1. TeamSTEPPS Simulations: A Practical Manual James Battles, PhD Heidi King, MS, FACHE Stephen Hines, PhD Barb Edson, RN, MBA, MHA David Baker, PhD

2. What's Next? Leveraging Current Tools to Support Implementation

3. T EAM STEPPS 05.2 Mod 1 05.2 Page 3 TeamSTEPPS Presenters James Battles, PhD Social Science Analyst for Patient Safety, AHRQ Heidi King, MS, FACHE Acting Director Department of Defense Patient Safety Program Stephen Hines, PhD Chief Research Officer, HRET Barb Edson, RN, MBA, MHA VP of Clinical Quality, HRET David Baker, PhD Senior Vice President, Health Division, IMPAQ International

4. T EAM STEPPS 05.2 Mod 1 05.2 Page 4 TeamSTEPPS Objectives Consider how TeamSTEPPS work influences other patient safety initiatives Discuss new TeamSTEPPS variations Lay out current and future plans for TeamSTEPPS national implementation

5. T EAM STEPPS 05.2 Mod 1 05.2 Page 5 TeamSTEPPS Where Have We Been and Where Do We Go From Here? James Battles, PhD AHRQ

6. T EAM STEPPS 05.2 Mod 1 05.2 Page 6 TeamSTEPPS What TeamSTEPPS ® Does

7. T EAM STEPPS 05.2 Mod 1 05.2 Page 7 TeamSTEPPS Combat Tested Been to war in IRAQ and Afghanistan

8. T EAM STEPPS 05.2 Mod 1 05.2 Page 8 TeamSTEPPS Hurricane Tested Played a critical role in Hurricane Sandy & other emergencies

9. T EAM STEPPS 05.2 Mod 1 05.2 Page 9 TeamSTEPPS TeamSTEPPS ® goes International Japan Korea China Taiwan Australia Canada Great Britain Netherlands Switzerland Singapore Germany Italy Peru Brazil All 50 States

10. T EAM STEPPS 05.2 Mod 1 05.2 Page 10 TeamSTEPPS Integrating TeamSTEPPS ® CUSP for CLASBI CUSP for CAUTI in hospitals and long term care CUSP for VAP\VAC Safe Surgery in Hospitals and Ambulatory Surgery Centers Perinatal Safety Improvement Program Medical Liability projects

11. T EAM STEPPS 05.2 Mod 1 05.2 Page 11 TeamSTEPPS Where to From Here? Discussions with WHO about a region-by-region implementation of TeamSTEPPS ® Need to create new modules dealing with virtual teams and coordination of care between units within healthcare facilities and across care settings

12. T EAM STEPPS 05.2 Mod 1 05.2 Page 12 TeamSTEPPS Where to From Here? Meeting growing demand for TeamSTEPPS ® training and implementation strategies in primary care New on-line Master Team Training to be developed

13. T EAM STEPPS 05.2 Mod 1 05.2 Page 13 TeamSTEPPS TeamSTEPPS New Tools and Resources from the Department of Defense Heidi King, MS, FACHE Department of Defense Patient Safety Program

14. T EAM STEPPS 05.2 Mod 1 05.2 Page 14 TeamSTEPPS DoD TeamSTEPPS: Where Have We Been?  Utilizing over 5000 (and climbing) Master Instructors  Training and implementation in 90% of Military Treatment Facilities  Over 70,000 continuing education credits awarded  Using simulation and coaching as adjunct to training  Spread throughout medical/trauma teams in Theatre of Operations: Iraq and Afghanistan  Partnering with various federal agencies to leverage TeamSTEPPS integration Foundational to achieving culture change

15. T EAM STEPPS 05.2 Mod 1 05.2 Page 15 TeamSTEPPS We needed a new sustainable model! DoD TeamSTEPPS: Where Are We Heading? We needed a new sustainable model! A E I OU  Align with patient safety and quality improvement initiatives  Encourage Innovation  Involve, Integrate, Impact: patients, staff, programs, outcomes  Overcoming challenges  Utilizing coaching and simulation for experiential learning TeamSTEPPS is part of our DNA…

16. T EAM STEPPS 05.2 Mod 1 05.2 Page 16 TeamSTEPPS TeamSTEPPS Resources: Integration! Patient Activation Resource Guide CoachingSBAR Toolkit Simulation-based Training (Centers and In-situ) Professional Conduct Toolkit Briefs, Huddles, Debrief Toolkits TeamSTEPPS and Partnership for Patients TeamSTEPPS Tip Sheets and Scenarios TEAMTPAT Learning Circles and Workshops Team UP DoD Website eBulletin and Learning Update FacebookPatient Safety Learning Center (Protected) http://www.health.mil/dodpatientsafety

17. T EAM STEPPS 05.2 Mod 1 05.2 Page 17 TeamSTEPPS TeamSTEPPS National Implementation Overview Barb Edson, RN, MBA, MHA HRET

18. T EAM STEPPS 05.2 Mod 1 05.2 Page 18 TeamSTEPPS Goals To provide TeamSTEPPS Master Training to health care organizations interested in improving teamwork to enhance performance and patient safety To grow the national cadre of TeamSTEPPS Master Trainers To support TeamSTEPPS users To evolve and advance the TeamSTEPPS program

19. T EAM STEPPS 05.2 Mod 1 05.2 Page 19 TeamSTEPPS TeamSTEPPS Master Training Two-day training course Train-the-trainer approach Prepares you to serve as a TeamSTEPPS Master Trainer by Providing instruction on TeamSTEPPS tools and strategies Providing an opportunity to develop and plan your TeamSTEPPS implementation Prepares you to serve as a leader for implementing TeamSTEPPS within your organization

20. T EAM STEPPS 05.2 Mod 1 05.2 Page 20 TeamSTEPPS Regional Training Centers North Shore Long Island Jewish TRC Duke TRC Minnesota -TRC University of Washington TRC Tulane University TRC UCLA TRC

21. T EAM STEPPS 05.2 Mod 1 05.2 Page 21 TeamSTEPPS Regional Training Centers North Shore Long Island Jewish Health System in New Hyde Park, New York (NSLIJ) Implemented TeamSTEPPS system-wide Duke Medical Center, Durham, North Carolina (Duke) Includes patients as part of TeamSTEPPS Master Training Tulane University, New Orleans, Louisiana (Tulane) Integrates simulation into TeamSTEPPS Master Training University of Minnesota Fairview Medical Center, Minneapolis, Minnesota (UM) Integrates TeamSTEPPS into inter-professional education (IPE) University of Washington Medicine, Seattle, Washington (UW) Integrates simulation into TeamSTEPPS Master Training University of California Los Angeles, Los Angeles, California (UCLA) New center launching in fall/winter of 2013

22. T EAM STEPPS 05.2 Mod 1 05.2 Page 22 TeamSTEPPS 2012 Accomplishments 766 people trained via: 15 basic trainings 1 training each focusing on IPE and Patient Engagement 4 trainings with a special focus on central line associated blood stream infections 395 attendees at the National Conference where: 99 attendees took part in a 1-day blended online and in- person Master Training course Conference topics spanned System-wide implementation Specific clinical usage Different training and educational models Networking opportunities mixed military and civilian champions of TeamSTEPPS

23. T EAM STEPPS 05.2 Mod 1 05.2 Page 23 TeamSTEPPS How do we support our participants?

24. T EAM STEPPS 05.2 Mod 1 05.2 Page 24 TeamSTEPPS Pre-Training Support Leadership Brief Provides a C-suite perspective http://teamstepps.ahrq.gov/abouttoolsmaterials.htm Prerequisite “Coursework” Pre-training recorded webinar Readiness Assessment Implementation Planning Participant on-boarding live webinar Orientate and prepare participants for training Meet training representative from Center staff Initiate implementation planning

25. T EAM STEPPS 05.2 Mod 1 05.2 Page 25 TeamSTEPPS Post-Training Support www.teamsteppsportal.org National Conference Help line/email http://teamstepps.ahrq.gov/

26. T EAM STEPPS 05.2 Mod 1 05.2 Page 26 TeamSTEPPS AHRQ Website AHRQ website (http://teamstepps.ahrq.gov/)http://teamstepps.ahrq.gov/ Program overview Training curricula (Essentials course; Fundamentals course; measures; new modules) Materials to download and/or order TeamSTEPPS Implementation Guide Measurement tools

27. T EAM STEPPS 05.2 Mod 1 05.2 Page 27 TeamSTEPPS TeamSTEPPS Portal A centralized resource for everything TeamSTEPPS Key features Webinars Tools and resources for use Implementation stories ListServ/Discussion forum

28. T EAM STEPPS 05.2 Mod 1 05.2 Page 28 TeamSTEPPS Upcoming Webinars Monthly scheduled webinars planned for 2013 Educational to support TeamSTEPPS users Invited speakers from around the field Special topics Program updates Portal updates Training updates Webinars are the second Wednesday of each month July 12: TeamSTEPPS and Simulation August 14: System-wide Implementation of TeamSTEPPS

29. T EAM STEPPS 05.2 Mod 1 05.2 Page 29 TeamSTEPPS Tools and Resources Ready-made implementation support tools Updated evidence base Scenarios Shared tools from users

30. T EAM STEPPS 05.2 Mod 1 05.2 Page 30 TeamSTEPPS Shared Tools Resource for posting and sharing new TeamSTEPPS tools TeamSTEPPS is customizable No sense in reinventing the wheel Others have dealt with similar problems and developed innovative solutions Contact AHRQTeamSTEPPS@aha.orgAHRQTeamSTEPPS@aha.org www.health.mil/dodpatientsafety/ProductsandSer vices/Toolkits.aspx www.health.mil/dodpatientsafety/ProductsandSer vices/Toolkits.aspx

31. T EAM STEPPS 05.2 Mod 1 05.2 Page 31 TeamSTEPPS Implementation Stories Cases studies of successful and unsuccessful TeamSTEPPS implementations Learn from these critical incidents HRET team will interview, summarize, and post the story Please follow the Survey Monkey link under “Case Studies” on the portal to share your experience

32. T EAM STEPPS 05.2 Mod 1 05.2 Page 32 TeamSTEPPS Discussion Forum Training-specific forums (for 2013 sessions) Reconnect with classmates Directly interact with faculty Share tools ListServ for the entire TeamSTEPPS community

33. T EAM STEPPS 05.2 Mod 1 05.2 Page 33 TeamSTEPPS TeamSTEPPS 2.0 David P. Baker, PhD IMPAQ International

34. T EAM STEPPS 05.2 Mod 1 05.2 Page 34 TeamSTEPPS Patient Safety Movement DoD MedTeams® ED Study Patient Safety and Quality Improvement Act of 2005 Executive Memo from President Institute for Healthcare Improvement 100K lives Campaign “To Err is Human” IOM Report T eam STEPPS® JCAHO National Patient Safety Goals TeamSTEPPS Released to the Public TeamSTEPPS National Implementation Program Began National Implementation of CUSP Centers for Medicare and Medicaid Partnership for Patients Campaign Medical Team Training 199519992001200320042005 2006 2007 2008 2011

35. T EAM STEPPS 05.2 Mod 1 05.2 Page 35 TeamSTEPPS What is TeamSTEPPS 2.0? Part of effort to continually evolve TeamSTEPPS Provides an opportunity to…. Leverage what has been learned so far: Lessons learned Feedback from users New and emerging evidence Consider meaningful ways to integrate current and future TeamSTEPPS efforts

36. T EAM STEPPS 05.2 Mod 1 05.2 Page 36 TeamSTEPPS Environmental Scan Review of prior work efforts related to a next iteration of TeamSTEPPS Usability reviews of existing curriculum and materials Interviews with AHRQ and DoD stakeholders Focus groups with TeamSTEPPS experts Participants referred by AHRQ and/or DoD Included TeamSTEPPS users, trainers, and those involved in its development 5 virtual focus groups conducted Represented over 80 years combined experience with teaching and/or implementing TeamSTEPPS!

37. T EAM STEPPS 05.2 Mod 1 05.2 Page 37 TeamSTEPPS Results Qualitative data analysis resulted in 189 aggregated recommendations Recommendations were clustered into 6 categories: Pre-training Training materials Training delivery Implementation and sustainment Evaluation Integrating new modules

38. T EAM STEPPS 05.2 Mod 1 05.2 Page 38 TeamSTEPPS TeamSTEPPS 2.0: Work in Progress Focuses on revisions, updates, and expansions to materials that support the Master Training course Improvements for TeamSTEPPS users Updated and expanded content Reduced size of hard copy materials! Better preparation for implementation planning Improvements for Master Trainers Improved and enhanced Instructor Guides Page numbers! Advance organizer for each instructional module New discussion questions and exercises

39. T EAM STEPPS 05.2 Mod 1 05.2 Page 39 TeamSTEPPS TeamSTEPPS 2.0: Work in Progress (Cont’d) Some highlights: Updating the evidence base Reorganizing the order of training to emphasize the importance of communication Providing information and guidance on engaging patients Emphasizing the importance of implementation planning pre-training and throughout the course Providing more detailed information on implementation and sustainment activities (e.g., Coaching, Measurement)

40. T EAM STEPPS 05.2 Mod 1 05.2 Page 40 TeamSTEPPS Next Steps Drafts of 2.0 materials are near completion! Review and testing with stakeholders – June 2013 Delivery for final AHRQ review – September 2013

41. T EAM STEPPS 05.2 Mod 1 05.2 Page 41 TeamSTEPPS TeamSTEPPS New Tools and Resources James Battles, PhD AHRQ Barb Edson, RN, MBA, MHA HRET

42. T EAM STEPPS 05.2 Mod 1 05.2 Page 42 TeamSTEPPS New Tools TeamSTEPPS ® Primary Care Version TeamSTEPPS ® Primary Care Version Adapts core concepts of TeamSTEPPS ® to reflect the environment of primary care office-based teams Adapts core concepts of TeamSTEPPS ® to reflect the environment of primary care office-based teams Team STEPPS ® Long-Term Care Version Team STEPPS ® Long-Term Care Version Adapted to the environment of nursing homes and other long-term care settings such as assisted living & continuing care retirement communities Adapted to the environment of nursing homes and other long-term care settings such as assisted living & continuing care retirement communities TeamSTEPPS ® Limited English Proficiency (LEP) Module TeamSTEPPS ® Limited English Proficiency (LEP) Module A module to help develop a customized plan to train staff in teamwork skills as applied to work with patients who have difficulty communicating in English A module to help develop a customized plan to train staff in teamwork skills as applied to work with patients who have difficulty communicating in English http://teamstepps.ahrq.gov

43. T EAM STEPPS 05.2 Mod 1 05.2 Page 43 TeamSTEPPS TeamSTEPPS for Primary Care Medical Offices Builds on “TeamSTEPPS for Primary Care Teams” Works as a Master Trainer course with material on How to be a practice facilitator of TeamSTEPPS How to coach TeamSTEPPS using a variety of methods How to implement, spread, and sustain TeamSTEPPS And how to measure and evaluate TeamSTEPPS

44. T EAM STEPPS 05.2 Mod 1 05.2 Page 44 TeamSTEPPS New Setting of Care, New Challenges, New Solutions Smaller teams with less ability to travel Varied background in team-training and quality improvement initiatives Available in a in-person training and online format Online trainings will include virtual, game-based learning

45. T EAM STEPPS 05.2 Mod 1 05.2 Page 45 TeamSTEPPS Interested? Please contact us at AHRQTeamSTEPPS@aha.org if you are interested AHRQTeamSTEPPS@aha.org Pilot testing begins late summer/early fall 2013 National Implementation begins late winter/early spring 2014

46. T EAM STEPPS 05.2 Mod 1 05.2 Page 46 TeamSTEPPS The Future of Teaching and Learning TeamSTEPPS Steve Hines, PhD HRET

47. T EAM STEPPS 05.2 Mod 1 05.2 Page 47 TeamSTEPPS Thoughts on the Future Teaching and learning TeamSTEPPS will change considerably Sometimes out of necessity Other times because of the opportunities presented by new technology Great challenges exist And there are approaches to address these challenges

48. T EAM STEPPS 05.2 Mod 1 05.2 Page 48 TeamSTEPPS Current Challenges to TeamSTEPPS Training Limited resources for meetings and trainings Funds are tight at healthcare organizations Time is valuable There are restrictions on meetings funded by the federal government Radical increase in number of ongoing QI activities Coordinating with other disciplines and settings of care Need to accommodate a broader range of trainees Work to understand how to best to connect and grow a community of users

49. T EAM STEPPS 05.2 Mod 1 05.2 Page 49 TeamSTEPPS How Can We Approach these Challenges? Expand our training center capacity Produce resources for a broader range of disciplines and settings of care Create user-friendly resources for those who are not at trainings Materials for the end user on the front lines to practice using the TeamSTEPPS tools Resources to help make the case for implementation from a financial, quality, and safety standpoint Alternative training modalities for self-teaching Expanded use of observation and mentoring

50. T EAM STEPPS 05.2 Mod 1 05.2 Page 50 TeamSTEPPS Time for Questions Thank you for spending time with us this week in Dallas!