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Department of Defense (DoD)

Learning Action Network (LAN)


Site Assessment: Where Do We Start?

12 March 2008

Presented by: HCTCP


Health Care Team Coordination Program
LAN

HCTCP Master Trainer Panel


Presentation Members
 Sandy Almeida, M.D., MPH
 Marcia Harmon, RN, MSN
 Capt. Stephen Powell, MS
 Mary Salisbury RN, MSN
 John Webster, M.D., MBA

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Objectives
Participants will:
 Be able to identify potential barrier and solutions at
each TeamSTEPPS intervention phase
 Be able to outline critical success factors for
implementing TeamSTEPPS
 Have an opportunity to share success strategies and
pose issues to the panel

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Overview
HCTCP panel members would like to create an
opportunity to address frequently asked questions
and provide responses on “How To Get Started”
within each phase of the TeamSTEPPS Initiative.
Specific areas of discussion shall include
 Decision To Commit
 Assessment & Alignment
 Planning & Implementation
 Measurement & Sustainment

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How To Get Started – Decision To Commit


Q. What is the best way to present a “Case for
TeamSTEPPS” to Senior Leadership?
 Begin with gathering of MTF specific existing data (e.g.,
adverse events, quality performance measures, AHRQ
Patient Safety Culture Survey, satisfaction and attitudinal
surveys, efficiency measures). Focus on how a
TeamSTEPPS Intervention could improve performance in
key indicators.
 Share success stories and lessons learned from other
facilities that have engaged in a TeamSTEPPS Initiative
 HCTCP can provide consultation and assistance in
development of a decision brief to present to senior leaders
to “sell the case”

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How To Get Started – Decision To Commit


Q. How does a facility determine readiness in
undertaking a TeamSTEPPS Initiative?
 Commitment and buy-in of senior leadership is the first step.
This also involves the time/ resource allocation
 Establishment of an organizational-level change team that
includes a designated executive sponsor
 Identification of a specific unit(s) or department(s) where
likelihood of success would be greatest
 Soliciting of unit-level clinical champions that have the desire
to engage in a teamwork initiative
 Agreement to measure impact and monitor progress over
time (ensure assignment of this role to a key individual)

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How To Get Started – Assessment &


Alignment
Q. What baseline patient safety and quality measures
would signal opportunities for improving
communication and other teamwork skills?
 Direct measures of patient safety and quality:
 Adverse event/near miss reporting
 AHRQ Patient Safety Culture Survey
 The Joint Commission quality measures (ORYX)
 National patient safety & quality initiatives (e.g., IHI 5M Lives,
National Surgical Quality Improvement Project)
 National Patient Safety Goals – compliance (e.g., handoff,
surgical “time-out”)
 Other local quality and patient safety measures

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How To Get Started – Assessment &


Alignment
Q. What baseline patient safety and quality measures would
signal opportunities for improving communication and
other teamwork skills?
 Indirect measures of patient safety and quality
 Staff satisfaction (surveys, complaints)
 Patient satisfaction (surveys, complaints, leaving before seen)
 Patient flow (e.g., OR on-time starts, ED wait times)
 Equipment availability (e.g., right equipment for case in OR)
 Tips for selecting measures (to show change in short-term)
 High volume events
 “Room for improvement”
 Feasible (already collected if possible)
 Resourcing of a specific individual responsible for
measurement collection
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How To Get Started – Planning &


Implementation
Q. How do you engage both physicians and staff in a
TeamSTEPPS intervention?
 Most physicians and staff are interested in understanding
how a teamwork initiative could improve work processes and
impact patient care outcomes
 Consider “WIIFM” and show alignment with existing work
and requirements
 Design your TeamSTEPPS™ intervention to ensure that the
WIIFM is demonstrated early in the process (Measure what’s
important to them!)
 Provide visible reporting of progress, and celebrate early
wins regularly
 Report upwards to ensure recognition
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How To Get Started – Planning &


Implementation
Q. How much time will the training take away from
clinical duties?
 Staff and physicians need to have the time to understand the
big picture and context of the TeamSTEPPS principles
covered in the Fundamentals Course
 Once teams have the context and core skills, tools and
strategies, implementation through coaching is conducted
“in-situation” and/or simulation
 Some process redesign may need to occur to integrate use
of the tools into the standard process of care (e.g., brief,
debrief, etc.)

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How To Get Started - Measurement &


Sustainment
Q. Our facility has had TeamSTEPPS training, but
momentum has been lost. How do we get back on track?
 Training and education alone are unlikely to create change
 Behavior change requires a change in the way we do
business, to include being explicit about the desired actions,
roles & responsibilities, expectations, etc.
 Coaching and reinforcement are critical in helping teams to
practice new behaviors; act your way into a new way of
thinking!
 Hardwiring of the behaviors, tools and strategies into the
systems and processes is essential. The goal is for the
actual behaviors to become part of the way business is
conducted

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How To Get Started - Measurement &


Sustainment
Q. How do we foster migration of TeamSTEPPS to
other units or departments?
 Begin by leveraging natural migration opportunities:
 ED migration to Cath Lab, Radiology, 1-2 med/surg floors
 OR migration to recovery, 1-2 post-op surg floors
 Identify at least 1 influential person (“Connector”) with a
cross cutting quality, performance, or patient safety role to
participate in the TeamSTEPPS Train-the-Trainer session
 Invite key stakeholders from potential migration units to gain
exposure to TeamSTEPPS during Fundamentals training

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How To Get Started - Measurement &


Sustainment
Q. How do we foster migration of TeamSTEPPS to
other units or departments?
 As the unit of reference is in their learning consolidation
phase, consider initiating a conversation about opportunities
for addressing transition of care issues and leverage
interested parties or existing opportunities identified by
performance gaps.
 Utilize local champions / converts to talk about progress and
results at internal professional meetings and maximize
existing relationships.

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Barriers to Team Effectiveness


BARRIERS TOOLS and OUTCOMES
STRATEGIES
 Inconsistency in Team
Brief
Membership  Shared Mental Model
Huddle
 Lack of Time
Debrief  Adaptability
 Lack of Information Sharing
 Hierarchy STEP
 Team Orientation
 Defensiveness Cross Monitoring
 Conventional Thinking Feedback  Mutual Trust
 Complacency Advocacy and Assertion  Team Performance
 Varying Communication Styles Two-Challenge Rule
 Conflict CUS  Patient Safety!!
 Lack of Coordination and DESC Script
Follow-Up with Co-Workers
Collaboration
 Distractions
SBAR
 Fatigue
 Workload Call-Out
 Misinterpretation of Cues Check-Back
 Lack of Role Clarity Handoff
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Leadership Opportunities:
• Teamwork as a priority
• Accountability
• Role modeling, Inspiration
• Creating the culture
• Integrate with other initiatives
• Customer service
• Quality
• Part of daily business
•Meetings
•Rounds
•Metrics

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