PARTICIPANT WORKBOOK · Team leaders should use a briefing checklist to plan and manage team briefs. Spend 10 minutes writing down your answers to the questions below. Have you ever

PARTICIPANT WORKBOOK

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Contents MODULE 1: INTRODUCTION ................................................................................................................................. 4

Slide 12: Medical Office Environment .............................................................................................................. 4

MODULE 2: TEAM STRUCTURE ............................................................................................................................. 6

Slide 6: Let’s Talk About Your Team ................................................................................................................. 6

Slide 8: Poorly Functioning Team Examples ..................................................................................................... 7

MODULE 3: COMMUNICATION............................................................................................................................. 9

Slide 12: Handoff Exercise ................................................................................................................................ 9

Slide 15: Proper Team Communication Example ........................................................................................... 10

Slide 17: Proper Team Communication: Review of the Video ........................................................................ 12

MODULE 4: LEADING TEAMS .............................................................................................................................. 13

Slide 8: Brief (To Plan) ..................................................................................................................................... 13

Slide 9: Briefing Checklist ................................................................................................................................ 14

Slide 11: Use a Huddle To Change the Plan .................................................................................................... 15

Slide 13: Debrief Checklist .............................................................................................................................. 16

Slide 14: Leadership in the Medical Office ..................................................................................................... 17

Slide 16: Leadership in the Medical Office: Reflect & Apply to Your Office ................................................... 19

Slide 17: Front Office Scenario ....................................................................................................................... 20

MODULE 5: SITUATION MONITORING ................................................................................................................ 21

Slide 5: Situation Monitoring .......................................................................................................................... 21

Slide 6: Cross-Monitoring Is… ......................................................................................................................... 22

Slide 8: Situation Monitoring in the Medical Office ....................................................................................... 23

Slide 10: Situation Monitoring Exercise .......................................................................................................... 25


MODULE 6: MUTUAL SUPPORT .......................................................................................................................... 27

Slide 5: Mutual Support .................................................................................................................................. 27

Slide 18: Two-Challenge Rule ......................................................................................................................... 28

Slide 24: Mutual Support in the Medical Office ............................................................................................. 29

Slide 26: Exercise: Reflect & Apply to Your Office .......................................................................................... 31


MODULE 7: SUMMARY: PUTTING IT ALL TOGETHER .......................................................................................... 33

Slide 7: Communication Tools ........................................................................................................................ 33

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Slide 8: Leading Teams Tools .......................................................................................................................... 34

Slide 9: Situation Monitoring Tools ................................................................................................................ 35

Slide 10: Mutual Support Tools ...................................................................................................................... 36

Slide 16: Beginning Your Journey ................................................................................................................... 37

MODULE 8: TEACHING AND COACHING ............................................................................................................. 39

Slide 9: Example: An Issue of Time ................................................................................................................. 39

Slide 12: An Example at Work – 100-Level Tools ............................................................................................ 41



Slide 23: Characteristics of Effective Coaches ................................................................................................ 47

Slide 30: Coaching Debriefs Using the 3 I’s ..................................................................................................... 48

Slide 33: Coaching SBAR “In the Moment” ..................................................................................................... 49

Slide 35: Coaching Situational Awareness Using the 3 I’s .............................................................................. 50

Slide 38: Coaching the Two-Challenge Rule Using the 3 I’s ............................................................................ 51

Slide 41: A Need for Coaching ........................................................................................................................ 52

MODULE 9: CHANGE MANAGEMENT ................................................................................................................. 54

Slide 7: Change Management Activity ............................................................................................................ 54

Slide 8: Change Management Activity Continued .......................................................................................... 56

MODULE 10: MEASUREMENT ............................................................................................................................. 57

Slide 25: Evaluating TeamSTEPPS in Office-Based Care Scenario ................................................................... 57

MODULE 11: IMPLEMENTATION PLANNING ...................................................................................................... 58

Slide 8: 10 Steps of Implementation Planning ................................................................................................ 58

Slide 10: Step 1: Create a Change Team ........................................................................................................ 59

Slide 12: Step 2: Define the Problem, Challenge, or Opportunity for Improvement ..................................... 60

Slide 15: Step 3: Define the Aims of Your TeamSTEPPS Intervention ............................................................ 61

Slide 17: Step 4: Design a TeamSTEPPS Intervention ..................................................................................... 62

Slide 19: Step 5: Develop a Plan for Testing Your Intervention(s) .................................................................. 63

Slide 21: Step 6: Develop an Implementation Plan ........................................................................................ 64

Slide 23: Step 7: Develop a Sustainment Plan ................................................................................................ 66

Slide 25: Step 8: Develop a Communications Plan ......................................................................................... 67

Slide 27: Step 9: Develop a TeamSTEPPS Implementation Plan Timeline ...................................................... 68

Slide 29: Step 10: Review Your Plan With Key Stakeholders .......................................................................... 69

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MODULE 1: INTRODUCTION

Slide 12: Medical Office Environment

Think about how this picture compares with the “front desk” picture that the

patient has of a medical office. Take 10 minutes and answer the questions

below and on the following page.

Do your patients have any idea how chaotic the office really is?

How would they know?

What would they hear or see?

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If you could describe the office in one word, what would it be?

If your patients could describe the office in one word, what would it be?

If someone asked you to explain a typical day, what would you say?

If patients described a typical visit, what would they say?

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MODULE 2: TEAM STRUCTURE

Slide 6: Let’s Talk About Your Team

Thinking about your team, what does it look like? Take 10 minutes and answer

the questions below.

Who are the team members?

When do you interact?

How do you exchange critical patient information?

If you had a magic wand, how would you change your team (if at all)?

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Slide 8: Poorly Functioning Team Examples

Record any observations you have while watching the video.

After you watch the video, take 10 minutes and answer the questions on the

following page. Think about some of the successes and failures and what could

have been done to improve the situation.

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What did the team do wrong in this video?

How could the situation have been handled better?

Are these situations that you could potentially see happening in your setting?

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MODULE 3: COMMUNICATION

Slide 12: Handoff Exercise

Spend 10 minutes developing a handoff checklist based on the needs of your

work setting.

As you develop your checklist, consider how your team is unique while keeping in

mind the core components of a handoff. Once you have come up with your

handoff checklist, share it with the rest of your team and discuss how it could be

used in your practice.

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Slide 15: Proper Team Communication Example


After you watch the video, take 10 minutes and answer the questions on the

following page. Think about what went well in this version of the scenario.

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Was proper communication demonstrated?

Was this strategy effective? Why or why not?

Did you see any other opportunities for better communication?

Have you encountered a situation similar to this in your team? If so, how did you

overcome it?

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Slide 17: Proper Team Communication: Review of the Video

Think about your team’s communication and spend 10 minutes writing down

your answers to the questions below.

What are some areas for improvement?

How are staff involved?

How are patients and family involved?

If you had a magic wand, what strategies would you use to address the

communication breakdowns in your team?

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MODULE 4: LEADING TEAMS

Slide 8: Brief (To Plan)

Think about your team meetings and briefs (if you currently implement them)

and spend 10 minutes writing down your answers to the questions below.

When and where does planning occur for you now?

Who attends? Clinical or operations? Or both?

Who should attend?

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Slide 9: Briefing Checklist

Team leaders should use a briefing checklist to plan and manage team briefs.

Spend 10 minutes writing down your answers to the questions below.

Have you ever participated in a brief?

If so, were the items on the checklist used? If not, what was missing?

What would you add to the briefing checklist shown on the slide?

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Slide 11: Use a Huddle To Change the Plan

Take 10 minutes to think about when a huddle would be appropriate in your

setting.

Think about a situation in your office in which the team leader should have called

a huddle but did not. What were the results?

List a few examples of when a huddle should be used. These examples can be

from actual experience or situations that you imagine could happen.

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Slide 13: Debrief Checklist

Take 10 minutes to think about how debriefs can be incorporated in your

setting.

When do discussions about process improvement take place?

Have you ever participated in a debrief? If so, were the items on the checklist

used? If not, what was missing?

Think about a situation in your office in which the team leader should have called

a debrief but did not. What were the results?

List a few examples of when a debrief should be used. These examples can be

from actual experience or situations that you imagine could happen.

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Slide 14: Leadership in the Medical Office


After you watch the video, take 10 minutes and think about how it compares to

the video you watched in the Team Structure Module about an office-based

care team who demonstrated poor team leadership.

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What went better in this version of the video? How did the team leader improve

the situation?

How was leadership demonstrated in this video?

Was the strategy effective? Why or why not?

Did you see any other opportunities for leadership to be demonstrated in this

video?

Have you encountered situations similar to this in your team?

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Slide 16: Leadership in the Medical Office: Reflect & Apply to

Your Office

Now take 10 minutes to think about your own office team in terms of

leadership and whether you have encountered leadership problems. Focus on

what has not worked rather than who has made it not work.

Have you encountered leadership problems?

What strategies could you use to overcome it?

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Slide 17: Front Office Scenario

The outcome in this scenario is only one of many possible outcomes. Spend 10

minutes and answer the question below.

Can you think of any other way the situation could have been resolved?

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MODULE 5: SITUATION MONITORING

Slide 5: Situation Monitoring

Think about situation monitoring and spend 10 minutes answering the

questions below.

Reflect about some of the ways in which you have used situation monitoring in

your medical office. Describe what happened.

What are some of the benefits of using situation monitoring?

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Slide 6: Cross-Monitoring Is…

Think about cross-monitoring and spend 10 minutes answering the questions

below.

Consider a time when cross-monitoring should have been used but was not. What

were the results?

Think of a time when cross-monitoring was successful. What were the results?

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Slide 8: Situation Monitoring in the Medical Office


After you’ve watched the video, spend 10 minutes answering the questions on

the following page.

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How was situation monitoring demonstrated in this video?


Did you see any other opportunities for situation monitoring to be demonstrated

in this video?

Have you encountered situations similar to this in your team? If so, how did you

overcome it?

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Slide 10: Situation Monitoring Exercise

Think about your own office team and daily routines in terms of situation

monitoring. Take 10 minutes and answer the questions below.

Have you encountered barriers to proper situation monitoring? If not, do you

anticipate barriers in this new team structure?

What are some strategies or tools you could use to overcome barriers to situation

monitoring?

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This scenario provided an example where TeamSTEPPS can be used in a

nonclinical way. Take 10 minutes and answer the question below.

Where can you see STEP (Status of the patient, Team members, Environment, and

Progress toward the goal) used clinically in your office?

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MODULE 6: MUTUAL SUPPORT

Slide 5: Mutual Support

Mutual support is the essence of teamwork. Take 10 minutes and answer the

question below.

What types of behavior might constitute mutual support or team backup

behavior?

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Slide 18: Two-Challenge Rule

Think about how team members should be empowered to “stop the line,” and

spend 10 minutes writing down your thoughts on the questions below.

Are team members currently able to stop the line? How do you know?

Are patients and families currently able to stop the line? How do you know?

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Slide 24: Mutual Support in the Medical Office



the following page.

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What went better in this version of the video? How did the team leader improve

the situation?

How was mutual support demonstrated in this video?


Did you see any other opportunities for mutual support to be demonstrated in

this video?

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Slide 26: Exercise: Reflect & Apply to Your Office

Now take 10 minutes to think about your own office team and whether you

have encountered problems in mutual support.

Have you encountered mutual support problems?

What strategies could you use to overcome them?

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After reading the scenario, take 10 minutes to answer the questions below.

The patient advocate successfully used advocacy and assertion to make sure Greg

was seen. Imagine if the administrative assistant had not appreciated the

feedback. What mutual support tool or tools could the patient advocate have

used next?

Based on the tool you chose in the previous question, write what the patient

advocate would say to the administrative assistant.

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MODULE 7: SUMMARY: PUTTING IT ALL TOGETHER

Slide 7: Communication Tools

Think about your work setting and spend 10 minutes answering the questions

below.

Which communication tools make sense and could work in your office?

Which ones seem more difficult and might be harder to use effectively? Why?

Choose one communication tool and explain how you would use it to solve a

specific problem in your office.

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Slide 8: Leading Teams Tools


below.

What potential challenges do you foresee when trying to implement briefs,

huddles, and debriefs?

What can you do to mitigate these challenges?

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Slide 9: Situation Monitoring Tools


below.

What benefits do you think improved situational awareness would have on your

practices?

In what specific situation do you feel you could use STEP?

Do you foresee any of your team members worrying that watching each other’s

backs will be misconstrued as being too intrusive? How will you alleviate this

concern?

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Slide 10: Mutual Support Tools

Spend 10 minutes and complete the CUS below about a situation that you’ve

encountered.

I’m concerned that:

I’m uncomfortable because:

This is a safety issue because:

Imagine your team member was not receptive to your CUS. Construct a DESC

script regarding this scenario.

Describe the situation:

Express how this makes you feel:

Suggest alternatives:

State the consequences:

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Slide 16: Beginning Your Journey



the following page.

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Were you surprised to learn it took Valerie 3 months to bring her plan to

leadership? How does this timing affect your plans for implementing

TeamSTEPPS?

Valerie is doing Plan-Do-Study-Act (PDSA) cycles with Dr. Simmons to get small

wins and leadership buy-in. What are you going to do to begin your TeamSTEPPS

journey in your office?

Valerie stressed the importance of getting staff input. How are you going to

gather staff input in your setting?

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MODULE 8: TEACHING AND COACHING

Slide 9: Example: An Issue of Time



the following page.

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What are some issues that can occur if staff consistently have to work past normal

hours?

What TeamSTEPPS tools might be useful in addressing this problem?

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Slide 12: An Example at Work – 100-Level Tools



the following page.

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Do you think SBAR, briefs, call-outs, and check-backs are all tools that can be

easily accepted in your office? If so, which tool would you start with?

Do you think that you'd consider these to be 100-level skills in your office

environment? How would you introduce these 100-level tools to your staff?

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the following page.

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How did the coaches use the huddle to understand their problem about SBAR not

being used?

What might have happened if the coaches did not have this huddle?

How would you build on the 100-level tools to introduce these more advanced

tools to your staff?

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After you’ve watched the video, spend 10 minutes answering the question on

the following page.

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Imagine that the individuals in the video said that the DESC script didn't work

because the other individual was unresponsive. How might you approach the

other individual and coach him or her about DESC?

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Slide 23: Characteristics of Effective Coaches

Take 10 minutes and answer the questions below.

Think of a coach in your life and list his or her characteristics. How do these

compare to what has just been discussed?

What types of powerful questions did this coach ask you to help you with your

development?

What types of powerful questions might you ask to help a teammate who is

anxious about using the CUS tool?

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Slide 30: Coaching Debriefs Using the 3 I’s

How would you use the 3 I's to coach a team member who just had a debrief

that skipped the step to discuss whether workload was equitable? Take 10

minutes and complete the 3 I’s below.

I saw this:

I wonder why:

I think that:

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Slide 33: Coaching SBAR “In the Moment”

Take 10 minutes and answer the questions below.

What type of leadership support do you need in order to have a culture where

you can coach in the moment?

When have you unofficially coached in the moment in your daily life? Was it

effective or ineffective?

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Slide 35: Coaching Situational Awareness Using the 3 I’s

How would you use the 3 I’s to coach Emily to have more situational

awareness? Take 10 minutes and complete the 3 I’s below.

I saw this:

I wonder why:

I think that:

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Slide 38: Coaching the Two-Challenge Rule Using the 3 I’s

How would you use the 3 I’s to coach Barbara in this situation? Take 10 minutes

and complete the 3 I’s below.

I saw this:

I wonder why:

I think that:

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Slide 41: A Need for Coaching



the following page.

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What TeamSTEPPS tools are being modeled by the coach?

What skills is she using to coach the CUS tool to Nurse Larry?

How could she continue to coach him after this initial encounter?

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MODULE 9: CHANGE MANAGEMENT

Slide 7: Change Management Activity

Take 30 minutes to complete the following activity.

Step 1: Think of a story, such as a critical incident, that you’ve experienced related

to organizational change. It can be an example of either a successful or an

unsuccessful change effort. It can be something that is work related or non-work

related. Think about how and why the change was introduced, and by whom.

What was the organizational change? Why was the change introduced? Who

introduced it? How was it received? Were any barriers involved?

If there were barriers, how were those barriers overcome? What happened? Was

it successful? What made it successful or unsuccessful?

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Step 2: Based on the change you’ve experienced, what are some best practices

related to implementing new programs in an organization? You may want to

discuss with other members of your office to gather a list of best practices.

Step 3: Identify which one or two are the most important best practices. Why did

you choose these?

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Slide 8: Change Management Activity Continued

Review the eight steps of change and spend 10 minutes answering the

questions below in Steps 4 and 5.

Step 4: Which one of these eight steps of change seem to be the most difficult for

your organization? Why?

Step 5: What are some common errors that occur in your organization when

trying to make an organizational change? How do you plan to address them

moving forward?

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MODULE 10: MEASUREMENT

Slide 25: Evaluating TeamSTEPPS in Office-Based Care

Based on the scenario, take 10 minutes and answer the following questions.

Which measure or measures would you use to assess whether instruction about

briefings transfers to this primary care office’s work environment? Why did you

choose the identified measures?

What organizational barriers might interfere with successful training transfer and

how can these barriers be addressed?

Which measure or measures would you use to determine whether briefings

affected patient safety outcomes?

Why did you choose the identified measures?

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MODULE 11: IMPLEMENTATION PLANNING

Slide 8: 10 Steps of Implementation Planning

As you go through the 10 steps of implementation planning, at the end of each

step, please take 10 minutes per step and answer the corresponding questions.

Please note, this is an abbreviated version. To access the complete

Implementation Workbook, visit AHRQ’s Web site:

https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/cu

rriculum-tools/teamstepps/officebasedcare/impworkbook.pdf

Describe the office:

Name of office area:

Size of office area:

Number of staff within office area

Physicians:

Nurses:

Other:

https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/officebasedcare/impworkbook.pdf

https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/officebasedcare/impworkbook.pdf

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Slide 10: Step 1: Create a Change Team

Members TeamSTEPPS Trained?

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Slide 12: Step 2: Define the Problem, Challenge, or

Opportunity for Improvement

What existing information will you review?

1.

2.

3.

What new information will you collect?

1.

2.

3.

What are the main problems and opportunities?

1.

2.

3.

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Slide 15: Step 3: Define the Aims of Your TeamSTEPPS

Intervention

Team Process Aims

1.

2.

3.

Team Outcome Aims

1.

2.

3.

Clinical Outcome Aims

1.

2.

3.

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Slide 17: Step 4: Design a TeamSTEPPS Intervention

List the risk points you intend to address:

1.

2.

3.

List the TeamSTEPPS tools and strategies that will be implemented:

1.

2.

3.

List the order in which the tools and strategies will be implemented:

1.

2.

3.

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Slide 19: Step 5: Develop a Plan for Testing the Effectiveness

of Your TeamSTEPPS Intervention

Who is responsible?

At what level will you measure and what measures will you use?

Level I: Reactions

Level II: Learning

Level III: Behavior

Level IV: Results

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Slide 21: Step 6: Develop an Implementation Plan

Who will attend the training sessions?

What skills will you train?

When will the training sessions occur and for how long?

Where will the sessions occur?

How will you train (method of presentation, tools, supplies, etc.)?

What are the logistics to consider?

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Determine how coaches will be used.

Number required:

When will coaches be trained?

How will coaches be trained?

How will coaches be used?

What are the expectations for the role of coaches?

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Slide 23: Step 7: Develop a Sustainment Plan

Identify components of a Sustainment Plan:

1. Measures and Targeted Outcomes

2. Data Sources

3. Resource Requirements

4. Individuals Responsible

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Slide 25: Step 8: Develop a Communications Plan

Who are the stakeholders?

What do you want to achieve?

What information will you communicate?

When will you communicate?

How will you communicate?

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Slide 27: Step 9: Develop a TeamSTEPPS Implementation Plan

Timeline

Step Lead Completion

Date Resources Required

1. Identify the Change Team

2. Define the Main Problems

3. Define TeamSTEPPS Aims

4. Describe the Intervention

5. Develop a Test Plan

6. Develop an Implementation Plan

7. Develop a Sustainment Plan

8. Develop a Communication Plan

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Slide 29: Step 10: Review Your Plan With Key Stakeholders

Who are the key stakeholders that need to review the plan?

1.

2.

3.

4.

5.

Documents

PARTICIPANT WORKBOOK · Team leaders should use a briefing checklist to plan and manage team briefs. Spend 10 minutes writing down your answers to the questions below. Have you ever