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
TeamSTEPPS Master Training
Webinar
October 8, 2013
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Instructor
Karyn Baum, M.D., M.S.Ed., Professor of Medicine and Associate Chair for Clinical Improvement, University of Minnesota
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TeamSTEPPS Master Training
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
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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
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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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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
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Thank You!
For more information, please contact our team at:
Karyn Baum [email protected]
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TeamSTEPPS Master Training
• 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
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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
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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
Thank you
69