Strategies and Tools to Enhance Performance and Patient Safety

1. Strategies and Tools to Enhance Performance and Patient Safety

2. Objectives • Describe the TeamSTEPPS training initiative • Explain your organization’s patient safety program • Describe the impact of errors and why they occur • Describe the TeamSTEPPS framework • State the outcomes of the TeamSTEPPS framework

3. Joint Commission Sentinel Events Targets for Teamwork

4. (Sexton, 2006) Johns Hopkins (Pronovost, 2003) Johns Hopkins Journal of Critical Care Medicine (Mann, 2006) Beth Israel Deaconess Medical Center Contemporary OB/GYN

5. “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” Team Strategies & Tools to Enhance Performance & Patient Safety

6. The Components of a Patient Safety Program

7. What Comprises Team Performance? KnowledgeCognitions“Think” AttitudesAffect“Feel” SkillsBehaviors“Do” …team performance is a science…consequences of errors are great…

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

9. 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-limitedmembership

10. High-Performing Teams Teams that perform well: • Hold shared mental models • Have clear roles and responsibilities • Have clear, valued, and shared vision • Optimize resources • Have strong team leadership • Engage in a regular discipline of feedback • Develop a strong sense of collective trust and confidence • Create mechanisms to cooperate and coordinate • Manage and optimize performance outcomes (Salas et al. 2004)

11. Multi-Team System (MTS) for Patient Care

12. Leadership

13. 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

14. Resource Management Core Team Leader Coordinating Team Leader • Information • Patient & Family • Plan of care • Facilities • Time • Equipment • Information • Administrative • Facilities • Time • Equipment • Patient flow • Otherdepartments HUMANCAPITAL FOCUS Team & Your Unit FOCUS Support Units

15. Delegation • Method of re-distributing tasks or assignments • Process includes 4 steps: • Decide what to delegate • Decide to whom to delegate • Communicate clear expectations • Request feedback

16. 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

17. Team Events • 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

18. Teamwork Actions • Empower team members to speak freely and ask questions • Utilize resources efficiently to maximize team performance • Balance workload within the team • Delegate tasks or assignments, as appropriate • Conduct briefs, huddles, and debriefs • Utilize conflict resolution techniques (i.e., Two-Challenge rule and DESC script)

19. “Attention to detail is one of the most important details ...” –Author Unknown Situation Monitoring

20. A Continuous Process SituationMonitoring(Individual Skill) SituationAwareness(Individual Outcome) Shared Mental Model(Team Outcome)

21. Components of Situation Monitoring:

22. Situation Awareness is… The state of knowing the current conditions affecting the team’s work • Knowing the status of a particular event • Knowing the status of the team’s patients • Understanding the operational issues affecting the team • Maintaining mindfulness

23. Conditions that Undermine Situation Awareness (SA) Failure to— • Share information with the team • Request information from others • Direct information to specific team members • Include patient or family in communication • Utilize resources fully (e.g., status board, automation) • Document

24. 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)

25. Shared Mental Model?

26. Teamwork Actions • Conduct team exercises to increase situation monitoring skills • Share information in a timely fashion • Include patient and/or family in communication • Use cross monitoring • Apply the STEP process when monitoring the situation • Foster communication to ensure that all members of the team have a shared mental model • Share information during briefs, team huddles, debriefs, and transitions in care “Teams do not seek consensus; they seek the best answer.” –Katzenbach and Smith

27. Mutual Support “A chain is only as strong as its weakest link.” –Author Unknown

28. Mutual Support Mutual support is the essence of teamwork • Protects team members from work overload situations that may reduce effectiveness and increase the risk of error

29. 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. “In support of patient safety, it’s expected!”

30. Characteristics of Effective Feedback Good Feedback is— • TIMELY • RESPECTFUL • SPECIFIC • DIRECTED toward improvement • Helps prevent the same problem from occurring in the future • CONSIDERATE “Feedback is where the learning occurs.”

31. Advocacy and Assertion • Advocate for the patient • Invoked when team members’ viewpoints don’t coincide with that of a decision maker • Assert a corrective action in a firm and respectful manner

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

33. Please Use CUS Wordsbut only when appropriate!

34. Conflict ResolutionDESC 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 shall be reached.

35. Teamwork Actions • Foster a climate supportive of task assistance • Provide timely and constructive feedback • Be assertive and advocate for the patient • Use the Two-Challenge rule, CUS, and DESC script to resolve conflict • Resolve conflict through collaboration—Create a “Win-Win-Win” situation “Those whom we support hold us up in life.” –Marie von Ebner-Eschenbauch

36. Communication Assumptions Fatigue Distractions HIPAA

37. 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

38. Call-Out is… A strategy used to communicate important or critical information • It informs all team members simultaneously during emergency situations • It helps team members anticipate next steps …On your unit, what information would you want called out?

39. Check-Back is…

40. Handoff • Optimized Information • Responsibility– Accountability • Uncertainty • Verbal Structure • Checklists • IT Support • Acknowledgement Great opportunity for quality and safety

41. Teamwork Actions • Communicate with team members in a brief, clear, and timely format • Seek information from all available sources • Verify and share information • Practice communication tools and strategies daily (SBAR, call-out, check-back, handoff)

42. Pulling it All Together • Recognize opportunities to improve patient safety • Assess your current organizational culture and existing Patient Safety Program components • Identify teamwork improvement action plan by analyzing data and survey results • Design and implement initiative to improve team-related competencies among your staff • Integrate TeamSTEPPS into daily practice. “High-performance teams create a safety net for your healthcare organization as you promote a culture of safety."