TeamSTEPPS: Improving Outcomes through Enhanced … · 2020. 5. 19. · Teamwork Perception...
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S TeamSTEPPS: Improving Outcomes through Enhanced Communication September 23-24, 2015 John Nunes, MD Gina Teeples, RNC MaryJo Schaarschmidt, RNC
Transcript of TeamSTEPPS: Improving Outcomes through Enhanced … · 2020. 5. 19. · Teamwork Perception...
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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
.
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“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
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What resistance sounds
like…
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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?
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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
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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
Gina Teeples, RNC
MaryJo Schaarschmidt, RNC
