Executive Briefing Team STEPPS What is Team STEPPSTM

Executive Briefing

Team. STEPPS What is Team. STEPPSTM? n An evidence-based teamwork system n Designed to improve: Quality n Safety n Efficiency of health care n Practical and adaptable n Provides ready-to-use materials for training and ongoing teamwork n Mod 1 05. 2 Page 2 TEAMSTEPPS 05. 2

Team. STEPPS Why Use Team. STEPPS? n Goal: Produce highly effective medical teams that optimize the use of information, people and resources to achieve the best clinical outcomes n Teams of individuals who communicate effectively and back each other up dramatically reduce the consequences of human error n Team skills are not innate; they must be trained Mod 1 05. 2 Page 3 TEAMSTEPPS 05. 2

Team. STEPPS Why Invest in Team. STEPPS? n Cost of Team. STEPPS is minimal compared to savings n Annual cost is approximately 98, 000 lives and $17 -29 billion n Errors can be reduced by changes to the health care system; specifically by providing interdisciplinary team training Reference: Kohn LT, Corrigan, JM, Donaldson, MS. Eds. To err is human: Building a safer health system. Washington, DC: Committee on Quality of Health Care in American, Institute of Medicine, National Academy Press, 2000. Mod 1 05. 2 Page 4 TEAMSTEPPS 05. 2

Team. STEPPS What Can Team. STEPPS Do for Us? Emergency Department 1 Clinical Units in a Medical Center 2 After implementation of multiple medical team training programs: • Improved observed team behaviors. • Enhanced staff attitudes toward teamwork. • Reduced observed clinical errors. Mod 1 05. 2 Page 5 After implementation of SBAR to improve communication among clinical caregivers: • Reduced rate of adverse drug events (from 30 to 18 per 1, 000 patient days). • Improved medication reconciliation at patient admission from 72% to 88% and at discharge from 53% to 89%. 1. Morey, JC, Simon, R, Jay GD, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: Evaluation results of the Med. Teams project. Health Serv Res. 37: 1553 -1581, 2002 2. Haig, K. , Sutton S, Whittington, J. SBAR: A shared mental model for improving communication between clinicians. JL Comm J Qual Patient Saf 32(3): 167 -75, March 2006. TEAMSTEPPS 05. 2

Team. STEPPS What Can Team. STEPPS Do for Us? Labor and Delivery Units 1 After implementation of multiple teamwork strategies and tools: - A 50% reduction in the Weighted Adverse Outcome Score (WAOS). The WAOS describes the adverse event score per delivery. - A 50% decrease in the Severity Index, which measures the average severity of each delivery with an adverse event. Intensive Care Units (ICU)2 After implementation of a “Patient Daily Goals” form to facilitate staff communication: • A 50% decrease in mean ICU length of stay from 2. 2 days to 1. 1 days. Mod 1 05. 2 Page 6 1. Mann, S, Marcus, R, Sachs, B. Lessons from the cockpit: How team training can reduce errors on L&D (Grand Rounds) Contemporary OB/Gyn v 51 i 1: 34(8), January 2006. 2. Pronovost, P, Berenholtz, S, Dorman, T, Lipsett, PA. , Simmonds, T, Haraden, C. Improving communication in the ICU using daily goals. J Cri Care 18(2): 71 -5, Jun 2003. TEAMSTEPPS 05. 2

Team. STEPPS What Can Team. STEPPS Do for Us? Operating Rooms (OR) After implementation of a “pre-op” brief: • Increased OR communication. 1, 2 • Increased administration of properly timed prophylactic antibiotics prior to incision from 84% to 95%. 1 • Increased pre-op deep vein thrombosis prophylaxis prior to induction from 92% to 100%. 1 • Error avoidance: Pre-op brief revealed seven patients (3. 3%) with previously unidentified severe surgical risks — surgery cancelled. 1 • A 16% reduction in nursing turnover rate. 2 • A 19% increase in OR employee satisfaction. 2 1. Awad, SS, Fagan, SP, Bellows, C. , Albo, D, et al. Bridging the communication gap in the operating room with medical team training. Am J Surg 190(5): 770 -4, Nov 2005. 2. Leonard, M, , Graham, S, Bonacum, D. The human factor: The critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 13 Suppl 1: i 85 -90, Oct 2004. Mod 1 05. 2 Page 7 TEAMSTEPPS 05. 2

Team. STEPPS What Makes Team. STEPPS Different? n Evidence-based and field-tested n Comprehensive n Customizable n Easy-to-use teamwork tools and strategies n Publicly available Mod 1 05. 2 Page 8 TEAMSTEPPS 05. 2

Team. STEPPS What Will Our Teams Learn? Mod 1 05. 2 Page 9 TEAMSTEPPS 05. 2

Team. STEPPS How Does Team. STEPPS Work? I. Assessment n Clearly define the need II. Planning, Training, and Implementation n Plan to sustain the effort n Train individuals n Implement and test the strategies III. Sustainment n Integrate into daily practice n Monitor and measure programs Mod 1 05. 2 Page 10 TEAMSTEPPS 05. 2

Team. STEPPS What Do We Need to Make This Work? n Clearly define the need n Focus on enhancing teamwork and establishing a teamwork n n and safety culture Support from senior leadership Allocate sufficient resources n Personnel n Time n Resources Measure success Reward and reinforce teamwork Mod 1 05. 2 Page 11 TEAMSTEPPS 05. 2

Team. STEPPS What Does Training Cost? Key to Table Figures n n n n n $A = Trainer preparation costs - Trainers’ time x trainers’ hourly rate $B = Travel costs related to any of the trainer sessions $C = Trainer costs to conduct training - Trainers’ time x trainer hourly rate $D = Trainee costs - Number of staff to be trained x (number of training hours) x staff hourly rate $E = Other training expenses - Food, senior leadership time for kickoff, etc. $F = Trainer costs for ongoing support - Number of “areas” participating X (hours of support) x trainer/coach hourly rate $G = Optional cost for staff time discussions - As normal course of business $H = Other ongoing support costs $I, $J, $K = Total - The estimated costs at bottom of each column Mod 1 05. 2 Page 12 TEAMSTEPPS 05. 2

Team. STEPPS What Does Training Cost? Trainer Staff Other Costs Preparing Trainers $A Conducting Training $C $D $E ongoing Support $F $G $H TOTAL $I $J $K Mod 1 05. 2 Page 13 TEAMSTEPPS 05. 2 $B

Team. STEPPS How Do We Start? 1. Create a sense of urgency 2. Pull together the guiding team 3. Formulate a change vision and strategy 4. Communicate your vision for understanding and buy-in 5. Send trainers to one of the Team. STEPPS National Implementation Project Training Resource Centers Mod 1 05. 2 Page 14 TEAMSTEPPS 05. 2

Team. STEPPS Training for the Guiding Team 1. Training is available until 9/1/09 2. Training is available on a “first come – first served” basis 3. Contact the National Implementation Project for Team. STEPPS and apply n n Mod 1 05. 2 Page 15 Complete the readiness assessment Submit the statement that indicates they have completed the readiness assessment and contact info by email: tsteppstrainingapps@air. org For answers to qualification questions, call: (877)-6 STEPPS (678 -3777) TEAMSTEPPS 05. 2

Team. STEPPS Backup Slides n The following slides (16 – 21) are slides that can support the briefing and may be integrated into slides 1 – 14 as appropriate. Mod 1 05. 2 Page 16 TEAMSTEPPS 05. 2

Team. STEPPS National Teamwork Initiatives n Accreditation Council for Graduate Medical Education (ACGME) and the Association for American Medical Colleges (AAMC) include aspects of communication, coordination, and collaboration in physician competencies n National Quality Forum (NQF) included teamwork training, skill building and teamwork interventions in Safe Practices for Better Health Care: A Consensus Report (2006 Update) n The Joint Commission has increasingly included elements of teamwork in their National Patient Safety Goals and accreditation standards n Centers for Medicare & Medicaid Services (CMS) included Team. STEPPS in the 9 th Scope of Work Mod 1 05. 2 Page 17 TEAMSTEPPS 05. 2

Team. STEPPS Importance of Communication n Communication failure has been identified as the leading root cause of sentinel events over the past 10 years (Joint Commission) n Communication failure is a primary contributing factor in almost 80% of more than 6000 root cause analyses of adverse events and close calls (VA Center for Patient Safety) Mod 1 05. 2 Page 18 TEAMSTEPPS 05. 2

Team. STEPPS What Does it Cost? n Costs can be modified by obtaining materials and having trainers teach themselves n Based on the National Implementation of Team. STEPPS Project, we estimate that a Change Team Member will spent 10% FTE (200 hrs) on this effort Mod 1 05. 2 Page 19 TEAMSTEPPS 05. 2

Team. STEPPS Resources Available Team. STEPPS resources include: n n n Mod 1 05. 2 Page 20 Three teamwork training curricula Course Management Guide Multimedia course materials Team. STEPPS Implementation Guide Measurement tools Web site for updated resources and information: http: //teamstepps. ahrq. gov/ TEAMSTEPPS 05. 2