Module 8: Teaching & Coaching

Welcome to Office-Based Care Online Course Module 8: Teaching & Coaching

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

Module Objectives After completing this module, you will be able to: Address teaching TeamSTEPPS tools as part of a coursework style approach where tools are divided into levels of difficulty Define the role of a coach Identify traits and skills of effective coaches Discuss the coaching process Practice coaching TeamSTEPPS tools individually, using the 3 I’s coaching method Your host for this module: Mary Salisbury

Teaching and Coaching Coaching fosters continual development and process improvement. It is vital to creating a lasting culture change. Coaching can be both formal and informal. It should be woven throughout the entireimplementation. You can consider the coaches as the chiefsustainment officers.

The Practice Facilitator Role As a Practice Facilitator, you'll prepare your Change Team members to also be coaches. It's important that you do not take on all of the coaching responsibilities alone. In fact, you may need more than the members of your change team to be coaches. The coaching methods covered in this toolkit are suggestions. Different coaching methods can be utilized and combined successfully with different TeamSTEPPS tools.

Teaching and Coaching TeamSTEPPS Tools Consider the audience Consider teaching as coursework at 100/200/300 levels Make sure you support your implementation with coaching Feel free to mix and match coaching models you see fit to use in your unique environment

100/200/300 Level Coursework Some TeamSTEPPS tools may be easily grasped. Depending on the user or the organizational culture, they may not be easily executed. One method to teaching is a leveled approach: • 100 level: basic, easy to execute • 200 level: intermediate, may take some coaching • 300 level: advanced, coaching almost a certainty Courtesy of the WWAMI Institute for Simulation in Healthcare

Example: An Issue of Time Office-based care teams often face long hours made longer by lapses in communication. TeamSTEPPS tools and principles can be used to address the problem. Watch the video to see the problem the office is having and what the coach, a physician’s assistant, recommends. Consider how you would answer the following questions: What are some of the issues that can occur if a staffconsistently has to work past normal hours? What TeamSTEPPS tools might be useful in addressingthis problem? Record your answers to these questions on page 39 of your Workbook

Video: An Issue of Time https://youtu.be/mFierduAemc

100-Level TeamSTEPPS Tools Are easily executed and likely to be accepted with little resistance. Require little coaching to put in place but need to be practiced. 100-level tools include: • SBAR • Brief • Closed loop communication • Call-out • Check-back • Cross-monitoring 100

An Example at Work On the next slide, a video will show how to introduce a 100-level solution. Watch to see how SBAR is introduced at the weekly meeting as a solution. Consider the following questions: Do you think SBAR, briefs, call outs, and check-backs are all tools that can be easily acceptedin your office? Do you think that you'd consider these to be100-level skills in your office environment? Record your answers to these questions on page 41 of your Workbook

Video: SBAR As Solution https://youtu.be/u7lmKWDJgJo

200-Level TeamSTEPPS Tools Are more advanced and more difficult to execute. Allow individuals to see themselves more as one important part of a working whole. 200-level tools include: • Huddle • Debrief • Handoff (I PASS the BATON) • STEP • Cross-monitoring • Task assistance 200

An Example at Work Watch the next video to see how the coach uses a simple tool, the huddle, to continue addressing the identified problem. Consider the following questions: How did the coaches use the huddle tounderstand their problem about SBARnot being used? What might have happened if the coachesdidn't have this huddle? Record your answers to these questions on page 43 of your Workbook

Video: Huddle As Solution https://youtu.be/SZuswD0ND3Q

300-Level TeamSTEPPS Tools Are the most advanced and need focused coaching to achieve a lasting result. Require team members to stand up to others, ask hard questions of themselves and others, and address issues of hierarchy in their teams. Focus on conflict resolution and threat management and avoidance. 300-level tools include: • CUS • Two-Challenge Rule • DESC script 300

An Example at Work The video on the next slide completes our story: An individual benefits from some coaching in the moment on using a 300-level tool. The DESC script is a powerful conflict resolution tool. For these 300-level tools, coaches are a necessity. After watching the video: Imagine that the individuals in the video said that theDESC script didn't work because the other individualwas unresponsive How might you approach the other individual andcoach him or her about DESC? Record your answers to these questions on page 45 of your Workbook

Video: DESC Script As Solution https://youtu.be/MFjmcFFfOsc

Overlap of Tools 100 The leveled approach is not set in stone. Some tools can be reinforced at multiple levels. It is also good to think of coaching the tools from the perspective of TeamSTEPPSprinciples: • Communication • Leading teams • Situation monitoring • Mutual support 200 300

Team Structure and Coaching In office-based care, teams consist of: • Core clinical staff • Support staff • Administration • Patients Coaches can come from allcategories (except patients). A coach should be available to each team member. TeamSTEPPS tools are effective only when used by all team members.

Definitions of Coaching Coaching is providing guidance, feedback, and direction to ensure successful performance. Coaching is supporting someone’s efforts toachieve personal and professional goals. Coaching is different from traditional instruction • Teaching implies an end at content mastery • Coaching takes place over a lifetime

Characteristics of Effective Coaches Effective coaches: Are competent in their skills Are influential Have strong interpersonal skills Provide effective feedback Listen actively Ask powerful questions Pause to discuss these characteristics. Record your thoughts on page 47 of your Workbook

Coaching Competencies

Sample Coaching Models

The 3 I’s I SAW THIS: Lay the groundwork for the coaching based on what the coach witnessed firsthand. I WONDER WHY: Question the reasoning for what is done and approach it as a puzzle to be solved together. I THINK THAT: Provide a solution that addresses not only the issue at hand but also the knowledge or attitudes that lead to the issue.

Using the 3 I’s Neither judgmental (You did this wrong) Nor nonjudgmental (Guess how I think you should do this better) Combines advocacy—a statement or observation With inquiry—a question Provides a hypothesis that can betested

DESC Script and the 3 I’s An opportunity for modeling the DESC script tool. The 3 I’s model shares many similarities with DESC. DESC mirrors the 3 I’s in the following way: • “I saw this” reflects the Describe phase of DESC • “I wonder why” encompasses the Express phase • “I think that” is similar to Suggest and Consequences

Coaching Leading Teams Tools Coaches are both official and unofficial leaders. They influence the behavior of otherseven when not coaching. Participating in leadership tools is also achance to coach by example: • Briefs • Huddles • Debriefs

Coaching Debriefs Using the 3 I’s The 3 I's is an excellent tool for coaching individuals in how to perform a proper debrief. The coach can lead by example by discussing the individual's debrief while using the debriefing tool itself. How would you use the three I's to coach a team who just had had a debrief that skipped the step to discuss whether workload was equitable? Record your answer to this question on page 48 of your Workbook

Using the 3 I’s: Example Possible answer: “I saw that the team skipped the step to discuss whether the workload was equitable during the previous shift.” “I wonder if individuals are uncomfortable bringing up complaints about their workload.” “I think that if we approach the debrief as a nonjudgmental period of trust and truth telling, people should be comfortable bringing up issues with the workload. I also think that mutual support is a useful TeamSTEPPS principle we should use to support ourselves if we have workload issues.”

Coaching Communication Tools Communication is inherent in coaching. Communication is more than talking—it is talking and listening, which is a key component that can be modeled via coaching. Coaching “in the moment” helps TeamSTEPPS communication tools to “stick”: • SBAR • Check-back/closed loop communication • Handoff (including I PASS THE BATON)

Coaching SBAR “In the Moment” Coaching in the moment: • Allows the coach to have a firsthand look at the situation • Provides immediate feedback • Can work well for providing feedback to individuals the coach has not built a relationship with previously If a tool is omitted or done incorrectly, it is easy to catch and fix on the spot. What are times when you already unofficiallycoached in the moment in your daily lives? Record your answer to this question on page 49 of your Workbook

Coaching Situation Monitoring Tools A coach constantly engages in the situation and monitors to assess the needs of the team. A coach can model these tools and help individuals translate the tools to their own experience: • Situation-monitoring process • Cross-monitoring • STEP

Coaching Situational Awareness Using the 3 I’s Consider Emily, a team member who may not exhibit very good situational awareness: She seems to “walk in a cloud” and not have any idea what is going on around her. In one situation she walked past a very crowded waiting room and said innocently, but too loudly, to her coworker at the front desk, “These people are going to wait forever! Glad my shift is done and I can get out of this chaos!” How would you use the 3 I’s to coach Emilyto have more situational awareness? Take a few moments to consider this beforegoing on to the next slide. Record your answer to this question on page 50 of your Workbook

Situational Awareness 3 I’s: Example Possible answer: “I saw that you seemed unaware of the crowded waiting room and that you announced in front of patients that you were glad to be leaving the chaotic office.” “I wonder if it's because you didn't realize that the patients could hear you, and that it would affect their experience.” “I think that in the future you could use situation monitoring to become more aware of stress levels among team members and patients. While it was certainly acceptable for you to leave at the end of the shift, it would be better not to announce you're leaving and make a joke that could harm team morale.”

Coaching Mutual Support Tools Coaching itself is a form of mutual support. Coaching provides ample opportunities to model mutual support tools. Coaching mutual support tools directly affects the culture of an organization. The mutual support tools are: • Task assistance • Feedback • Advocacy and Assertion • Two-Challenge Rule • CUS • DESC script • Collaboration

Coaching the Two-Challenge Rule Using the 3 I’s All coaching models allow coaches to support others. Consider the following situation: You see Barbara disregard David’s use of the Two-Challenge Rule. You take David aside and learn that whenever he uses the Two-Challenge Rule with Barbara, his superior, she continues to disregard what he says. How would you use the 3 I’s to coach Barbara in this situation? Take a moment to consider this before moving on to the next slide. Record your answer to this question on page 51 of your Workbook

Two-Challenge Rule 3 I’s: Example Possible answer: “I saw that you disregarded the Two-Challenge Rule when David used it with you earlier. After speaking with David, I learned this was not an isolated case.” “I wonder if you do not acknowledge David when he uses the Two-Challenge Rule because you are his superior and have been at nursing much longer than he has.” “I think that the Two-Challenge Rule is a useful mutual support tool. It helps us catch possible risks before they turn into actual issues. David may not always be right, but you can acknowledge that you heard his challenge and explain, even at a later time, why you disregarded it.”

Tying It All Together An effective coach models all the TeamSTEPPS principles. He or she displays: • Leadership • Mutual Support • Situational Awareness • Communication This positively reinforces good behaviorto those being coached.

A Need for Coaching Watch the video on the next slide and answer the following: • What TeamSTEPPS tools are being modeled by the coach? • What skills is she using to coach the CUS tool to Nurse Larry? • How could she continue to coach him after this initial encounter? Record your answers to these questions on page 52 of your Workbook

Video: A Need for Coaching https://youtu.be/rK-8gj1vFvE

Review Questions from the Video How would you answer these questions? What TeamSTEPPS tools are being modeled by the coach? What skills is she using to coach the CUS tool to Nurse Larry? How could she continue to coach him after this initial encounter? The coach is modeling situational awareness and mutual support. She huddles with Larry, then coaches the CUS tool using a coaching in the moment. She could observe Larry using the tool from afar, and then rehuddle with him and use the three I's.

Summary Implementation of TeamSTEPPS needs to be supported by considerable teaching and coaching. TeamSTEPPS tools may be taught to thestaff and then rolled out in a leveledcoursework format. Specific coaching models such as the 3 I’scan be paired with TeamSTEPPS toolsto reinforce what has been taught.

Module 8 Summary In this module you learned to: Address teaching TeamSTEPPS tools as a part of a coursework style approach where tools are divided into levels of difficulty Define the role of a coach Identify traits and skills of effective coaches Discuss the coaching process Practice coaching TeamSTEPPS tools individually, using the 3 I’s coaching method

Module 8: Teaching & Coaching