S

TeamSTEPPS:

Improving Outcomes

through Enhanced

Communication

September 23-24, 2015

John Nunes, MD

Gina Teeples, RNC

MaryJo Schaarschmidt, RNC

The Impact of Medical Errors

Two Boeing 747s, operated by

KLM and Pan Am, collide due to

breakdowns in communication

and safety checks. Number of

people killed: 583

This plane flew in a holding pattern for 77 minutes while awaiting

landing clearance at JFK and crashed due to a failure to

communicate the urgency of its fuel situation.

Number of people killed: 73

Asiana Airlines Flight 214 from Seoul to SFO

July 6, 2013 crashed on landing

due to no communication between the pilot and

the crew

As many as 400,000 DEATHSoccur as a result of medical errors

each year

That’s the same as a 747 jet falling out of the sky

EVERYDAY for a YEAR!

More Americans die from medical

errors than from breast cancer, AIDS or

car accidents combined

Cost associated

with medical

errors is

$8–29 billion

annually

Failures in Communication and

Human Factors are the leading contributors to

sentinel events.

~The Joint Commision

The solution?

TeamSTEPPS

S Strategies and Tools

to Enhance

Performance and

Patient Safety

TeamSTEPPS: Improving Outcomes

Through Enhanced Communication

Objectives

S Explore the role of organizational leadership in program

development and sustainment.

S Evaluate techniques that support the adoption of

TeamSTEPPS concepts and tools.

S Describe strategies to encourage staff and physician

engagement.

S Discuss the manifestation and relevance of resistance to

change and the positive effect of applying TeamSTEPPS

and in situ simulation as an integrated tool to overcoming

this resistance.

Definition of Resistance…..

synonyms: opposition to, hostility to, refusal to

accept"resistance to change"

•the refusal to accept or comply with something

•the attempt to prevent something by action or argument

•the ability not to be affected by something, especially adversely

•refusal to accept something new or different

•effort made to stop or to fight against someone or something

•the ability to prevent something from having an effect

Resistance

“Lies in one’s inability to

mentally conceive of certain

possibilities to think beyond

the boundaries of what we

presumably know or believe”

Liebler & McConnell, 2012

.

S

“In the United States things move from

the Impossible to the Inevitable without

stopping at the Probable.”

Alexis de Tocqueville

RESISTANCE

Characteristics of Resistance

RESISTANCE

Manifestations of Resistance

Patient Safety Movement

and Team Training

Patient Safety

and Quality

Improvement

Act of 2005

Executive

Memo from

President

DoD

MedTeams®

ED Study

Institute for

Healthcare

Improvement

100K lives

Campaign

“To Err

Is Human”

IOM Report TeamSTEPPS®

1995 1999 2001 2003 2004 2005

JCAHO National

Patient Safety

Goals

2006

TeamSTEPPS

Released to the

Public

2007

TeamSTEPPS

National

Implementation

Program Began

2008

National

Implementation

of CUSP

Centers for

Medicare &

Medicaid Services

Partnership for

Patients Campaign

2011

Medical Team Training

Institute of Medicine (1999)

S As many as 98,000 deaths occur as a result of medical errors

each year

James (2013)

S Estimates …”the true number of premature deaths associated

with preventable harm to patients was estimated at more than

400,000 per year.”

S “Serious harm seems to be 10 – 20 fold more common than

lethal harm.”

The State of Healthcare

Root Cause Analysis Information

Human Factors 189

Communication 170

Assessment 168

Leadership 149

No root cause identified 56

Information Management 43

Physical Environment 28

Continuum of Care 23

Care Planning 21

Medication Use 9

Perinatal events including death or permanent loss of function as reported by The Joint Commission.

(Full term infant > 2,500 g and absence of obvious congenital abnormality).

2004 through June 2013

(n = 254)

Root Cause

Analysis

Information

Wrong Patient, Wrong Site, Wrong Procedure Events

2004 – June 2013

(n = 988)

Leadership 812

Communication 674

Human Factors 666

Information Mgt. 364

Operative Care 339

Assessment 325

Physical Environment 94

Patient Rights 60

Anesthesia Care 52

Continuum of Care 36

S

What resistance sounds

like…

S

Physician Resistance

TeamSTEPPS

“Where are the doctors?”

“Are the doctors required to take this course?”

Two of the most frequently asked questions:

Dynamics that

Affect Physicians

S Loss of autonomy

S Loss of control

S Implementation of EMR

S Employment reality

S Complexity of care

S Lifestyle changes

S Life/work balance

Physician

Resistance to

Quality Measures

Individual competency vs

processes

Distrust of administration

Distrust of quality data

Self reliance above all else

Slow to accept need for

change

Baby Boomers vs Gen X

Teach

Medical

Students

Run

Practice

Solo for

7

Months

Need M-A

“Slow

Down”

FNP

Physician

Mentor

Support

and Lose

Practice

Partner

Support

to New

Partner

Leave Practice Pay

Large Non-Compete to

Build New Practice

Build New

Practice

Call

One

Clinic

Site

Director

Here’s The Reality!

Eric Hoffer

“In Times of Change, Learners Inherit

the Earth, while the Learned find

themselves beautifully equipped to deal

with a World that no longer Exists”

Change Without Resistance

Isn’t Change

J Curve of Change

Have we really transformed

the culture of our healthcare

environment?

The solution?

52

What Makes Up Team Performance?

Knowledge

Cognitions

“Think”

Attitudes

Affect

“Feel”

Skills

Behaviors

“Do”

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

Leadership

BEHAVIORS &

SKILLS

TOOLS &

STRATEGIES

Clear roles and

responsibilities

Team Leader

Performance

expectations

Delegation/

Resource

management

Facilitate team

problem solving

Brief

Huddle

Debrief

Team Leader

S Designated

S Situational

Situation Monitoring

BEHAVIORS &

SKILLS

TOOLS &

STRATEGIES

Actively

scanning

behaviors and

actions

Shared Mental

Model/

Situational

Awareness

Provide

feedback to

allow team

member to

self-correct

Cross

Monitoring

Establish a

safety net

STEP

Mutual Support

BEHAVIORS &

SKILLS

TOOLS &

STRATEGIES

Shift workload

to underutilized

team members

Task

Assistance

Give and

receive

information

Feedback

Advocacy and

Assertion

Conflict

resolution

Two-Challenge

Rule

Advocacy and

assertion

CUS

Communication

BEHAVIORS &

SKILLS

TOOLS &

STRATEGIES

Structured

communication

techniques

R-SBAR

Follow-up and

acknowledgement

Call-Out

Check-Back

Handoff

Why Teamwork?

“High-performance teams create a safety net for

your healthcare organization as you promote a

culture of safety."

SExperiential

SClinical setting

SLow or high fidelity

SSuspend disbelief

SActive debrief

SEducational

STeam-focused

In Situ Simulation

Equipment

Computers

Cameras

Supplies

Hal

Noelle

In Situ Simulation Set-Up

Vaginal Delivery with

Transport to the Operating Room

Value of an Integrated Model

S Creates an interactive, impactful team learning

environment that facilitates and changes culture from

the individual to the entire team

S Affords the opportunity to apply concepts and tools in

an educational environment

S Impacts team dynamic, communication, and clinical

performance

“Change is needed for us to develop

our skills, knowledge, and experience

for the benefit of our patients”

(Stonehouse, 2012)

Debrief

Performance Improvement

• Critical

• Empowers team

members

• Fosters collaboration

• Taking care of each

other

JERK

BAD

Simulation in Action

Neonatal Resuscitation

Team Assessment Questionnaire

Team Assessment Questionnaire

78

Results

“The team is a safety net for patients.”

Pre TeamSTEPPS training Post TeamSTEPPS training

Likert scale: 1 Strongly disagree, 2 Disagree, 3 Neither, 4 Agree, 5 Strongly Agree

Teamwork Attitude Questionnaire

(T-TAQ)

Teamwork Attitude Questionnaire

(T-TAQ)

It is important to have a standardized

method for sharing information

Teamwork Perception Questionnaire

(T-TPQ)Team Structure

Leadership

Communication

Situational MonitoringMutual Support

Teamwork Perception Questionnaire

(T-TPQ)

Team Structure

Leadership

Mutual Support

Staff are held accountable for their actions

Staff resolve conflicts, even when personal

Staff exchange relevant information as it becomes available.

Staff scan environment for important information

Staff share information about potentail complications.

Staff Notes….

Challenges

Based on

Setting

Culture

Competing

priorities

Resources

Leadership is

Key

Change leaders…

SEmbrace change

SExpect resistance

SEngage employees

SLeverage champions

SPlan thoroughly

SCommunicate fully

SConvince as necessary

SMonitor, monitor, monitor…

•Communication

and involvement are

a MUST!

“Change itself is neither good

nor bad, it is inevitable.”

“It’s what you learn after you know it

all that counts.”

John Robert Wooden,

Former UCLA Head Coach

The Price of Doing Great Things

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Thank you!

John Nunes, MD

drnunes@me.com

Gina Teeples, RNC

gteeples@valleycare.com

MaryJo Schaarschmidt, RNC

mschaars@valleycare.com