for OfficeBased Care Online Taking Team STEPPS Beyond

for Office-Based Care Online Taking Team. STEPPS Beyond the Hospital to Primary Care Settings: The Metro. Health Story

Team. STEPPS for Office. Based Care This Webinar and Future Webinars n Webinar is part of a library to support and amplify your work on Team. STEPPS for Office-Based Care Online is funded by AHRQ. Mod 1205. 2 Page 2 Slide TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Rules of Engagement n Dial-in: 1 -877 -410 -5657 Passcode: 165984 n Questions are encouraged throughout the presentation and will be answered at the end. n To submit a question, type it into the Chat Area and send it at any time during the presentation. n An evaluation will be emailed to you shortly after the webinar. Mod 1305. 2 Page 3 Slide TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Presenters n Maria Podmore, M. P. A. , B. S. N. , RN, NEA, Director of Nursing n Katie Carney, M. P. A. , B. S. N. , RN, NEA, Associate Chief Nursing Officer n Robert L. Smith, Ph. D. , Director, Medical Staff Assistance Programs & Team. STEPPS Mod 1405. 2 Page 4 Slide TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Team. STEPPS at Metro. Health Primary Care Team. STEPPS Primary Care Mod 1505. 2 Page 5 Slide TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Overview of Metro. Health n Level I Adult Trauma n Burn Center n Level III NICU n Academic Medical Center n Case Western Reserve University School of Medicine n Magnet Mod 1605. 2 Page 6 Slide Serving Cuyahoga County since 1837 TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Metro. Health Services n $1 billion in operating n Over 3, 000 births revenue n Twenty-three health centers n Over 1, 200, 000 ambulatory visits n Over 125, 000 emergency department visits n Over 7, 500 employees n Over 5, 000 trauma n Five Metro Express. Care n Four discount Drug Mart Clinics n Three community EDs n Two micro hospitals activations Mod 1705. 2 Page 7 Slide n Nine pharmacies TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Team. STEPPS n Initiated Program in 2013: Mod 1805. 2 Page 8 Slide n Identified Team. STEPPS Champion n Established Team. STEPPS Change Team n Prepared Master Trainers n Developed Steering Committee n Agreed To Implement Systemwide n Developed Instructor Training Course TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Recent History of Metro. Health’s Primary Care Growth n Cleveland divided into east, west, and south n Acquired an existing primary care network - their facilities, equipment, and many staff, as well as their patients n Expanded Metro. Health’s capacity overnight n Faced with integrating a new network into our existing organization and building new clinical teams Mod 1905. 2 Page 9 Slide TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Leadership’s Role in Overcoming Barriers in Primary Care Setting n Supporting for the Train-the-Trainer Model n Enabling instructors to dedicate time to teaching classes n Engaging physicians and ensuring participation n Approving staff to take time away from work for training n Approving changes in templates for patient care Mod 110 Slide 05. 2 Page 10 TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care First Pitfall in Primary Care Setting n New satellite was struggling and leadership believed in Team. STEPPS and wanted a “quick fix. ” n Timeline was too short for Train-the-Trainer approach: Mod 111 Slide 05. 2 Page 11 n Required use of Master Trainers in a single-day course for all staff n Felt like an assembly line; simply an educational session; no staff ownership or buy-in TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Three Stages in Implementing Team. STEPPS in Ambulatory Care n Stage 1: Planning n Identify instructors, conduct survey, and develop curriculum. n Using survey results to customize concepts to departmental needs n Stage 2: Training n Schedule sessions that work for the department. n Stage 3: Sustaining Mod 112 Slide 05. 2 Page 12 n Create Team. STEPPS Action Council (TAC). n Implement solutions using Team. STEPPS concepts. TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Stage 1: Planning n Identified Coordinators, who attended AHRQ Primary Care Team. STEPPS Master Trainer Class n Had employees who attended Train-the-Trainer class (24 instructors) help design ambulatory care curriculum n Created one universal ambulatory team to develop the training process n Held weekly meetings to develop training: Mod 113 Slide 05. 2 Page 13 n Divided group to address four topics: Leadership, Mutual Support, Situational Monitoring, and Communication n Allowed instructors to choose section but ensured groups were diverse in positions, personalities, and sites TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Stage 1: Planning (cont’d) n Pushed to roll out to all ambulatory satellites: Mod 114 Slide 05. 2 Page 14 n Initial thought to close sessions to capture whole team at same location n Problems Identified: n Too many locations and sessions n Too many “travelers, ” working in multiple clinics n Impact on staffing n Impact on revenue TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Stage 1: Planning (cont’d) n Allowed variation in training to engage staff: n Together, as a department or site, they adapted the curriculum. n Instructors came from the universal ambulatory team. n Internal Medicine Clinic: n n n Mod 115 Slide 05. 2 Page 15 Developed their own curriculum and selected their own instructors Offered four 1 -hour session over 4 months, with each session covering one of the components of Team. STEPPS Satellites also used a creative approach. TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Creative Approach for Satellites n Curriculum developed by the universal ambulatory team Barriers Mod 116 Slide 05. 2 Page 16 Solutions Too many locations and sessions to close Integrated sessions Travelers working at different clinics Self-selected location Space not available Sessions held at large sites east/west Impact on staffing and workflow Sent staff that worked best for clinic Revenue impact Did not close sessions Lack of staff engagement Made training fun and interactive TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Framework n Total staff to be trained divided by class size (20 max) n Selected locations: east and west side locations n Process to identify instructors for each session n n Used online tool Had signup for providers and another process for other staff n Learning management system for signup n Coordinators who assisted in overcoming stumbling blocks: n n Mod 117 Slide 05. 2 Page 17 Helped with creative scheduling options (evenings and Saturdays) Called in TS champion to increase motivation TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Stage 2: Training n Needed to improve engagement—not just another program: n Added videos that simplified concepts and that were entertaining (created laughter) n Created a video in one of the clinics demonstrating undesirable and then desirable behavior using Team. STEPPS tools n Mod 118 Slide 05. 2 Page 18 Video was “relatable” by including people they knew and a familiar environment. TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Stage 2: Training (cont’d) n Needed to get trainees out of their seats n Set up an exercise using tennis balls to simulate the four principles: Mod 119 Slide 05. 2 Page 19 n Balls represented patients. n The group represented employees of a new clinic and they had to create the new workflow. n Exercise was conducted after each principle was taught, building on the last one. TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Stage 2: Training (cont’d) n Ready…Set…Go!!!! n Email blast with instructions to all site leadership for staff to sign up on LMS: Mod 120 Slide 05. 2 Page 20 n Medical Leads n Regional Directors n Directors of Nursing n Nurse Managers n Operations Managers TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Stage 2: Training Sessions n First 8 sessions were canceled due to lack of understanding of expectations. n Sponsor continued to have multiple discussions with ambulatory senior leadership. n We recruited a small class. SUCCESS! The word goes out: Mod 121 Slide 05. 2 Page 21 n Increased signups n Canceled more sessions to better fill classes n Added sessions as needed TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Stage 2: Lessons From Training n Struggled with instructor signup because it was in addition to their “day job”: n Clinics could not spare time from staffing. n Float pool staff were used as instructors. n Created a trainer kit for grab and go training: Mod 122 Slide 05. 2 Page 22 n Binder with step-by-step instructions n Speaking notes n Bag of balls n Candy n Sign-in sheets and feedback forms n Exercise tools TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Stage 2: Training Metrics Mod 123 Slide 05. 2 Page 23 Sessions Participants Sites/ Departments 50+ 633 27 TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Stage 2: Training Feedback n Sample Comments: Mod 124 Slide 05. 2 Page 24 n “I didn’t want to come to this class and was not interested… it was the best class I have ever taken. ” n “I can’t wait to CUS. ” n “Excellent reinforcement of team principles. ” n “I think the class was great; enjoyed the videos. ” n “Get more departments together as it enriches the program. ” n “It was great!!” TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Stage 3: Sustaining n Team. STEPPS Action Council (TAC) n Part of sustainability n Clinical and non-clinical areas n Goals: n Improve Patient Safety/Customer Service (Quality). n Improve Patient/Customer Satisfaction (Patient Experience). n Improve Employee Engagement (Human Resources). n Mod 125 Slide 05. 2 Page 25 Improve Processes and Increase Efficiencies (Lean/Six Sigma). TEAMSTEPPS 05. 2

Stage 3: Structure of the TACs Team. STEPPS for Office. Based Care n Action Council has two co-chairs: n Co-chairs are not part of leadership. They are line staff. n Master Trainer sits on the Action Council to support the co-chairs. n One person represents every discipline/job category on the unit. n Council includes patient and family advisors. n One administrator serves on the council to address barriers. n One Team. STEPPS Master Trainer serves on the council. Mod 126 Slide 05. 2 Page 26 TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Examples of Team. STEPPS Implementation and TAC Formation Mod 127 Slide 05. 2 Page 27 TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Stage 3: Sustaining—Next Steps n Monthly Sustainment Committee meeting was created: n Committee members would report what current TACs were doing. n Committee would discuss how to help departments establish their TACs: n Mod 128 Slide 05. 2 Page 28 Struggles because it is something new and not sure how to make it work n Wondering how we share ideas to share ideas…. . n Too difficult to have everyone come to a monthly meeting TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Stage 3: Sustaining—Use of Huddle n Created a monthly conference call: Mod 129 Slide 05. 2 Page 29 n Established dates and time n Set call-in number n Established a lead for the call n Asked member of each TAC to provide a monthly update n Generated high-level discussion, sharing ideas and addressing barriers TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Briefing Checklist Mod 130 Slide 05. 2 Page 30 TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Current Actions and Next Steps n Quality projects are reported to leadership, highlighted on our intranet, and presented at seminars and conferences. n Next Steps: Mod 131 Slide 05. 2 Page 31 n Meet with satellite leadership to encourage and assist establishing a TAC. Continuous work in progress. n Determine areas in need of “redosing. ” TEAMSTEPPS 05. 2

Team. STEPPS for Office. Based Care Questions Mod 132 Slide 05. 2 Page 32 TEAMSTEPPS 05. 2