Mutual Support in Office-Based Care Course

1. Welcome to Office-Based Care Online Course Module 6: Mutual Support

2. The Materials You Will Use The Participant Workbook: Exercises Video reflections Scenarios AHRQ TeamSTEPPS website: Classroom slides Instructor Guide (select to view) Videos Ancillary materials

3. Module Objectives After completing this module, you will be able to: Describe how mutual support affects team processes and outcomes Discuss specific strategies to foster mutual support (e.g., task assistance, feedback) Identify specific tools to facilitate mutual support Describe conflict resolution strategies

4. Mutual Support Mutual support is the essence of teamwork It includes the ability to anticipate the needs of other team members through knowledge of their tasks andresponsibilities It provides a safety net for work overload situationsthat may reduce effectiveness and increase the riskof error What types of behavior might constitute mutualsupport or team backup behavior? Use page 27 of the Participant Workbook to record your thoughts

5. Task Assistance Team members foster a climate in which it is expected that assistance will be actively sought and offered as a method for reducing the occurrence of error Some people have been conditioned to avoid asking for help “In support of patient safety, task assistance is expected!”

6. Task Assistance Examples Task assistance may involve: Asking for assistance when overwhelmed or unsure Helping team members perform their tasks Shifting workload by redistributing tasks to other team members Delaying or rerouting work so the overburdened member can recover Filling in for overburdened team members Assistance should be actively offered and given whenever there is a concern for patient safety related to workload

7. What Is Feedback? “Feedback is the giving, seeking, and receiving of performance-related information among the members of a team.” (Dickinson and McIntyre, 1997) Any team member can give feedback at any time Feedback: Fosters improvement in work performance Meets the team’s and individual’s need for growth Promotes better working relationships Helps the team set goals for ongoing improvement

8. Types of Feedback Can be Formal or Informal Constructive Feedback: Is considerate, task specific, and focuses attention on performance and away from the individual (Baron, 1988) Is provided by all team members Evaluative Feedback: Helps the individual by comparing behavior to standards or to the individual’s own past performance (London, Larson, and Thisted, 1999) Most often used by an individual in a coaching or mentoring role

9. Characteristics of Effective Feedback Effective feedback is: Timely Respectful Specific Directed toward improvement • Helps prevent the sameproblem from recurringin the future Considerate “Feedback is wherethe learning occurs.”

10. When To Give Feedback You must give thought to when and where to give feedback to an individual Feedback must be timely enough for an individual to be able to readily associate itwith the behavior Negative feedback should never beexpressed to individuals in front of otherteam members

11. Feedback Examples Let’s look at some examples: Cautioning team members about potentially unsafe situations: “The asthma patient appears to be breathing harder after the nebulizer treatment. Do you think we should address this by informing Dr. Smith?” Providing necessary information: “Did you know that the patient saw her cardiologist last week? There’s no report in the chart. I’ll have her office fax over the report.” Providing encouragement: The physician praising a new clinical support person for doing a good job

12. Advocacy and Assertion Advocate for the patient Invoked when team members’ viewpointsdon’t coincide with that of a decision maker Failure to employ advocacy and assertion isa primary contributor to the clinical errorsfound in malpractice cases and sentinel events Assert a corrective actionin a firm and respectful manner

13. The Assertive Statement Respect and support authority while clearly asserting concerns and suggestions Use an assertive statement that is nonthreatening and ensures that critical information is addressed Five steps: • Make an opening • State your concern • State the problem • Offer a solution • Obtain an agreement

14. Assertive Statement Example Consider a scenario in which a nurse witnesses a physician treating a receptionist rudely in front of a patient Following the five steps: Open the discussion: “I’d like to share my thoughts on your discussion with the receptionist” State the concern: “I am concerned that what you said and how you said it sounded rude” State the problem, real or perceived: “And if I considered it rude, the patient may have as well. And that is not the type of behavior we want patients to see” Offer a solution: “In the future, if you have feedback to give the receptionist, please do so privately, and in a constructive and respectful manner” Obtain an agreement: “Can we agree that would be a better way to handle such situations?”

15. Conflict Resolution Options Information Conflict (We have different information) Personal Conflict (Hostile and harassing behavior) Two-Challenge Rule DESC script

16. Two-Challenge Rule 1 2

17. Two-Challenge Rule Invoked when an initial assertion is ignored: It is your responsibility to assertively voice yourconcern at least two times to ensure thatit has been heard If the outcome is still not acceptable: • Take a stronger course of action • Use chain of command The member being challenged must acknowledge the concerns Think about the following questions: • Are team members able to stop the line now? How do you know? • Are patients and families able to stop the line? How do you know? Use page 28 of the Participant Workbook to record your thoughts

18. Please Use CUS Wordsbut only when appropriate!

19. Conflict Resolution: DESC Script A constructive approach for managing and resolving conflict D—Describe the specific situation E—Express your concerns about the action S—Suggest other alternatives C—Consequences should be stated Ultimately, consensus should be reached

20. DESC-It Have timely discussion Work on “win-win” Frame problem in terms of your own experience Use “I” statements to minimize defensiveness Avoid blaming statements Critique is not criticism Focus on what is right, not who is right Let’s “DESC-It!”

21. Ineffective Approaches to Conflict Resolution Some commonly used – but ineffective - methods are: • Compromise—Both parties settle for less • Avoidance—Issues are ignored or sidestepped • Accommodation—Focus is on preserving relationships • Dominance—Conflicts are managed through directives for change

22. Collaboration Achieves a mutually satisfying solution resulting in the best outcome All Win!: Patient Care Team (team members, the team, and the patient) Includes commitment to a common mission Meet goals without compromising relationships “True collaboration is a process, not an event.”

23. Mutual Support in the Medical Office Consider the poor mutual support you saw in the Team Structure module On the next slide, you will watch them demonstrate proper mutual support Use page 30 of the Participant Workbook to record your thoughts

24. Mutual Support Example Video https://youtu.be/sKqo5qi2qVY

25. Exercise: Reflect & Apply to Your Office How does that video compare to the video scenario in the Team Structure module? Ask yourself: Was mutual support demonstrated in this video? Was this strategy effective? Why was it effective or not effective? Did you see any other opportunities for mutual support in this video? Think about your office and the mutual support problemsyour team could encounter Use page 31 of the Participant Workbook to record your thoughts

26. Front Office Scenario Consider the following scenario: Your clinic has a rule that patients will be seen if they arrive within a thirty minute window of their appointment. Greg arrives five minutes past the window and sincerely apologizes for being late. The administrative assistant tells Greg that he will simply have to reschedule the appointment for a later time. The patient advocate overhears this and pulls the administrative assistant aside. She agrees that Greg should be rescheduled according to the clinic’s rules, but she explains to the administrative assistant that he lives very far away and relies on friends and family to transport him to doctor’s visits and that all efforts should be made to see him today. The administrative assistant appreciates this informationand the fact that the advocate pulled him aside to tell him.The administrative assistant returns to the patient andassures him that he will be seen today. Use page 32 of the Participant Workbook to record your thoughts

27. Tools & Strategies Summary • TOOLS and STRATEGIES • Communication • SBAR • Call-Out • Check-Back • Handoff • Leadership • Brief • Huddle • Debrief • Situation Monitoring • STEP • Mutual Support • Task Assistance • Feedback • Assertive Statement • Two-Challenge Rule • CUS • DESC Script BARRIERS Inconsistency in Team Membership Lack of Time Lack of Information Sharing Hierarchy Defensiveness Conventional Thinking Complacency Varying Communication Styles Conflict Lack of Coordination and FollowupWith Coworkers Distractions Fatigue Workload Misinterpretation of Cues Lack of Role Clarity OUTCOMES • Shared Mental Model • Adaptability • Team Orientation • Mutual Trust • Team Performance • Patient Safety!!

28. Module 6 Summary In this module you learned to: Describe how mutual support affects team processes and outcomes Discuss specific strategies to foster mutual support (e.g., task assistance, feedback) Identify specific tools to facilitate mutual support Describe conflict resolution strategies