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What can Healthcare Learn from Team Training and Other
Domains?
David P. Baker, Ph.D.American Institutes for Research
TEAMSTEPPS 05.2Mod 1 05.2 Page 2Mod 1 06.2 Page 2
Session Objectives
Demonstrate the importance of teamwork in healthcare
Review the evidence on the effectiveness of team training
Present guidelines for implementing effective team training programs
Describe current initiatives in medical team training
TEAMSTEPPS 05.2Mod 1 05.2 Page 3Mod 1 06.2 Page 3
Teamwork and Healthcare
In most all cases, the delivery of healthcare involves: Two or more individuals (RNs, MD, PharmDs, etc.) Performing distinct tasks Working interdependently Ensuring a safe outcome (i.e., common goal)
The delivery of healthcare requires teamwork! Team members come from different backgrounds,
disciplines, and are seldom trained together
TEAMSTEPPS 05.2Mod 1 05.2 Page 4Mod 1 06.2 Page 4
What Do Effective Healthcare Teams Look Like?
…have members who anticipate each other.
…can coordinate without the need to communicate overtly.
…can recognize and adjust their strategy under stress.
…manage conflict well-team members confront each other effectively.
…backup and fill in for each other.
TEAMSTEPPS 05.2Mod 1 05.2 Page 5Mod 1 06.2 Page 5
…communicate often "enough”.
…effectively “span” boundaries with stakeholders outside the team.
…regularly provide feedback to each other, both individually and as a team (“de-brief”).
…have members who understand each others’ roles and how they fit together.
What Do Effective Healthcare Teams Look Like?
TEAMSTEPPS 05.2Mod 1 05.2 Page 6Mod 1 06.2 Page 6
Producing Effective Teams
Team membership-selection (Klimoski & Jones, 1995)
Modify team tasks, workflow, structure (Campion et al, 1995)
Provide support, resources, performance aids
Build team member knowledge, skill, and attitude competencies (KSAs) - TRAINING (Salas & Cannon-Bowers, 2001)
TEAMSTEPPS 05.2Mod 1 05.2 Page 7Mod 1 06.2 Page 7
Targets of Team Training
Team Members
Cognitions
Knowledge
“Think”
Behaviors
Skills
“Do”
Attitudes
Affect
“Feel”
TEAMSTEPPS 05.2Mod 1 05.2 Page 8Mod 1 06.2 Page 8
Team Process
Mutual Trust
Shared Mental Models
TeamOrientation
Team Leadership
Close LoopComm.
Back-UpBehavior
MPM
Adaptability
THE CORE
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Meta Analysis Results (Salas)
Team Training leads to improvements in: Attitudes Knowledge Skills
Findings consistent across military, aviation, and emerging in healthcare
Cross training, team self-correction, TDT, CRM Little evidence for organizational impact
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Guideline 1Engage Leadership (Physicians)
If physicians do not believe that teamwork is critical it will be an uphill battle
Physicians need to be included as team members and leaders
Physicians must be champions for teamwork and training
Physicians must value and reinforce team principles
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Guideline 2Develop Training Systematically
Training development requires: Needs analysis
Specification of objectives that are linked to desired outcomes
Content development
Delivery
Evaluation
Preparing the transfer environment
TEAMSTEPPS 05.2Mod 1 05.2 Page 13Mod 1 06.2 Page 13
Guideline 3Training Should be Scientifically Rooted
There is a science of team performance and training (Baker et al. 2005, Advances in Patient Safety)
There are principles, tools and strategies that have been shown to work
TEAMSTEPPS 05.2Mod 1 05.2 Page 14Mod 1 06.2 Page 14
Guideline 4Determine if Staff are Ready for Training
Teamwork and training must be valued
Trainees must be motivated to learn – negative pre-training experiences increase motivation
Past experiences with training in the organization shape pre-training expectations
Self efficacy is important
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Guideline 5Prepare the Learning Environment
The organization must communicate that team training is important
There should be systems in place to:
Reinforce learned principles
Transfer trained skills
Establish coaches at the sharp end of care
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Guideline 6Incorporate Opportunities for Practice
Practice is essential when developing team skills
Simulation is an excellent tool for skills practice
Simulation must incorporate sound learning strategies like scenario-based training
Practice must be structured and paired with measurement and feedback to be effective
TEAMSTEPPS 05.2Mod 1 05.2 Page 17Mod 1 06.2 Page 17
Guideline 7Evaluate Training at Multiple Levels
Evaluation involves systematic review of the training program to ensure it produces the desired outcome
There are 4 levels of evaluation: Reactions (Did they like it? Find it useful?) Learning (What do they know?) Behavior (What can they do?) Outcomes (What impact has there been on the
organization?)
TEAMSTEPPS 05.2Mod 1 05.2 Page 18Mod 1 06.2 Page 18
Guideline 8Training is not a One-Time Event
Refresher training is required
Medicine is an evolving field
More and more research is focused on healthcare teams
New training strategies are being develop, tested and validated
Want to produce a learning organization
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Guideline 9Training Must be Aligned
Team training will reduce but not eliminate error
Human failure is inevitable
Team training must align with the organization’s broader patient safety program
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TeamSTEPPSTM
• Evidenced – based• Scientifically rooted• Customizable• Publicly available• Multiple strategies• Evaluation tools
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Course Summary TOOLS and
STRATEGIESBrief
Huddle DebriefSTEP
Cross MonitoringFeedback
Advocacy and AssertionTwo-Challenge Rule
CUSDESC ScriptCollaboration
SBARCall-Out
Check-BackHandoff
OUTCOMES
Shared Mental Model
Adaptability
Team Orientation
Mutual Trust
Team Performance
Patient Safety!!
BARRIERS
Inconsistency in Team Membership
Lack of Time Lack of Information Sharing Hierarchy Defensiveness Conventional Thinking Complacency Varying Communication Styles Conflict Lack of Coordination and
Follow-Up with Co-Workers Distractions Fatigue Workload Misinterpretation of Cues Lack of Role Clarity
TEAMSTEPPS 05.2Mod 1 05.2 Page 22Mod 1 06.2 Page 22
Kick-Off planSenior Leadership involvementExecutive Sponsor & Change Team Mentor and Role-model BehaviorsTraining ClassesMetric Reinforcement through Post-training AssessmentEssentials course for support staffWeb-based teamwork updatesLearning Action Network for follow-up and Information Sharing
Kick-Off planSenior Leadership involvementExecutive Sponsor & Change Team Mentor and Role-model BehaviorsTraining ClassesMetric Reinforcement through Post-training AssessmentEssentials course for support staffWeb-based teamwork updatesLearning Action Network for follow-up and Information Sharing
Pre-Training Assessment-Readiness
Train-the-Trainer: Train the Participants
Implementation & Sustainment
Selection of Instructors/CoachesSupporting training materials providedTrain-the-Trainer
•Fundamentals Course•Implementation Workshop•Culture Change Workshop
Practice teachingEstablishment of Training and Implementation TimelinesImplementation Roll-out PlanObservation Toolkits
Selection of Instructors/CoachesSupporting training materials providedTrain-the-Trainer
•Fundamentals Course•Implementation Workshop•Culture Change Workshop
Practice teachingEstablishment of Training and Implementation TimelinesImplementation Roll-out PlanObservation Toolkits
Site assessmentAHRQ Hospital Survey on Patient Safety CultureExecutive Brief to gain Senior Leadership buy-inSelection of Executive Sponsor and Change Team MembersEstablishment of Goals/ValuesCommunication CampaignPre-training (baseline) AssessmentImplementation plan
Site assessmentAHRQ Hospital Survey on Patient Safety CultureExecutive Brief to gain Senior Leadership buy-inSelection of Executive Sponsor and Change Team MembersEstablishment of Goals/ValuesCommunication CampaignPre-training (baseline) AssessmentImplementation plan
Three Critical Phases
TEAMSTEPPS 05.2Mod 1 05.2 Page 23Mod 1 06.2 Page 23
“Report Card”“Report Card”
ImprovedPatient Outcomes
Improved Staffand Patient Satisfaction
Improved Processes
StaffRetention
ImprovedPatient Outcomes
Improved Staffand Patient Satisfaction
Improved Processes
StaffRetention
Level IV Evaluation
Level IV Evaluation
Pre-TrainingMeasurement
-Knowledge-Skills-Attitudes
Pre-TrainingMeasurement
-Knowledge-Skills-Attitudes
Intervention Intervention
Training Transfer
Training Transfer
MethodsMethods
TrainingTraining
Training Objectives
Level III EvaluationLevel III EvaluationLevel II EvaluationLevel II Evaluation
ToolsTools
Post-TrainingMeasurement
-Knowledge-Skills-Attitudes
Post-TrainingMeasurement
-Knowledge-Skills-Attitudes
Level II EvaluationLevel II Evaluation
Competencies
-Knowledge-Skills-Attitudes
Competencies
-Knowledge-Skills-Attitudes Level I EvaluationLevel I Evaluation
TRANSFORMATIONAL CHANGE FACTORSTRANSFORMATIONAL CHANGE FACTORS
Safety CultureTransparency/Trust
Systems-EfficacyLearning Environment
Pre-training ExperienceSelf Efficacy
Training Motivation
Org LevelOrg Level
Leadership LevelLeadership Level
Individual LevelIndividual Level
Lead the WayEstablish the Sense of Urgency Create a Vision or Gain-Plan & PrepareDevelop a Coalition-Assess Environment
Communication ProcessEnable Change to LastImprove Systems and Structures
Sentinel Event
TEAMSTEPPS 05.2Mod 1 05.2 Page 24Mod 1 06.2 Page 24
David P. Baker, PhD
American Institutes for Research
1000 Thomas Jefferson Street, NW
Washington, DC 20007
202-264-0659