Team STEPPS Simulations A Practical Manual James Battles

Team. STEPPS Simulations: A Practical Manual James Battles, Ph. D Heidi King, MS, FACHE Stephen Hines, Ph. D Barb Edson, RN, MBA, MHA David Baker, Ph. D

What's Next? Leveraging Current Tools to Support Implementation

Team. STEPPS Presenters James Battles, Ph. D Social Science Analyst for Patient Safety, AHRQ Mod 1 05. 2 Page 3 Heidi King, MS, FACHE Acting Director Department of Defense Patient Safety Program Stephen Hines, Ph. D Chief Research Officer, HRET TEAMSTEPPS 05. 2 Barb Edson, RN, MBA, MHA VP of Clinical Quality, HRET David Baker, Ph. D Senior Vice President, Health Division, IMPAQ International

Team. STEPPS Objectives n Consider how Team. STEPPS work influences other patient safety initiatives n Discuss new Team. STEPPS variations n Lay out current and future plans for Team. STEPPS national implementation Mod 1 05. 2 Page 4 TEAMSTEPPS 05. 2

Team. STEPPS WHERE HAVE WE BEEN AND WHERE DO WE GO FROM HERE? JAMES BATTLES, PHD AHRQ Mod 1 05. 2 Page 5 TEAMSTEPPS 05. 2

Team. STEPPS What Team. STEPPS® Does Mod 1 05. 2 Page 6 TEAMSTEPPS 05. 2

Team. STEPPS Combat Tested n Been to war in IRAQ and Afghanistan Mod 1 05. 2 Page 7 TEAMSTEPPS 05. 2

Team. STEPPS Hurricane Tested n Played a critical role in Hurricane Sandy & other emergencies Mod 1 05. 2 Page 8 TEAMSTEPPS 05. 2

Team. STEPPS® goes International Canada All 50 States Great Britain Netherlands Germany Switzerland Italy China Korea Peru Taiwan Brazil Singapore Australia Mod 1 05. 2 Page 9 Japan TEAMSTEPPS 05. 2

Team. STEPPS Integrating Team. STEPPS® n CUSP for CLASBI n CUSP for CAUTI in hospitals and long term care n CUSP for VAPVAC n Safe Surgery in Hospitals and Ambulatory Surgery Centers n Perinatal Safety Improvement Program n Medical Liability projects Mod 1 05. 2 Page 10 TEAMSTEPPS 05. 2

Team. STEPPS Where to From Here? n Discussions with WHO about a region-by-region implementation of Team. STEPPS® n Need to create new modules dealing with virtual teams and coordination of care between units within healthcare facilities and across care settings Mod 1 05. 2 Page 11 TEAMSTEPPS 05. 2

Team. STEPPS Where to From Here? n Meeting growing demand for Team. STEPPS ® training and implementation strategies in primary care n New on-line Master Team Training to be developed Mod 1 05. 2 Page 12 TEAMSTEPPS 05. 2

Team. STEPPS TEAMSTEPPS NEW TOOLS AND RESOURCES FROM THE DEPARTMENT OF DEFENSE HEIDI KING, MS, FACHE DEPARTMENT OF DEFENSE PATIENT SAFETY PROGRAM Mod 1 05. 2 Page 13 TEAMSTEPPS 05. 2

Team. STEPPS Do. D Team. STEPPS: Where Have We Been? Ø Utilizing over 5000 (and climbing) Master Instructors Ø Training and implementation in 90% of Military Treatment Facilities Over 70, 000 continuing education credits awarded Ø Using simulation and coaching as adjunct to training Ø Spread throughout medical/trauma teams in Theatre of Operations: Iraq and Afghanistan Ø Partnering with various federal agencies to leverage Team. STEPPS integration Ø Foundational to achieving culture change Mod 1 05. 2 Page 14 TEAMSTEPPS 05. 2

Team. STEPPS Do. D Team. STEPPS: Where Are We Heading? We needed a new sustainable model! Ø Ø Ø A E IOU Align with patient safety and quality improvement initiatives Encourage Innovation Involve, Integrate, Impact: patients, staff, programs, outcomes Overcoming challenges Utilizing coaching and simulation for experiential learning Team. STEPPS is part of our DNA… Mod 1 05. 2 Page 15 TEAMSTEPPS 05. 2

Team. STEPPS Resources: Integration! Patient Activation Resource Guide Coaching SBAR Toolkit Simulation-based Training (Centers and In-situ) Professional Conduct Toolkit Briefs, Huddles, Debrief Toolkits Team. STEPPS and Partnership for Patients Team. STEPPS Tip Sheets and Scenarios TEA MTPAT Learning Circles and Workshops Team UP Do. D Website e. Bulletin and Learning Update Facebook Patient Safety Learning Center (Protected) http: //www. health. mil/dodpatientsafety Mod 1 05. 2 Page 16 TEAMSTEPPS 05. 2

Team. STEPPS TEAMSTEPPS NATIONAL IMPLEMENTATION OVERVIEW BARB EDSON, RN, MBA, MHA HRET Mod 1 05. 2 Page 17 TEAMSTEPPS 05. 2

Team. STEPPS Goals n To provide Team. STEPPS Master Training to health care organizations interested in improving teamwork to enhance performance and patient safety n To grow the national cadre of Team. STEPPS Master Trainers n To support Team. STEPPS users n To evolve and advance the Team. STEPPS program Mod 1 05. 2 Page 18 TEAMSTEPPS 05. 2

Team. STEPPS Master Training n Two-day training course n Train-the-trainer approach n Prepares you to serve as a Team. STEPPS Master Trainer by n n Providing instruction on Team. STEPPS tools and strategies Providing an opportunity to develop and plan your Team. STEPPS implementation n Prepares you to serve as a leader for implementing Team. STEPPS within your organization Mod 1 05. 2 Page 19 TEAMSTEPPS 05. 2

Team. STEPPS Regional Training Centers University of Washington TRC Minnesota -TRC UCLA TRC North Shore Long Island Jewish TRC Duke TRC Tulane University TRC Mod 1 05. 2 Page 20 TEAMSTEPPS 05. 2

Team. STEPPS Regional Training Centers n North Shore Long Island Jewish Health System in New Hyde Park, New York (NSLIJ) n Implemented Team. STEPPS system-wide n Duke Medical Center, Durham, North Carolina (Duke) n Includes patients as part of Team. STEPPS Master Training n Tulane University, New Orleans, Louisiana (Tulane) n Integrates simulation into Team. STEPPS Master Training n University of Minnesota Fairview Medical Center, Minneapolis, Minnesota (UM) n Integrates Team. STEPPS into inter-professional education (IPE) n University of Washington Medicine, Seattle, Washington (UW) n Integrates simulation into Team. STEPPS Master Training n University of California Los Angeles, California (UCLA) n Mod 1 05. 2 Page 21 New center launching in fall/winter of 2013 TEAMSTEPPS 05. 2

Team. STEPPS 2012 Accomplishments n 766 people trained via: 15 basic trainings n 1 training each focusing on IPE and Patient Engagement n 4 trainings with a special focus on central line associated blood stream infections n 395 attendees at the National Conference where: n 99 attendees took part in a 1 -day blended online and inperson Master Training course n Conference topics spanned n n n Mod 1 05. 2 Page 22 System-wide implementation Specific clinical usage Different training and educational models Networking opportunities mixed military and civilian champions of Team. STEPPS TEAMSTEPPS 05. 2

Team. STEPPS HOW DO WE SUPPORT OUR PARTICIPANTS? Mod 1 05. 2 Page 23 TEAMSTEPPS 05. 2

Team. STEPPS Pre-Training Support n Leadership Brief n Provides a C-suite perspective n http: //teamstepps. ahrq. gov/abouttoolsmaterials. htm n Prerequisite “Coursework” n Pre-training recorded webinar n Readiness Assessment n Implementation Planning n Participant on-boarding live webinar n n n Mod 1 05. 2 Page 24 Orientate and prepare participants for training Meet training representative from Center staff Initiate implementation planning TEAMSTEPPS 05. 2

Team. STEPPS Post-Training Support n www. teamsteppsportal. org n National Conference n Help line/email n http: //teamstepps. ahrq. gov/ Mod 1 05. 2 Page 25 TEAMSTEPPS 05. 2

Team. STEPPS AHRQ Website n AHRQ website (http: //teamstepps. ahrq. gov/) n Program overview n Training curricula (Essentials course; Fundamentals course; measures; new modules) n Materials to download and/or order n Team. STEPPS Implementation Guide n Measurement tools Mod 1 05. 2 Page 26 TEAMSTEPPS 05. 2

Team. STEPPS Portal n A centralized resource for everything Team. STEPPS n Key features n Webinars n Tools and resources for use n Implementation stories n List. Serv/Discussion forum Mod 1 05. 2 Page 27 TEAMSTEPPS 05. 2

Team. STEPPS Upcoming Webinars n Monthly scheduled webinars planned for 2013 Educational to support Team. STEPPS users n Invited speakers from around the field n Special topics n Program updates n Portal updates n Training updates n Webinars are the second Wednesday of each month n July 12: Team. STEPPS and Simulation n August 14: System-wide Implementation of Team. STEPPS n Mod 1 05. 2 Page 28 TEAMSTEPPS 05. 2

Team. STEPPS Tools and Resources n Ready-made implementation support tools n Updated evidence base n Scenarios n Shared tools from users Mod 1 05. 2 Page 29 TEAMSTEPPS 05. 2

Team. STEPPS Shared Tools n Resource for posting and sharing new Team. STEPPS tools n Team. STEPPS is customizable n No sense in reinventing the wheel n Others have dealt with similar problems and developed innovative solutions n Contact AHRQTeam. STEPPS@aha. org n www. health. mil/dodpatientsafety/Productsand. Ser vices/Toolkits. aspx Mod 1 05. 2 Page 30 TEAMSTEPPS 05. 2

Team. STEPPS Implementation Stories n Cases studies of successful and unsuccessful Team. STEPPS implementations n Learn from these critical incidents n HRET team will interview, summarize, and post the story n Please follow the Survey Monkey link under “Case Studies” on the portal to share your experience Mod 1 05. 2 Page 31 TEAMSTEPPS 05. 2

Team. STEPPS Discussion Forum n Training-specific forums (for 2013 sessions) Reconnect with classmates n Directly interact with faculty n Share tools n List. Serv for the entire Team. STEPPS community n Mod 1 05. 2 Page 32 TEAMSTEPPS 05. 2

Team. STEPPS TEAMSTEPPS 2. 0 DAVID P. BAKER, PHD IMPAQ INTERNATIONAL Mod 1 05. 2 Page 33 TEAMSTEPPS 05. 2

Team. STEPPS Patient Safety Movement JCAHO National Patient Safety Goals “To Err is Human” IOM Report 1995 1999 2001 Team. STEPPS® Institute for Healthcare Improvement 100 K lives Campaign Executive Memo from President Do. D Med. Teams® ED Study Team. STEPPS Released to the Public 2003 2004 Patient Safety and Quality Improvement Act of 2005 2006 2007 Medical Team Training Mod 1 05. 2 Page 34 TEAMSTEPPS 05. 2 Team. STEPPS National Implementation Program Began Centers for Medicare and Medicaid Partnership for Patients Campaign National Implementation of CUSP 2008 2011

Team. STEPPS What is Team. STEPPS 2. 0? n. Part of effort to continually evolve Team. STEPPS n. Provides an opportunity to…. n Leverage what has been learned so far: n n Mod 1 05. 2 Page 35 Lessons learned Feedback from users New and emerging evidence Consider meaningful ways to integrate current and future Team. STEPPS efforts TEAMSTEPPS 05. 2

Team. STEPPS Environmental Scan n Review of prior work efforts related to a next iteration of Team. STEPPS n Usability reviews of existing curriculum and materials n Interviews with AHRQ and Do. D stakeholders n Focus groups with Team. STEPPS experts n n Mod 1 05. 2 Page 36 Participants referred by AHRQ and/or Do. D Included Team. STEPPS users, trainers, and those involved in its development 5 virtual focus groups conducted Represented over 80 years combined experience with teaching and/or implementing Team. STEPPS! TEAMSTEPPS 05. 2

Team. STEPPS Results n Qualitative data analysis resulted in 189 aggregated recommendations n Recommendations were clustered into 6 categories: n n n Mod 1 05. 2 Page 37 Pre-training Training materials Training delivery Implementation and sustainment Evaluation Integrating new modules TEAMSTEPPS 05. 2

Team. STEPPS 2. 0: Work in Progress n Focuses on revisions, updates, and expansions to materials that support the Master Training course n Improvements for Team. STEPPS users n n Improvements for Master Trainers n n Mod 1 05. 2 Page 38 Updated and expanded content Reduced size of hard copy materials! Better preparation for implementation planning Improved and enhanced Instructor Guides Page numbers! Advance organizer for each instructional module New discussion questions and exercises TEAMSTEPPS 05. 2

Team. STEPPS 2. 0: Work in Progress (Cont’d) n Some highlights: n Updating the evidence base n Reorganizing the order of training to emphasize the importance of communication n Providing information and guidance on engaging patients n Emphasizing the importance of implementation planning pre-training and throughout the course n Providing more detailed information on implementation and sustainment activities (e. g. , Coaching, Measurement) Mod 1 05. 2 Page 39 TEAMSTEPPS 05. 2

Team. STEPPS Next Steps n Drafts of 2. 0 materials are near completion! n Review and testing with stakeholders – June 2013 n Delivery for final AHRQ review – September 2013 Mod 1 05. 2 Page 40 TEAMSTEPPS 05. 2

Team. STEPPS TEAMSTEPPS NEW TOOLS AND RESOURCES JAMES BATTLES, PHD AHRQ BARB EDSON, RN, MBA, MHA HRET Mod 1 05. 2 Page 41 TEAMSTEPPS 05. 2

Team. STEPPS New Tools n Team. STEPPS® Primary Care Version n Adapts core concepts of Team. STEPPS® to reflect the environment of primary care office-based teams n Team STEPPS® Long-Term Care Version n Adapted to the environment of nursing homes and other long -term care settings such as assisted living & continuing care retirement communities n Team. STEPPS® Limited English Proficiency (LEP) Module n A module to help develop a customized plan to train staff in teamwork skills as applied to work with patients who have difficulty communicating in English http: //teamstepps. ahrq. gov Mod 1 05. 2 Page 42 TEAMSTEPPS 05. 2

Team. STEPPS for Primary Care Medical Offices n Builds on “Team. STEPPS for Primary Care Teams” n Works as a Master Trainer course with material on n How to be a practice facilitator of Team. STEPPS n How to coach Team. STEPPS using a variety of methods n How to implement, spread, and sustain Team. STEPPS n And how to measure and evaluate Team. STEPPS Mod 1 05. 2 Page 43 TEAMSTEPPS 05. 2

Team. STEPPS New Setting of Care, New Challenges, New Solutions n Smaller teams with less ability to travel n Varied background in team-training and quality improvement initiatives n Available in a in-person training and online format n Mod 1 05. 2 Page 44 Online trainings will include virtual, game-based learning TEAMSTEPPS 05. 2

Team. STEPPS Interested? n Please contact us at AHRQTeam. STEPPS@aha. org if you are interested n Pilot testing begins late summer/early fall 2013 n National Implementation begins late winter/early spring 2014 Mod 1 05. 2 Page 45 TEAMSTEPPS 05. 2

Team. STEPPS THE FUTURE OF TEACHING AND LEARNING TEAMSTEPPS STEVE HINES, PHD HRET Mod 1 05. 2 Page 46 TEAMSTEPPS 05. 2

Team. STEPPS Thoughts on the Future n Teaching and learning Team. STEPPS will change considerably n Sometimes out of necessity n Other times because of the opportunities presented by new technology n Great challenges exist n And there approaches to address these challenges Mod 1 05. 2 Page 47 TEAMSTEPPS 05. 2

Team. STEPPS Current Challenges to Team. STEPPS Training n Limited resources for meetings and trainings Funds are tight at healthcare organizations n Time is valuable n There are restrictions on meetings funded by the federal government n Radical increase in number of ongoing QI activities n Coordinating with other disciplines and settings of care n Need to accommodate a broader range of trainees n Work to understand how to best to connect and grow a community of users n Mod 1 05. 2 Page 48 TEAMSTEPPS 05. 2

Team. STEPPS How Can We Approach these Challenges? n Expand our training center capacity n Produce resources for a broader range of disciplines and settings of care n Create user-friendly resources for those who are not at trainings n Materials for the end user on the front lines to practice using the Team. STEPPS tools n Resources to help make the case for implementation from a financial, quality, and safety standpoint n Alternative training modalities for self-teaching n Expanded use of observation and mentoring Mod 1 05. 2 Page 49 TEAMSTEPPS 05. 2

Team. STEPPS Time for Questions Thank you for spending time with us this week in Dallas! Mod 1 05. 2 Page 50 TEAMSTEPPS 05. 2