PowerPoint Presentation - MMIC Group. The Joint Commission Journal;2011,37:339-340. 8/16/2012 11 TEAMSTEPPS 05.2 Mod 1 05.2 Page 31 TeamSTEPPS Overview TeamSTEPPSTM Ready to use ...

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TeamSTEPPS: A Powerful Solution Betty Van Woert, RN, BSN, CPHRM

Tom Cleary, BS, RHIA, CPHQ, CPHRM

TEAMSTEPPS 05.2 Mod 1 05.2 Page 2 Mod 1 05.2 Page 2

TeamSTEPPS Overview

Why do we need teamwork?

Annual cost of medical errors:

approximately 98,000 lives and

$17-29 billion1,2

Training in communication and teamwork addresses root causes of errors

Joint Commission Leadership Standards3

1. Kohn et al., Eds. To err is human: Building a safer health system. Washington, DC:

Committee on Quality of Health Care in American, Institute of Medicine, National Academy

Press, 2000.

2. http://www.soa.org/files/pdf/research-econ-measurement.pdf

3. http://www.jcrinc.com/common/Documents/OnlineExtras/JCLS09/JCLS09_H.pdf


TeamSTEPPS Overview

Joint Commission Sentinel Events

http://www.jointcommission.org/assets/1/18/Root_Causes_Event_Type_2004-3Q2011.pdf

http://www.soa.org/files/pdf/research-econ-measurement.pdf





http://www.jcrinc.com/common/Documents/OnlineExtras/JCLS09/JCLS09_H.pdf

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TeamSTEPPS Overview

“People make fewer

errors when they work

in teams.”

IOM (2000). To Err is Human: Building a Safer Health System. p. 173

Why we need teamwork


TeamSTEPPS Overview


TeamSTEPPS Overview

Our objectives……

The value of TeamSTEPPS

Core competencies of TeamSTEPPS:

Leadership

Situation Monitoring

Communication

Mutual Support

Implementing TeamSTEPPS in your organization

Are you ready to be part of the

transformation of health care?

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TeamSTEPPS Overview

Survey Says…….

Where are you on your TeamSTEPPS journey?

Fully implemented throughout organization

Implemented in some units or departments

Trainers trained and soon to roll-out to staff

Have thought about utilizing TeamSTEPPS

This is our first consideration of TeamSTEPPS


TeamSTEPPS Overview

What is TeamSTEPPSTM?

Team

Strategies and

Tools to

Enhance

Performance and

Patient

Safety


TeamSTEPPS Overview

What is TeamSTEPPSTM?

An evidence-based teamwork system

Designed to improve

Safety

Quality

Efficiency

Practical and adaptable

Performance

Delivery

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TeamSTEPPS Overview

Why Use TeamSTEPPS?

Produce highly effective medical teams that

optimize the use of information, people

and resources to achieve the best clinical

outcomes

Teams of individuals who communicate

effectively and back each other up

dramatically reduce the consequences of

human error

Team skills are not innate; they must be

trained


TeamSTEPPS Overview

Teamwork Is All Around Us


TeamSTEPPS Overview

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Why Do Errors Occur?

Poor handoffs

Ineffective

communication

Not following protocol

Workload fluctuations

Interruptions

Fatigue

Multi-tasking

Failure to follow up

Excessive

professional courtesy

Halo effect

Passenger syndrome

Hidden agenda

Complacency

High-risk phase

Strength of an idea

Task fixation

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TeamSTEPPS Overview

What Teams Will Learn


TeamSTEPPS Overview

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TeamSTEPPS is a Paradigm Shift

to a Team 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


TeamSTEPPS Overview

Leadership

“The art of getting someone else to do

something you want done because he

wants to do it.” ---

Dwight D. Eisenhower

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TeamSTEPPS Overview

Leadership

Effective leaders use tools to:

Organize the team

Communicate clear goals

Make decisions through collective input

Empower team members to speak up

Model effective team skills and behaviors

Manage conflict

Manage resources


TeamSTEPPS Overview

Leadership Planning Tool - Brief

Brief Checklist Who is on core team?

All members understand and agree upon goals?

Roles and responsibilities understood?

Plan of care?

Staff availability?

Workload?

Available resources? Know the plan, share the

plan, review the risks.


TeamSTEPPS Overview

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Leadership Learning Tool - Debrief

Debrief Checklist

Communication clear?

Roles and responsibilities understood?

Situation awareness maintained?

Workload distribution?

Did we ask for or offer assistance?

Were errors made or avoided?

What went well, what should change, what can improve?

Debriefs are where

learning takes place.

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TeamSTEPPS Overview

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Situation Monitoring:

What Do You See?

Individual

perceptions

Individual

assigns

meaning

Sharing of

information


TeamSTEPPS Overview

Mutual Support

C-U-S

I’m Concerned about Mrs.

Smith, because her symptoms

are consistent with a DVT.

No response…

I’m Uncomfortable continuing

treatment unless we rule out a

DVT.

No response…

Mrs. Smith’s Safety is at risk.


TeamSTEPPS Overview

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Communication: Call-Out

A strategy used to communicate important

or critical information

Informs all team members simultaneously

during an emergency situation

Helps team members anticipate next steps

Direct actions by name

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TeamSTEPPS Overview

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Communication: Check-Back


TeamSTEPPS Overview

Teams that perform well…

Share clear mental models

Hold clear roles and responsibilities

Optimize resources

Utilize strong team leadership

Engage in a cycle of feedback

Optimize their performance outcomes

Cooperate and coordinate

Develop a strong sense of collective trust


TeamSTEPPS Overview

Every 5% increase in team behavior:

11% communication openness

15% teamwork within departments

19% exchange of information across depts

22% sharing critical information at shift change

24% perception mgt is interested in patient

safety before adverse events

25% perception serious mistakes don’t happen

by chance

Jones KJ, Skinner A, High R, Reiter-Palmon R. A THEORY-DRIVEN LONGITUDINAL

EVALUATION OF THE IMPACT OF TEAM TRAINING ON SAFETY CULTURE IN 24

HOSPITALS. Submitted to BMJ Quality and Safety Feb. 29, 2012.

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TeamSTEPPS Overview

TeamSTEPPS in the OR After implementation of a “pre-op” brief:

• Increased OR communication.1,2

• Increased administration of properly timed prophylactic antibiotics

prior to incision from 84% to 95%.1

• Increased pre-op deep vein thrombosis prophylaxis prior to

induction from 92% to 100%.1

• Error avoidance: Pre-op brief revealed seven patients (3.3%) with

previously unidentified severe surgical risks — surgery cancelled.1

• A 16% reduction in nurse turnover rate.2

• A 19% increase in OR employee satisfaction.2

1. 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.

2. 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.


TeamSTEPPS Overview

TeamSTEPPS in the Clinic

Better continuity of care, access to care, and patient satisfaction

Stevenson K, Baker R, Farooqi A, Sorrie R, Khunti K. Features of primary health

care teams associated with successful quality improvement of diabetes care. Fam Pract. 2001;18:21-26

Higher patient-perceived quality of care Campbell SM, Hann M, Hacker J, et al. Identifying predictors of high quality care

in English general practice: observational study. BMJ. 2001;323:1-6.

Superior care for diabetic patients Bower, P., Campbell, S., Bojke, C., & Sibbald, B. Team structure, team climate,

and the quality of care in primary care: An observational study. QSHC. 2003; 12: 273-279.


TeamSTEPPS Overview

TeamSTEPPS in Long Term Care

Nursing Homes are applying these principles

and tools—one Quality Advisor states:

“We see it every time we visit a facility that has

been a part of the (TeamSTEPPS) training.“

Georgia Medical Care Foundation

The Medicare Quality Improvement Organization for Georgia March 31, 2010

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TeamSTEPPS Overview

How Do We Start?

1. Create a sense of urgency

2. Pull together your guiding team

3. Envision change

4. Support your strategy

5. Spread your vision

6. Select and train trainers


TeamSTEPPS Overview

How to Make it Stick?

Reinforce a teamwork and safety culture

Senior leadership support

Create psychological safety to speak up

Allocate sufficient resources

Personnel

Time

Resources

Measure success

Reward and reinforce teamwork success


TeamSTEPPS Overview

What works in team training?

Training accounts for 12% - 19% of the

variability in team outcomes

What an organization does to sustain the

effects of training accounts for the other 80%

Salas et al. Does team training improve team performance? A meta-analysis.

Human Factors; Dec. 2008:903-933.

Salas et al. Team training can enhance patient safety—the data, the challenge

ahead. The Joint Commission Journal;2011,37:339-340.

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TeamSTEPPS Overview

TeamSTEPPSTM

Ready to use

Publicly available

Course Materials

Implementation Guide

Measurement Tools

http://teamstepps.ahrq.gov/


TeamSTEPPS Overview

What Does it Cost?

Trainer time in training and coaching team members {200 hours x hourly rate}

Travel costs related to any train the trainer sessions

Material costs

Trainee time costs {Number of staff to be trained x their hourly rate} x average 4 hours training

Other training expenses Food, senior leadership time for kickoff, etc.


TeamSTEPPS Overview

http://teamstepps.ahrq.gov/

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TeamSTEPPS Overview

Taking Your Next Steps

1. Complete the AHRQ Culture of Patient

Safety Survey http://www.ahrq.gov/qual/patientsafetyculture

2. Complete the TeamSTEPPS Readiness

Assessment http://teamstepps.ahrq.gov/readiness

3. Review your results and formulate your

change vision and strategy

4. Designate a guiding team: your energized

and empowered champions


TeamSTEPPS Overview

Contact Information

Tom Cleary

[email protected] 402-384-5215

Betty Van Woert

[email protected] 515-267-2657

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Are you ready to be part of the

transformation of health care?

http://www.ahrq.gov/qual/patientsafetyculture

http://teamstepps.ahrq.gov/readiness

mailto:[email protected]

mailto:[email protected]