depersonalize inappropriate communication and/or behavior allows us to effectively begin the process of conflict resolution
When we do not feel diminished or upset we can focus on the goal

29. Communication 101 Two goals of any conversation
including conflict resolution:
Good working relationships with co-workers
Safe and optimal patient care

30. Conflict resolution 101 Make positive assumptions
Keep goal of communication in mind
If you meet with resistance…”I don’t know what you’re talking about”, “whatever”..,” you’re crazy”, don’t respond to the words, respond to the feelings and keep focused on goal, “You’re getting upset, that’s not my intent”.
Repeat goal of conversation

31. Communication Breakdown
Reasons for communication breakdown between nurse and physician
Disagreement over discharge orders
Disagreement over treatment plan
Misunderstanding the other’s rationale for action or for delay in meds or treatments
Focus on:
Patient safety, danger or harm to patient
Ethical considerations

32. Delegation Why is it such a problem? Process includes 4 steps:
Decide what to delegate
Decide to whom to delegate
Communicate clear expectations
Request feedback
Why is it such a problem?

33. Standards of Effective Communication
Complete
Communicate all relevant information
Clear
Convey information that is plainly understood
Brief
Communicate the information in a concise manner
Timely
Offer and request information in an appropriate timeframe
Verify authenticity
Validate or acknowledge information
Respectful
Critical aspect of effective delegation

34. TeamSTEPPS Tools for Effective Communication

35. Tools for Conflict Resolution
DESC
D escribe the situation
E xpress concerns
S uggest alternatives
C onsequences of actions
CUS
I am Concerned!
I am Uncomfortable!
This is a Safety issue!

36. Remember to introduce yourself . . .
SBAR provides…
A framework for team members to effectively communicate information to one another
Communicate the following information:
Situation - What is going on with the patient?
Background - What is the clinical background or context?
Assessment - What do I think the problem is?
Recommendation - What would I recommend?
Remember to introduce yourself . . .

37. SBAR Video
Play Video

38. Handoff
The transfer of information (along with authority and responsibility) during transitions in care across the continuum; to include an opportunity to ask questions, clarify, and confirm

39. Handoff Optimized Information Responsibility– Accountability
ELIMINATE Uncertainty
Verbal Structure
Checklists
Acknowledgement of Understanding, Feedback
Great opportunity for quality and safety

40. Additional TeamSTEPPS Team Communication Tools
Briefs – planning
Huddles – problem solving
Debriefs – process improvement
Leaders are responsible to assemble the team and facilitate team events
But remember…
Anyone can request a brief, huddle, or debrief

41. Briefs Planning Form the team Clarify team roles and responsibilities
Establish goals (shift, patient,unit)
Engage team in short and long-term planning

42. Briefing Checklist TOPIC Who is on team? All members understand
and agree upon goals?
Roles and responsibilities
understood?
Plan of care?
Staff availability?
Workload?
Available resources?

43. Brief Video
Play Video

44. Huddle Problem solving
Hold ad hoc, “touch-base” meetings to regain situation awareness
Discuss critical issues and emerging events
Anticipate outcomes and likely contingencies
Assign resources
Express concerns

45. Huddle Video
Play Video

46. Debrief Process Improvement
Brief, informal information exchange and feedback sessions
Occur after an event or shift
Designed to improve teamwork skills
Designed to improve outcomes
An accurate reconstruction of key events
Analysis of why the event occurred
What should be done differently next time

47. Debrief Checklist TOPIC Communication clear?
Roles and responsibilities understood?
Situation awareness
maintained?
Workload distribution?
Did we ask for or offer
assistance?
Were errors made or
avoided?
What went well, what should change, what can improve?

48. Debrief Video
Play Video

49. The primary role of all Healthcare providers is patient advocacy
Effective communication and conflict resolution are essential

50. Carter preps for surgery
ER Video
Carter preps for surgery
Play Video

51. “When each member accepts full responsibility and strives for excellence…trust and performance increase exponentially…the team is ready to take off.”
- Scott ‘Yogi’ Beare

52. Kaleida Health Patient Safety Initiative 2010
Educate staff on TeamSTEPPS tools*
Brief
Debrief
Huddle
Handoff
Situation monitoring
*Orientation, Preceptor Workshop, PICU at WCHOB

53. Using TeamSTEPPS tools will impact patient safety

54. This is urgent…
This is personal.
Play Video

55. TeamSTEPPS Assessment

56. You have completed the TeamSTEPPS presentation. Thank you