TeamSTEPPS Master Training Webinar · 2013. 10. 8. · TEAMSTEPPS 05.2 06.1 Page 15 Webinar 15...

TeamSTEPPS

Master Training

Webinar

October 8, 2013

1

Webinar Agenda

• Overview & Introductions – Betsy Lee

• TeamSTEPPS Master Training– Karyn

Baum, M.D., M.S.Ed.

• Wrap-up/Questions – Betsy Lee

2

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

3

https://www.surveymonkey.com/s/20131008TeamSTEPPSWebinar

TeamSTEPPS Master Training

Webinar

October 8, 2013

TEAMSTEPPS 05.2 06.1 Page 5

Webinar

Instructor

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


Webinar


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


Webinar

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

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Materials

8

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

Strategies and Tools

to Enhance Performance

and Patient Safety

MODULE 1. Introduction


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Ice Breaker NOTE: Will do this at the in-person training!


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Sue Sheridan Video


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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


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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


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Teamwork Is All Around Us


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Indemnity Experience

20

11

0

5

10

15

20

25

Malpractice Claims, Suits, and Observations

Pre-Teamwork Training Post-Teamwork Training

Adverse Outcomes

50%

Reduction

50%

Reduction

(Mann, 2006) Beth Israel Deaconess Medical Center

Contemporary OB/GYN

1

1.2

1.4

1.6

1.8

2

2.2

2.4

June July August Sept Oct Nov Dec Jan Feb March April May

Avg

. L

en

gth

of

Sta

y (

days)

Length of ICU Stay After Team Training

50% Reduction

OR Teamwork Climate and Postoperative Sepsis Rates

(per 1000 discharges)

Group Mean

Low Teamwork

ClimateMid Teamwork

Climate

High Teamwork

Climate

0

2

4

6

8

10

12

14

16

18

AHRQ National Average

Teamwork Climate Based on Safety Attitudes Questionnaire

Low High(Sexton, 2006) Johns Hopkins

(Pronovost, 2003) Johns Hopkins

Journal of Critical Care Medicine


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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)


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“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


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The Components of a

Patient Safety Program


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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


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If I had a “Magic Wand”

and could make changes

within my unit or facility

in the areas of patient

quality and safety…

Introductions and Exercise:

Magic Wand


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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


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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

Cost associated with medical errors

is $8–29 billion annually.

Federal Action:

By 5 years;

medical errors by 50%,

nosocomial by 90%; and

eliminate “never-events”

(such as wrong-site surgery)


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JCAHO Sentinel Events


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What Comprises Team Performance?

Knowledge

Cognitions

“Think”

…team performance is a

science…consequences

of errors are great…

Attitudes

Affect

“Feel”

Skills

Behaviors

“Do”


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Outcomes of Team Competencies

Knowledge Shared Mental Model

Attitudes

Mutual Trust Team Orientation

Performance

Adaptability Accuracy Productivity Efficiency Safety


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Swiss cheese model of errors

Team Structure

The ratio of We’s to I’s is the best

indicator of the development of a

team.

–Lewis B. Ergen NEXT:


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Objectives

Identify the characteristics of high-performing teams

Discuss benefits of teamwork and team structure

Describe components and composition of a multi-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


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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


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Why Teamwork?

Reduce clinical errors

Improve patient outcomes

Improve process outcomes

Increase patient satisfaction

Increase staff satisfaction

Reduce malpractice claims


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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)


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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


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Exercise: Teams and Teamwork

Write down the names (or positions) of the people in your immediate work area or unit who contribute

to successful patient care.


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Multi-Team System (MTS) for Patient Care


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Core Team members have the closest contact with

the patient!

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


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A team comprising those

work area members who are

responsible for managing

the operational

environment that

supports the

Core Team

A Coordinating Team is…


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A time-limited team formed

for emergent or specific

events and composed

of members from

various teams

A Contingency Team is…


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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.

Ancillary & Support Services

Provide…


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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

the organization

The Role of Administration is to…


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Example: A Multi-Team System in the OR


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Exercise: Your Multi-Team System

? ?

Team Member Characteristics


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Team Failure Video

Vig%204aLg001.mpg


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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-limited membership

What Defines a Team?


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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


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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”

Effective Team Members


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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

CHANGE MANAGEMENT:

HOW TO ACHIEVE A

CULTURE OF SAFETY


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John Kotter

8 Steps of Change


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Set the Stage and

Create a Sense of Urgency Get people’s attention!

Sell the need for change … sell the pain and the consequences of not changing

Discuss ways to solve the problems people identify with the change

Empower people to solve the “problem”


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Pull Together the Guiding Team

Choose key players, especially staff-level managers

Multidisciplinary

Goal is informed; intelligent decisions are being made

Credibility and integrity of change leaders

Choose proven leaders who can drive the change process

Strong position power, broad expertise, and high credibility

Need both management and leadership skills

Management skills control the process

Leadership skills drive the change

…TeamSTEPPS initiative should have

a designated executive sponsor


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Develop the Change Vision

and Strategy

Senior Leadership is responsible for:

Establishing the definition of a “culture of safety” aligned with expectations, core values, and shared beliefs

Informing the organization of these values and evaluating the culture; communication

Leading the process of:

Translating values into expected behaviors

Establishing trust and accountability


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Communicate for Understanding

and Buy-In Provide supportive actions for fear, anger, and resistance

Encourage discussion, dissent, disagreement, debate … keep people talking

Tell people what you know―and what you don’t know

Acknowledge people’s pain, perceived losses, and anger

Value resisters

They clarify the problem and identify other problems that need to be solved first

Their tough questions can strengthen and improve the change

They may be right―it is a dumb idea!

…communicate, communicate, communicate…


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Empower Others to Act

Develop a shared sense of purpose

Align structures with vision and goals

Train employees so they have the desired skills and attitudes

Confront high-level resisters

An organization cannot be improved from the top only


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Produce Short-Term Wins

Provide positive feedback

Further builds morale and motivation

Lessons learned help

Greater difficulty for resisters to block

Provide leadership with evidence of success

Build momentum


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Don’t Let Up

Acknowledge hard work

Celebrate successes and accomplishments

Reaffirm the vision

Bring people together toward the vision

Develop long-term goals and plans

Provide tools and training to reinforce new behaviors

Reinforce and reward the new behaviors

Prepare people for the next change


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Create a New Culture Develop action steps for stabilizing, reinforcing, and sustaining

the change:

Give people time to mourn their actual losses

Provide skill and knowledge training

Revise job descriptions

Develop new reward systems

Strengthen social connections and relationships

Recognize and celebrate accomplishments

Develop performance measures to continually monitor the results from the change and to identify opportunities for further improvements

Make adjustments to the change vision and strategy to reflect new learning and insights


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Culture Change Comes Last,

Not First!

Most alterations in norms and shared values come at the end of the transformation process

New approaches sink in after success has been proven

Feedback and reinforcement are crucial to buy-in

Sometimes the only way to change culture is to change key people

Individuals in leadership positions need to be on board

Otherwise, the old culture will reassert itself

…Reculturing takes time and it really never ends


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Sizing Up The Culture

Readiness assessment

Read through and answer the questions on the “Sizing Up the Culture Exercise Sheet”

Before we meet in person

As you answer the questions, consider the state of your current organization and the current safety climate.


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Identify Specific Areas for

Improvement

Define the Need that is Driving Your Organization to Consider TeamSTEPPS

What are the areas for improvement?

In which units/organizations are the improvements needed?

Determine Whether Stronger Teamwork and Safety Culture is an Appropriate Strategy for Addressing Your Organization’s Needs


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Learn About Other TeamSTEPPS

Efforts in Your Organization

Gather Knowledge Related to Other Uses of TeamSTEPPS within Your Organization

Has leadership already been involved in any TeamSTEPPS efforts?

Have other units/areas of your hospital already implemented aspects of TeamSTEPPS?

If so, which ones, and were they successful?

Are there TeamSTEPPS tools and/or strategies your organization already knows and/or uses?


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Determine Readiness

Factors for Consideration

Which units/areas are most ready for and in need of TeamSTEPPS?

Is/are there any unit(s) in which TeamSTEPPS can be implemented now?

Is the timing right in terms of avoiding competition with other major initiatives or changes?

In which units/areas can success be expected, and later used as an example for spreading TeamSTEPPS in the organization?


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Questions and Answers

64


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Thank You!

For more information, please contact our team at:

Karyn Baum [email protected]

65

mailto:[email protected]


• Offered as a part of the IHA Coalition for Care

• Three one-day training sessions will be offered

Oct. 24 Courtyard Fort Wayne, Fort Wayne

Nov. 13 Marten House, Indianapolis

Nov. 14 Comfort Inn, Columbus

• 7:30 am - registration begins

8:00 am - meeting starts

12:15 - 1 pm - lunch, on your own 5:00 pm - meeting concludes

66

TeamSTEPPS Master Training • Pre-conference webinar: Oct. 8, 2-4 pm ET

– Required for all participants; recording available for those not able to

attend

• Space is limited at each location. Only IHA Coalition for

Care hospitals may register.

• IHA is not limiting the number of registrations per

hospital at this time. – Adjustments may be necessary for hospitals with multiple registrations

to accommodate additional participating hospitals.

• Registration: www.regonline.com/2013teamSTEPPS

• IHA TeamSTEPPS Resources:

https://www.ihaconnect.org/Quality-Patient-Safety/Pages/Team-

STEPPS-Resources.aspx

67

http://www.regonline.com/2013teamSTEPPS

https://www.ihaconnect.org/Quality-Patient-Safety/Pages/Team-STEPPS-Resources.aspx









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

68

https://www.surveymonkey.com/s/20131008TeamSTEPPSWebinar

Thank you

69

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