Team STEPPS OBGYN A Department Initiative Audrey Perry

Team. STEPPS OBGYN: A Department Initiative • Audrey Perry, CNMW, IPECS Initiative • Jane Hooker, Director, Patient Safety • Mark B. Woodland, MS, MD

Team. STEPPS Departmental Goals • Explore evidence based communication methods • Recognize barriers to situational leadership • Develop shared techniques to resolve conflict • Shared mental model/ language of team work “A Department of OBGYN Inter-professional Initiative” 2

Team. STEPPS Teamwork Attitudes Survey • Participants (n=76) • RN (4), CNM (19), NP (11), PA (7), MD (26), Resident (9) • General positive attitudes toward communication best practices • General positive attitude toward team based best practices “A Department of OBGYN Inter-professional Initiative” 3

Pre. Survey Results: “A Department of OBGYN Inter-professional Initiative” 4

Team. STEPPS Director Patient Safety Observations Project Began Sharing Information on Communication and Patient Safety • Communication breakdowns figured in 30% of all malpractice claims between 2009 -2013 • Communication breakdowns occurred in all settings o 44% IP, 48% Medical Offices, 8% ED • Miscommunication occurs between all roles • TJC findings reveal communication primary root cause in over 70% of Sentinel Events • 75% of these events ended with the death of the patient “A Department of OBGYN Inter-professional Initiative”

Team. STEPPS Director Patient Safety Observations Over-arching issues from the literature • • Language (different between professions and EMR**) Education (lack of knowledge, skills) Social status (hierarchy) Personal styles Culture Generational gaps/Historical context Pace of work and life Rapid pace of evolution of science in medicine “A Department of OBGYN Inter-professional Initiative”

Team. STEPPS Chair Observations • Unique experience for an entire department to highlight OPPE (Ongoing Professional Performance Evaluation). • Different providers engaged differently. • Majority of providers saw the value of the exercise and the message in communication. • Action items were identified to help improve communication to enhance patient experience, safety and quality of care. Here a few: • Optimize electronic communication - Electronic communication has many advantages and many disadvantages. Disadvantages decrease provider satisfaction and can adversely impact patient experience, quality and safety of care. • Enhance human to human communication – Human to human communication is essential to know that communication has happened. • Facilitate Documentation - Documentation of communication is also essential. • Close Communication Loops - Open loops in communication must be closed and this is responsibility of all providers. • Promote provider professionalism - Part of provider professionalism is to stay engaged, take responsibility for duties and actions, and promote patient safety and quality. “A Department of OBGYN Inter-professional Initiative”

Team. STEPPS: Unanticipated Consequences • General acceptance of program • 37 Physicians, 37 APC’s, 16 Residents, 36 Nurses • • • Collaborative engaged IP work group Enhanced provider relationships Institutional endorsement/promotion In situ development of best practice fixes Others…. . • Summit Response and Debrief “A Department of OBGYN Inter-professional Initiative” 8

Team. STEPPS Team Summary Themes • Barriers to communication • uncomfortably with disagreement/ conflict in hierarchical culture • lack of standardized language/ communication to address disagreements • lack of role clarity • technology overload • Tools to enhance communication • build respect/ relationships • standardized communication tool to address disagreements/ concerns/ safety issue • time out prior to delivery • DESC • Departmental communication quarterly, breakdown silos of communication “A Department of OBGYN Inter-professional Initiative” 9