Integrating Quality Improvement Methods to Improve Teamwork and

Integrating Quality Improvement Methods to Improve Teamwork and Patient Safety December 9, 2015

Integrating QI Methods to Improve Teamwork Team. STEPPS® Rules of Engagement n Audio for the webinar can be accessed in two ways: 1. Through the phone (*Please mute your computer speakers) 2. Through your computer n A Q&A session will be held at the end of the presentation n Written questions are encouraged throughout the presentation and will be answered during the Q&A session n Mod 1 05. 2 Page 2 Slide 2 To submit a question, type it into the Chat Area and send it at any time during the presentation TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Upcoming Team. STEPPS Events n Monthly Webinars n n n Scheduled through August 2016 Topics, speakers, and registration information will be posted on the portal Register now for the January webinar: n “Team. STEPPS in the NICU and the Role of Leaders in the Process, ” presented by Jim Rost, MD, Shady Grove Medical Center and Jennifer Ustianov, MS BSN RN, National Institute for Children’s Health Quality n Master Training Courses n Registration for course through April 2016 open now n Annual Conference n June 8 -10, 2016 n Hyatt Regency Capitol Hill, Washington, DC Mod 1 05. 2 Page 3 Slide 3 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Upcoming Team. STEPPS Events (Cont’d) n Online Course Availability n Not able to travel? Training through the Team. STEPPS 2. 0 Online Master Trainer Course is available. n Register at: https: //tslms. org n Learn more and register for all events at www. Team. STEPPSportal. org Mod 1 05. 2 Page 4 Slide 4 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Help Line (312) 422 -2609 Or email: AHRQTeam. STEPPS@aha. org Mod 1 05. 2 Page 5 Slide 5 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Today’s Presenters n Randolph Steadman, MD, MS n Professor and Vice Chair, Anesthesiology n Director, UCLA Simulation Center n Yue Ming Huang, Ed. D, MHS n Associate Adjunct Professor, Anesthesiology n Education Director, UCLA Simulation Center n Robert Martin, Psy. D n Performance Excellence Specialist n UCLA Health System n Kenneth Miller, RN, MSN, CCRN n Nursing Simulation Program Coordinator n UCLA Nursing Research and Education Mod 1 05. 2 Page 6 Slide 6 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Objectives n Compare two quality improvement models designed to improve patient safety n Discuss how to integrate the models into a single program n Demonstrate three lean tools that can be applied to a Team. STEPPS course n Evaluate exercises designed to utilize these tools Mod 1 05. 2 Page 7 Slide 7 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Team. STEPPS Concept / Tool Lean Concept / Tool SBAR: situation, background, assessment, recommendation Example of standardized work; PDCA/PDSA (plan, do, check/study, act) A 3 methodology Call-Out / Check-Back: closed loop, directed communication Binary (yes/no) directed communication Handoff/I PASS THE BATON Example of standardized work Brief Huddle Debrief Reflection (Hansei) Situation Monitoring/STEP Example of standardized work Cross-Monitoring/Mutual Support/Task Assistance Level-loading (Heijunka) I’M SAFE Example of standardized work Shared Mental Model/Situation Awareness Visual Workflows & Andon Advocacy and Assertion Customer Voice (Value) Two-Challenge Rule / CUS “Stop the line” & Andon Conflict Management / DESC Smiling (Niko-Niko) calendar Mod 1 05. 2 Page 8 Slide 8 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® What is Lean? Mod 1 05. 2 Page 9 Slide 9 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Who is Implementing Lean? Mod 1 05. 2 Page 10 Slide 10 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® What is Lean Problem-Solving (PDCA/A 3)? Mod 1 05. 2 Page 11 Slide 11 TEAMSTEPPS 05. 2

Team. STEPPS® Mod 1 05. 2 Page 12 Slide 12 A 3 Example TEAMSTEPPS 05. 2 Integrating QI Methods to Improve Teamwork

Integrating QI Methods to Improve Teamwork Team. STEPPS® Problem Statement n Critical Care Transport n The average response times from medical plaza to transport patients either as direct or emergency room admissions is 55 minutes. This not only affects patient through-put, but it also influences our patient satisfaction. Mod 1 05. 2 Page 13 Slide 13 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Lean Tool: Process Mapping n Visual representation of steps in a process n Benefits: n Gives everyone clear understanding of the process n Helps identify value and waste n These are the most common symbols: Mod 1 05. 2 Page 14 Slide 14 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Critical Care Transport: Current State Process Map Mod 1 05. 2 Page 15 Slide 15 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Critical Care Patient Transport: New Process Using SBAR Mod 1 05. 2 Page 16 Slide 16 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Lean Tool: Time Observation n Accurately measure “what actually happens” n Helps streamline process and identify waste n Steps to perform time observation: n Describe each task in detail n Write the running time n Write notes & possible waste/issues n Calculate times and average n Perform more observations Mod 1 05. 2 Page 17 Slide 17 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Time Observation Example Mod 1 05. 2 Page 18 Slide 18 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Time Observation Example Mod 1 05. 2 Page 19 Slide 19 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Time Observation Example Mod 1 05. 2 Page 20 Slide 20 TEAMSTEPPS 05. 2

Team. STEPPS® Integrating QI Methods to Improve Teamwork Waste Models Can Help You Identify/Find Waste For “non-value added” activities, next you find/identify waste; this is made easier by using a model such as DOWNTIME* *Different systems classify wastes into different amounts of categories. Most use 7 (same as above but without N) or 8 but some use up to 11! ** There are different types of waste – Type 1 and Type 2. Type 1 adds no value and can be removed easily. Type 2 adds no value but is necessary in the current system and/or is very Mod 1 05. 2 Page 21 Slide difficult 21 to remove. This distinction will become more important when focusing on solutions TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Eight Wastes (Clinical Examples) n Defects n Incomplete Specialty referrals n Overproduction n Full sheet of labels printed when only one is needed n Waiting n Pt waits in exam room for MD n Not utilizing talent n Numerous ideas are “lost” only to be rediscovered later n MD/Nurse time spent on clerical tasks Mod 1 05. 2 Page 22 Slide 22 TEAMSTEPPS 05. 2 n Transport n Patients are taken from waiting room -> vitals intake -> waiting room -> exam room n Inventory n Expired supplies because of excess ordering n Motion n MA/Nurse spends time looking in multiple places for a particular supply n Extra processing n Patients asked the same questions multiple times

Integrating QI Methods to Improve Teamwork Team. STEPPS® DOWNTIME Analysis Mod 1 05. 2 Page 23 Slide 23 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Process Maps and Time Observations Help Define Goals n Critical Care Transport n Incorporate the use of SBAR in dispatch to decrease response time from 55 to 30 minutes within 6 months Mod 1 05. 2 Page 24 Slide 24 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® What is Root Cause Analysis (RCA)? n Problem: The granite of the Jefferson Memorial is crumbling at an increased rate n Why? n Because it was being washed frequently n Why? n Because it needed to be cleaned more often n Why? n Because many birds were increasing waste n Why? n Because of the number of spiders for birds to eat n Why? n Because spiders were eating a lot of smashed midge egg sacs n Why? n Because midges are attracted to the lights, which are turned on before dusk, and they smash into the memorial while swarming Mod 1 05. 2 Page 25 Slide 25 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Fishbone Diagrams to Illustrate RCA n Cause & Effect Diagrams (i. e. , Ishikawa or Fishbone) can be used to brainstorm or categorize causes (proximate or root) n Any set of categories can be mixed and matched depending on the situation (or make your own like the example below) n Identified root causes should be highlighted n 4 Ps (Place, Procedure, People, Policy) n 4 Ms (Method, Machine, Materials Manpower) n RSs (Surroundings, Suppliers, Systems, Skills) n Make up your own: Environment, Culture, etc. Mod 1 05. 2 Page 26 Slide 26 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Fishbone RCA: Critical Care Patient Transport Mod 1 05. 2 Page 27 Slide 27 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Mod 1 05. 2 Page 28 Slide 28 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Outcome of Integrating Lean and Team. STEPPS n By using lean tools and SBAR, we improved response time from 55 to 22 minutes n Potential to improve patient satisfaction Mod 1 05. 2 Page 29 Slide 29 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Summary n Team. STEPPS and lean are complementary n We can use lean tools to implement Team. STEPPS and vice versa n Lean tools we discussed: n n n Mod 1 05. 2 Page 30 Slide 30 PDCA/A 3 Process map Time observation sheet DOWNTIME analysis RCA/Fishbone diagram TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Questions and Answers Mod 1 05. 2 Page 31 Slide 31 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Questions? n Call us at: (310) 267 -2114 n Yue Ming Huang: yhuang@mednet. ucla. edu n Ken Miller: kenmiller@mednet. ucla. edu n Robert Martin: rsmartin@mednet. ucla. edu n Randolph Steadman: rsteadman@mednet. ucla. edu Mod 1 05. 2 Page 32 Slide 32 TEAMSTEPPS 05. 2

Integrating QI Methods to Improve Teamwork Team. STEPPS® Thank You! For more information, please contact our team at: AHRQTeam. STEPPS@aha. org Mod 1 05. 2 Page 33 Slide 33 TEAMSTEPPS 05. 2