TeamSTEPPS Master Training Webinar

1. TeamSTEPPS Master Training Webinar October 8, 2013

2. Webinar Agenda • Overview & Introductions – Betsy Lee • TeamSTEPPS Master Training– Karyn Baum, M.D., M.S.Ed. • Wrap-up/Questions – Betsy Lee

3. Evaluation • Webinar funded by CMS through the Partnership for Patients • CMS reviews results and wants 80% of participants to evaluate educational sessions • Please complete the simple three question evaluation by Oct. 15, 2013: https://www.surveymonkey.com/s/20131008TeamSTEPPSWebinar

4. TeamSTEPPS Master Training Webinar October 8, 2013

5. Instructor • Karyn Baum, M.D., M.S.Ed., Professor of Medicine and Associate Chair for Clinical Improvement, University of Minnesota

6. TeamSTEPPS Master Training • Train-the-trainer approach • Prepares you to serve as a TeamSTEPPS Master Trainer by: • Providing instruction on TeamSTEPPS tools and strategies • Providing guidance on how to teach TeamSTEPPS to others in your organization • Prepares you to serve as a leader for implementing TeamSTEPPS within your organization

7. Rationale for This Course • Meet demand for TeamSTEPPS training • Considering time demands • Strategy • Mixture of webinar and in-person • Maintain equivalence to the two-day in-person training

8. Materials • Webinar (October 8) • Ppt Slides • Slides will be posted later; session recorded • In-Person Training (3 dates) • TeamSTEPPS Instructors Guide • TeamSTEPPS CD and DVD • Other

9. MODULE 1. Introduction Strategies and Tools to Enhance Performance and Patient Safety

10. Ice BreakerNOTE: Will do this at the in-person training!

11. Sue Sheridan Video

12. Video Discussion • Why to errors occur? • How can we prevent medical errors? • What are the solutions? …Improved teamwork and communications… Ultimately, a culture of safety

13. Objectives • Describe the impact of errors and why they occur • Describe the TeamSTEPPS training initiative • Describe the TeamSTEPPS framework • List outcomes of the TeamSTEPPS framework

14. Teamwork Is All Around Us

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

16. Introduction Evolution of TeamSTEPPS Curriculum Contributors • Department of Defense • Agency for Healthcare Research and Quality • Research Organizations • Universities • Medical and Business Schools • Hospitals—Military and Civilian, Teaching and Community-Based • Healthcare Foundations • Private Companies • Subject Matter Experts in Teamwork, Human Factors, and Crew Resource Management (CRM)

17. “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

18. The Components of a Patient Safety Program

19. Course Agenda • Module 1—Introduction • Module 2—Team Structure • Module 3—Leadership • Module 4—Situation Monitoring • Module 5—Mutual Support • Module 6—Communication • Module 7—Summary—Pulling It All Together

20. Introductions and Exercise: Magic Wand If I had a “Magic Wand”and could make changes within my unit or facilityin the areas of patient quality and safety…

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

22. Institute of Medicine Report Impact of Error: • 44,000–98,000 annual deaths occur as a result of errors • Medical errors are the leading cause, followed by surgical mistakes and complications • More Americans die from medical errors than from breast cancer, AIDS, or car accidents • 7% of hospital patients experience a serious medication error Federal Action: By 5 years;  medical errors by 50%,  nosocomial by 90%; and eliminate “never-events” (such as wrong-site surgery) Cost associated with medical errors is $8–29 billion annually.

23. JCAHO Sentinel Events Targets for Teamwork

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

25. Outcomes of Team Competencies • Knowledge • Shared Mental Model • Attitudes • Mutual Trust • Team Orientation • Performance • Adaptability • Accuracy • Productivity • Efficiency • Safety

26. Swiss cheese model of errors

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

28. Objectives • Identify the characteristics of high-performing teams • Discuss benefits of teamwork and team structure • Describe components and composition of amulti-team system (e.g., Core Team, Coordinating Team, Contingency Team, Ancillary Services, and Administration) • Understand what defines a team • Define the roles and effectiveness of team members

30. Partnering with the Patient Embrace patients as valuable and contributing partners in patient care • Learn to listen to patients • Assess patients’ preference regarding involvement • Ask patients about their concerns • Speak to them in lay terms • Ask for their feedback • Give them access to relevant information • Encourage patients and their families to proactively participate in patient care

31. Why Teamwork? • Reduce clinical errors • Improve patient outcomes • Improve process outcomes • Increase patient satisfaction • Increase staff satisfaction • Reduce malpractice claims

32. 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)

33. 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 Barriers to Team Performance

34. Exercise: Teams and Teamwork Write down the names (or positions) of the peoplein your immediate work area or unit who contribute to successful patient care.

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

36. A Core Team is… A group of care providers who work interdependently to manage a set of assigned patients from point of assessment to disposition Core Team members have the closest contact with the patient!

37. A Coordinating Team is… A team comprising those work area members who are responsible for managing the operational environment that supports the Core Team

38. A Contingency Team is… A time-limited team formed for emergent or specific events and composed of members from various teams

39. Ancillary & Support Services Provide… Ancillary Services provide direct, task-specific, time-limited care to patients. Support Services provide indirect service-focused tasks which help to facilitate the optimal healthcare experience for patients and their families.

40. The Role of Administration is to… • Establish and communicate vision • Develop policies and set expectations for staff related to teamwork • Support and encourage staff during implementation and culture change • Hold teams accountable for team performance • Define the culture of theorganization

41. Example: A Multi-Team System in the OR

42. Exercise: Your Multi-Team System ? ?

43. Team Member Characteristics

44. Team Failure Video

45. 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

46. Paradigm Shift to Team System Approach Dual focus (clinical and team skills) Team performance Informed decision-making Clear understanding of teamwork Managed workload Sharing information Mutual support Team improvement Team efficiency Single focus (clinical skills) Individual performance Under-informed decision-making Loose concept of teamwork Unbalanced workload Having information Self-advocacy Self-improvement Individual efficiency

47. Effective Team Members • Are better able to predict the needs of other team members • Provide quality information and feedback • Engage in higher level decision-making • Manage conflict skillfully • Understand their roles and responsibilities • Reduce stress on the team as a whole through better performance “Achieve a mutual goal through interdependent and adaptive actions”

48. Teamwork Actions • Assemble a team • Establish a leader • Identify the team’s goals and vision • Assign roles and responsibilities • Hold team members accountable • Actively share information among team members • Provide feedback “Individual commitment to a group effort—that is what makes a team work, a company work, a society work, a civilization work.” –Vince Lombardi

49. CHANGE MANAGEMENT: HOW TO ACHIEVE A CULTURE OF SAFETY

50. 8 Steps of Change John Kotter