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TeamSTEPPS

TeamSTEPPS. PeaceHealth Southwest. It is all about Teamwork. TeamSTEPPS defined. T eam S trategies and T ools to E nhance P erformance and P atient S afety Evidence-based teamwork system Optimizes patient outcomes Communication skills Team work skills

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TeamSTEPPS

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  1. TeamSTEPPS PeaceHealth Southwest

  2. It is all about Teamwork PeaceHealth Southwest Medical Center

  3. TeamSTEPPS defined • Team Strategies and Tools to Enhance Performance and Patient Safety • Evidence-based teamwork system • Optimizes patient outcomes • Communication skills • Team work skills • Focuses on specific skills that support team performance PeaceHealth Southwest Medical Center

  4. TeamSTEPPS partners • Department of Defense • Agency for Healthcare Research and Quality • 20 years of research from High-Reliability Organizations (HROs) PeaceHealth Southwest Medical Center

  5. TeamSTEPPS goals • Produce highly effective medical teams • Optimize use of information, people, and resources • Achieve best clinical outcomes PeaceHealth Southwest Medical Center

  6. “Doing the job we were trained to do…” Chesley Sullenberger, 1-25-09 PeaceHealth Southwest Medical Center

  7. Why you are here today “JUST A ROUTINE OPERATION” PeaceHealth Southwest Medical Center

  8. Video Discussion ...Improved teamwork and communications...Ultimately a culture of safety PeaceHealth Southwest Medical Center

  9. Breaches in safety are inevitable… PeaceHealth Southwest Medical Center

  10. Frequency of medical errors • IOM Report: To Error is Human, 1999 • 44,000-98,000 deaths/year • Cost $17-29 billion/year • As of 2005 national estimates have shown “little improvement” (Leape & Berwick, JAMA May 2005.) PeaceHealth Southwest Medical Center

  11. Root cause: communication failure • 65% sentinel events over the past 10 years (Joint Commission, 2005, n= 3548) • 80% of 6000 root cause analyses of adverse events and close calls (VA Center for Patient Safety) PeaceHealth Southwest Medical Center

  12. Why Do Errors Occur—Some Obstacles • Workload fluctuations. • Interruptions. • Fatigue. • Multi-tasking. • Failure to follow up. • Poor handoffs. • Ineffective communication. • Not following protocol. • Excessive professional courtesy. • Halo effect. • Passenger syndrome. • Hidden agenda. • Complacency. • High-risk phase. • Strength of an idea. • Task (target) fixation PeaceHealth Southwest Medical Center

  13. Compensating for human fallibility Reduce consequences of human error by: • Communicating effectively with team • Backing team members up PeaceHealth Southwest Medical Center

  14. Organizational benefits Emergency Department • Improved observed team behaviors • Enhanced staff attitudes toward teamwork • Reduced observed clinical errors Morey, JC, Simon, R, Jay GD, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: Evaluation results of the MedTeams project. Health Serv Res. 37:1553-1581, 2002 PeaceHealth Southwest Medical Center

  15. Organizational benefits Clinical Units in a Medical Center After implementation of SBAR: • Reduced rate of adverse drug events (from 30 to 18 per 1,000 patient days) • Improved medication reconciliation at patient admission from 72% to 88% and at discharge from 53% to 89% Haig, K., Sutton S, Whittington, J. SBAR: A shared mental model for improving communication between clinicians. JL Comm J Qual Patient Saf 32(3):167-75, March 2006 PeaceHealth Southwest Medical Center

  16. Organizational benefits Operating Rooms (OR) After implementation of a “pre-op” brief: • Increased OR communication • Increased administration of properly timed prophylactic antibiotics prior to incision from 84% to 95% • Increased pre-op deep vein thrombosis prophylaxis prior to induction from 92% to 100% • Error avoidance: Pre-op brief revealed seven patients (3.3%) with previously unidentified severe surgical risks — surgery cancelled • 16% reduction in nursing turnover rate • 19% increase in OR employee satisfaction Awad, SS, Fagan, SP, Bellows, C., Albo, D, et al. Bridging the communication gap in the operating room with medical team training. Am J Surg 190(5): 770-4, Nov 2005. Leonard, M,, Graham, S, Bonacum, D. The human factor: The critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 13 Suppl 1:i85-90, Oct 2004 PeaceHealth Southwest Medical Center

  17. PeaceHealth Southwest Medical Center

  18. PeaceHealth Southwest Medical Center

  19. Four core competencies of teamwork • Patient safety culture through • Leadership • Situational monitoring • Mutual support • Communication PeaceHealth Southwest Medical Center

  20. Outcomes of Team Competencies • Knowledge • Shared Mental Model • Attitudes • Mutual Trust • Team Orientation • Performance • Adaptability • Accuracy • Productivity • Efficiency • Safety PeaceHealth Southwest Medical Center

  21. Leadership PeaceHealth Southwest Medical Center

  22. Team Leader Two types of leaders: • Designated—The person assigned to lead. • Situational—Any team member. PeaceHealth Southwest Medical Center

  23. Situation Monitoring Attention to detail is one of the most important details... — Author Unknown PeaceHealth Southwest Medical Center

  24. A Continuous Process PeaceHealth Southwest Medical Center

  25. 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) PeaceHealth Southwest Medical Center

  26. 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." PeaceHealth Southwest Medical Center

  27. Shared Mental Model? PeaceHealth Southwest Medical Center

  28. What Do You See? PeaceHealth Southwest Medical Center

  29. Mutual Support "A chain is only as strong as its weakest link." –Author Unknown PeaceHealth Southwest Medical Center

  30. 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 PeaceHealth Southwest Medical Center

  31. Communication Communication is the response you get from the message you sent regardless of its intent. — Author Unknown PeaceHealth Southwest Medical Center

  32. Communication is... • The process by which information is exchanged between individuals, departments, or organizations • The lifeline of the Core Team • Effective when it permeates every aspect of an organization PeaceHealth Southwest Medical Center

  33. PeaceHealth Southwest Medical Center

  34. The ratio of We's to I's is the best indicator of the development of a team.— Lewis B. Ergen PeaceHealth Southwest Medical Center

  35. Why Teamwork? • Reduce clinical errors. • Improve outcomes. • Increase patient & staff satisfaction. • Reduce malpractice claims. PeaceHealth Southwest Medical Center

  36. High Performing Teams have: • Shared mental models. • Clear roles and responsibilities. • Shared vision. • Optimization of resources. • Strong team leadership. • Feedback. • Collective trust and confidence. • Cooperation and coordination. PeaceHealth Southwest Medical Center

  37. Barriers to Team Performance • Inconsistency in team membership. • Lack of time. • Lack of information sharing. • Hierarchy. • Defensiveness. • Conventional thinking. • Varying communication styles. • Conflict. • Lack of coordination and follow-up. • Distractions. • Fatigue. • Workload. • Misinterpretation of cues. • Lack of role clarity. PeaceHealth Southwest Medical Center

  38. PeaceHealth Southwest Medical Center

  39. TeamSTEPPS Tools/Strategies: • Brief • Huddle • Debrief • STEP • Cross Monitoring • Feedback • Advocacy & Assertion • Two-challenge Rule • Call-out • Check-back • CUS • DESC • Collaboration • SBAR • Handoff PeaceHealth Southwest Medical Center

  40. PHSW Key Strategies TeamSTEPPS tools: • Huddle • SBAR • CUS PeaceHealth Southwest Medical Center

  41. TeamSTEPPS Tools 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. PeaceHealth Southwest Medical Center

  42. Huddle Video http://www.ahrq.gov/video/teamsteppstools/ts_Huddle_ER/huddleER-400-300.html PeaceHealth Southwest Medical Center - Emergency Department

  43. Communication tools SBAR • 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 do to correct it? PeaceHealth Southwest Medical Center

  44. SBAR Video http://www.ahrq.gov/video/teamsteppstools/ts_SBAR_NurseToPhysician/SBAR_NurseToPhysician-400-300.html PeaceHealth Southwest Medical Center - Emergency Department

  45. RSBA Some situations may get a quicker response when the provider knows early on what it is that you feel the patient requires. PeaceHealth Southwest Medical Center

  46. The Assertive Statement • Mutual respect and support • Clearly assert concerns and suggestions • Use an assertive statement (nonthreatening and ensures that critical information is addressed) • Make an opening • State the concern • State the problem • Offer a solution • Reach an agreement PeaceHealth Southwest Medical Center

  47. CUS Please Use CUS Words but only when appropriate! PeaceHealth Southwest Medical Center

  48. Cusser and Cussee • Always remember there is a ‘Cusser’(Clarifier) and a ‘Cussee’ (Clarifiee). • The appropriate response for Cussee to say is “Thank you” (for raising that concern/speaking up/letting me know you were worried/sharing with me the patient’s situation/etc.) PeaceHealth Southwest Medical Center

  49. CUS Video http://www.ahrq.gov/video/teamsteppstools/ts_CUS_LandD/CUS_LandD.html PeaceHealth Southwest Medical Center - Emergency Department

  50. BREAK PeaceHealth Southwest Medical Center - Emergency Department

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