7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 1/20

EHM: Teamwork,

Communication and Culture

Make no little plans…..

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 2/20

Understanding Culture

• Why Culture Matters

 – CUSP:

•Methods to examine culture

 – Team Check-up Tool

• Tools for changing culture

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 3/20

What is my Unit’s Culture?

The set of shared attitudes, values,

goals, and practices that characterizesmy unit…or an institution, organization

or group

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 4/20

What is a Safety and QualityCulture?

“The enduring value and priority placed on a worker and

public safety by everyone in every group at every level of 

the organization. It refers to the extent to which

individuals and groups will commit to personal

responsibility for safety and quality; act to preserve,

enhance and communicate safety concerns; strive to

actively learn, adapt and modify (both individual and

organizational) behavior based on lessons learned from

mistakes; and be rewarded in a manner consistent with

these values.”

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 5/20

High Functioning Teams

• Positive Communication patterns

• Deceased levels of interpersonal conflict

• Increase collaboration• Increase cooperation

• Increase participation

5

Lemieux –Charles, MacQuire, What do we know about health careteam effectiveness? Review of the literature, Med Car Res Rev, 2006.

63:263-300

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 6/20

Safety, Quality & US Healthcare System

• Medication errors

• Adverse events

• Unnecessary infections and deaths – Nearly 2 million HAIs in US hospitals each year

 – Nearly 100,000 deaths from HAIs

 – Cost of HAIs is $5-6 billion annually

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 7/20

Culture Matters: The Evidence

Safety Theme Author Description

Unit Variation

/Mgr +

attitudes

Huang

2007

Safety culture variation exists across ICUs of a single

hospital. ICU nursing directors tend to overestimate their

personnel’s attitudes, particularly for teamwork

Units are key &

team training

works

Mohr ,

2004

Mann,

2006

A clinical microsystem (unit) is an important level to focus

safety interventions, where errors can be prevented or

mitigated After team training, a 50% reduction in adverse

outcomes was achieved

Teamwork

reduces nurse

turnover

Di Meglio

2005

Organizations that have effectively implemented a

medical teamwork system have a 27% reduction in nurse

turnover

7

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 8/20

Antenatal Steroid Use in CA 2005-2007

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 9/20

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 10/20

Communication Disconnection

www.youtube.com/watch?v=1fuDDqU6n4o 

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 11/20

Teamwork Disconnect

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 12/2012

0

10

20

30

40

50

60

70

80

90

100

   %   o    f   r   e   s   p   o   n   d   e   n   t   s   w

   i   t   h   i   n   a   n   I    C   U   r   e   p   o   r   t   i   n   g   g   o   o   d   t   e   a   m   w   o   r   k

   c   l   i   m   a   t   e

Teamwork Climate Across Michigan ICUs

No BSI 21% No BSI 44%No BSI 31%

No BSI = 5 months or more w / zero

The st rongest predictor of clinical excellence:caregivers feel comfor table speaking up if t hey

perceive a problem w it h patient care

Health Services Research, 2006;41(4 Part II):1599.

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 13/20

0

10

20

30

40

50

60

70

80

90

100

RN Teamwork Climate Staff Physician Teamwork Climate

Teamwork Climate &Annual Nurse Turnover

13

   %   r   e   p   o   r   t   i   n   g   p   o   s   i   t   i   v   e   t   e   a   m   w   o   r

   k   c   l   i   m   a   t   e

High Turnover 16.0% Low Turnover 7.9%Mid Turnover 10.8%

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 14/20

“Needs Improvement” Statewide

Michigan CUSP ICU Results

• “Needs Improvement” means

less than 60% of respondents

reported good safety climate

•

Statewide in 2004 84%needed improvement, in

2007 23%

• Safety Climate item that

drives improvement: “I am

encouraged by my colleagues

to report any patient safety 

concerns I may have”

14

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 15/20

Team Check Up Tool

• Purpose: Monitor progress of project teams to

increase breastfeeding rates

• Team Use

 – Identify activities that influence performance

 – Identify barriers

 – Identify opportunities

 – Communication: Senior leaders, nurse, physician,

families

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 16/20

EHM Team Check Up Tool

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 17/20

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 18/20

Other Teamwork and Communication

Tools

• Daily Goals Checklist

• Morning briefing or “Huddle”

• “Walk Rounds”• Debriefing

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 19/20

TCT Time!

• 10 minutes to complete TCT at your tables

• One representative report out

7/31/2019 PQCNC Human Milk Phase II Learning Session 1: Culture Communication Teamwork

http://slidepdf.com/reader/full/pqcnc-human-milk-phase-ii-learning-session-1-culture-communication-teamwork 20/20

Make no little plans…

“Make no little plans; they have no magic tostir men's blood and probably willthemselves not be realized. Make big plans;

aim high in hope and work, rememberingthat a noble, logical diagram once recordedwill not die.”

Daniel Burnham (Master Architect and CityPlanner Chicago, DC, Union Station…)