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TEAMSTEPPS 05.2 Culture Change 06.2 Page 1 Principles for Pressure Ulcer Reduction and Restraint Elimination Welcome
TEAMSTEPPS 05.2Culture Change 06.2 Page 1
Principles for Pressure Ulcer Reduction
and Restraint Elimination
Welcome
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Georgia, how are we doing?
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Georgia, how do we rate?
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TEAMSTEPPS 05.2Culture Change 06.2 Page 6
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and Restraint EliminationCan we do better?
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Where have we been and where are we going?
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The Sue Sheridan Story
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Strategies and Tools
to Enhance Performance
and Patient Safety
For Today’s Hospital’s and
Nursing Homes
TeamSTEPPS
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Building Trust:
Spring 2009
Enhances Quality Care
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Objectives
Recognize that mistrust and poor communication are
contributors to medical errors and increase staff and
resident dissatisfaction
Learn how to increase trust, mutual support and
communication among your team
Practice techniques that support a ―safety culture‖
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Exercise
What drives you crazy at work?
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Things that drive us crazy……
What is your Popeye moment
―That’s all I can stands,cuz I can’t stands n’more!‖
Or makes you say―It doesn’t have to be likethis‖
"That's all Ican stands, cuzI can't stands
n'more!"
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What drives you crazy at work?
List 2-3 things that drive you crazy at work
Share them with a small group
Within the small group, agree on the top 1-2 items
Report back to larger audience
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Typical Issues Identified
Poor quality of care
Staff who don’t show up for work
―Not my job‖
Low staff morale
Complicated process that no one follows
Risks to patient safety
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Great leadership does not mean running away from reality. Sometimes the hard truths might just demoralize the company, but at other times sharing difficulties can inspire people to take action that will make the situation better.”
John Kotter
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What’s wrong in healthcare today?
Root Cause Analysis (RCA)
At the root, is ―every man for himself‖
At the root of ―every man for himself‖ is a profound lack of trust
If we, the leaders of a healthcare community can’t earn the trust of each other – how can we systematically improve safety, quality, and outcomes
Excerpt from: ―Optimizing Work Environments‖; Brian Wong, MD; Georgia Patient Safety Summit
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Defining Trust
Think of a person whom you really trust
Write down some descriptors
Share with small group
Think of a person whom you do not trust
Write down some descriptors
Share with small group
Within small group arrive at a consensus on
2-3 things in each category
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Defining Trust
Qualities of High Trust
Integrity
Strength
Ability
Surety
Hope
Follow-through
Reliable
Qualities of Low Trust
Misgiving,
Suspicion,
Suspect
No confidence
Undependable
Unreliable
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Attributes of Trusted Colleague
T = Team Player
R = Respectful and Responsive
U = Understanding
S = Safe
T = Talented
E = Executes
D = Dedicated
Excerpt from: ―Optimizing Work Environments‖; Brian Wong, MD; Georgia Patient Safety Summit
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Trust
Trust is both an emotional and logical act.
Trust helps you predict what other people will do
Trust is certainty based on past experience
Help begets help just as trust begets trust.1
Trust is the ability to act on what you see and trusting that you are trained to see what is right or wrong in a situation.
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Common Approaches That May Impact Trust Adversely
Often used to manage conflict; however, typically do not result in the best outcome—
Compromise—Both parties settle for less
Avoidance—Issues are ignored or sidestepped
Accommodation—Focus is on preserving relationships
Dominance—Conflicts are managed through directives
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Collaboration Achieves a mutually satisfying solution resulting in
the best outcome
All Win! Patient Care Team (team members, the team, and the patient)
Includes commitment to a common mission
Meet goals without compromising relationships
Creates Trust!
“True collaboration is a process, not an event.”
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Mutual Support Tool
Mutual support is the essence of teamwork
Protects team members from work overload situations that may reduce effectiveness and increase the risk of error
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!”
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Enhancing Mutual Support Builds Team Trust and Improves Safety
Foster an environment where you seek the support of others and offer assistance to team members
Provide feedback to team members to improve performance
Be assertive if safety is at risk
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Please Use CUS Wordsbut only when appropriate!
28
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When is CUS appropriate?
CUS is a signal phrase
Other signal words
Danger
Warning
Caution
Used to draw attention to the magnitude of the issue.
Not to be used casually
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Your turn to CUS
Take a card
Find the person with your same card but the opposite color
Role play the situation using CUS
Switch and role play again
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Communication
As
su
mp
tio
ns
Fati
gu
e
Dis
tra
cti
on
s
Ste
reo
typ
es
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Assu
mp
tio
ns
Fa
tig
ue
Ste
reo
typ
es
Real World Communication
Both the receiver and sender may have barriers that prevent effective communication including:
Language barriers
Distractions
Physical proximity
Personalities
Workload
Hierarchy
Professional Standing……….
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Phrases that SignalBad Communication
Whatever you want to do is fine – Complacency/Apathy
You need to run that up the chain of command, have you spoken to
your supervisor? – Hierarchical
You are just a CNA, get the nurse to call me –Professional
Standing
We always do it this way – Conventional Thinking
We will get around to it later – Time/Fatigue/Workload
Why do you ask? No one ever told me that –Defensiveness
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Overcoming Barriers to Communication
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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
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Communication Check List
Get the person’s attention
Make eye contact, face the person
Use the person’s name
Express concern
Use the communication technique (e.g., SBAR)
Verify that they understand the message
Re-assert as necessary
Decision reached or Escalate if necessary
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Structured CommunicationsA framework for team members to effectively communicate
information to one another
Hand-Offs
SBAR
Closed LoopCommunications
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Communicate in a structured way all the time and it will become common in
the case of an emergency
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Handoff
Relevant Information
Responsibility– Accountability
Reduce Uncertainty
Verbal Structure
Checklists
Electronic Records
AcknowledgementGreat opportunity for quality and safety
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Handoff
---AND---
Point of danger
Opportunity for error detection and recovery
Great opportunity for quality and safety
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Effective Handoff Strategies
Interactive communications
Include up-to-date information
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Effective Handoff Strategies
Limited Interruptions
Verification Process Required
Receiver has opportunity to review relevant data
Building on SkillsSBAR
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SituationWhat is going on with the patient?
State your name and unit
I am calling about (patient name)
Patient age
Gender
Mental status
Patient stable/unstable
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BackgroundWhat is the clinical background or context?
Pertinent medical history
Allergies
Sensory Impairment/Disabilities
Interpreter required
Religion/culture
Family location
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Vitals
Isolation required
Skin
Risk factors
Issues I am concerned about
AssessmentWhat do I think the problem is?
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Recommendation/RequestWhat would I recommend?
Specific care required immediately or soon
Priority areas
Pain control
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SBARExercise
Form groups of 4-5 people
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Scenario #1
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Scenario #2
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Scenario #3
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Debrief the Exercise
Was it easy for you to organize the information you were given into the SBAR?
This question is for the listeners:
How clear did the information seem to you?
Did it seem that you were missing out on any of the information you needed to proceed?
Did it prompt you to action?
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Was there anything missing?
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Check-Back is…
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In Summary
Recognize that mistrust and poor communication are contributors to medical errors and increase staff and resident dissatisfaction
Learn how to increase trust, mutual support and communication among your team
Practice techniques that support a ―safety culture‖
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The Challenge
Pick one tool
Pick one unit or neighborhood in your facility
Pick one shift
Find one champion for change
Teach the staff how to use the tool
Commit together to implement that one tool for one month
Evaluate for effectiveness at the end of the month and adjust if needed.
Thanks for ComingPlease complete your
evaluation
see you in the Fall if not before
