Team Strategies and Tools to Enhance Performance and

Team Strategies and Tools to Enhance Performance and Patient Safety Quality Improvement Leaders January 26, 2015

Introduction Goals of presentation Mod 1 06. 2 05. 2 Page 2 n Become familiar with the use teamwork fundamentals and tools of Team. STEPPS n Provide a practice environment for teamwork improvement in your core teams n Provide a practice environment and strategies for improving teamwork between QI teams and departments TEAMSTEPPS 05. 2 2

Introduction Survey Results Overall I’m satisfied with my knowledge of teamwork tools and strategies & when to use them WITHIN my QI workgroup/departm ent. Mod 1 06. 2 05. 2 Page 3 We work well as a team WITHIN my QI workgroup/ department. We have opportuniti es to improve the level of teamwork WITHIN my QI workgroup /departme nt. TEAMSTEPPS 05. 2 We have opportunities to improve the level of teamwork ACROSS QI workgroups/departments. We demonstrate good teamwork ACROSS QI workgroups/depart ments. 3

Introduction Survey Results Please share a successful teamwork example and the tools/techniques that were employed Please share an example of a time in which your team didn't work so well together and what opportunities you saw for improvement Mod 1 06. 2 05. 2 Page 4 TEAMSTEPPS 05. 2 4

Introduction Fundamentals Mod 1 06. 2 05. 2 Page 5 n Leadership n Situation Awareness n Mutual Support n Communication TEAMSTEPPS 05. 2 5

Introduction Why Errors Occur n Workload fluctuations courtesy n Interruptions n Fatigue n Halo effect n Multi-tasking n Passenger syndrome n Failure to follow up n Hidden agenda n Poor handoffs n Complacency n Ineffective n High-risk phase communication n Strength of an idea n Not following protocol Mod 1 06. 2 05. 2 Page 6 n Excessive professional TEAMSTEPPS 05. 2 n Task (target) fixation 6

Introduction Mod 1 06. 2 05. 2 Page 7 TEAMSTEPPS 05. 2 7

Introduction JAMA, October 20, 2010—Vol 304, No. 15 Mod 1 06. 2 05. 2 Page 8 TEAMSTEPPS 05. 2 8

Introduction W. Edward Deming Mod 1 06. 2 05. 2 Page 9 TEAMSTEPPS 05. 2 "What we need to do is learn to work in the system, by which I mean that everybody, every team, every platform, every division, every component is there not for individual competitive profit or recognition, but for contribution to the system as a whole on a win-win basis. " 9

5 Dysfunctions of a Team Introduction Patrick Lencioni Mod 1 06. 2 05. 2 Page 10 TEAMSTEPPS 05. 2 10

Introduction Mod 1 06. 2 05. 2 Page 11 TEAMSTEPPS 05. 2 11

Leadership

Introduction Effective Team Leaders n Organize the team n Articulate clear goals n Make decisions through collective input of members n Empower members to speak up and challenge, when appropriate n Skillful at conflict resolution Mod 1 06. 2 05. 2 Page 13 TEAMSTEPPS 05. 2 13

Team Events n Briefs – planning n Huddles – problem solving n Debriefs – process improvement Leaders are responsible to assemble the team and facilitate team events But remember… Anyone can request a brief, huddle, or debrief 14

Introduction Brief n During the brief, the team should address the following questions: n Who is on the team? n Do all members understand agree upon goals? n Are roles and responsibilities understood? n What is our plan? n What is staff's availability? n How is workload shared among team members? n What resources are available? Mod 1 06. 2 05. 2 Page 15 TEAMSTEPPS 05. 2 15

Introduction Huddle Problem solving Mod 1 06. 2 05. 2 Page 16 n Hold ad hoc, “touch-base” meetings to regain situation awareness n Discuss critical issues and emerging events TEAMSTEPPS 05. 2

Introduction Debriefs should be conducted for the following reasons: Mod 1 06. 2 05. 2 Page 17 n So team collectively learns from actual situations n So teams can improve performance n Valuable time to reinforce and recognize good teamwork behavior TEAMSTEPPS 05. 2 17

Introduction Debriefs What went well? What didn’t go so well? What can we do better next time? Mod 1 06. 2 05. 2 Page 18 TEAMSTEPPS 05. 2 18

Introduction PRACTICE IN SMALL GROUPS Mod 1 06. 2 05. 2 Page 19 TEAMSTEPPS 05. 2 19

Introduction SITUATION MONITORING Mod 1 06. 2 05. 2 Page 20 TEAMSTEPPS 05. 2 20

Introduction Situation Monitoring Process 1. Situation Awareness (Individual Outcome) Situation Monitoring (Skill) 2. Shared Mental Models (Team Outcome) 3. Mod 1 06. 2 05. 2 Page 21 TEAMSTEPPS 05. 2 21

Introduction Situation Monitoring Mod 1 06. 2 05. 2 Page 22 n Cross Monitoring n I’M SAFE – ask for assistance – “watch my back” TEAMSTEPPS 05. 2 22

Introduction How to Foster a Shared Mental Model n Routinely update others n Acknowledge deviations or changes in the situation n Alert team to actual or potential problems n Verbalize a course of action n Request needed information when uncertain Mod 1 06. 2 05. 2 Page 23 TEAMSTEPPS 05. 2 23

Introduction DISCUSS USE IN OUR AREAS Mod 1 06. 2 05. 2 Page 24 TEAMSTEPPS 05. 2 24

Communication

Introduction Check Back Sender verifies that the message was received Receiver accepts the message and provides feedback confirmation Sender initiates the message Mod 1 06. 2 05. 2 Page 26 TEAMSTEPPS 05. 2 26

Introduction Callout n A strategy used to communicate important information. n It informs all team members simultaneously n It helps team members anticipate next steps n In your work situations, what information would you want called out? Mod 1 06. 2 05. 2 Page 27 TEAMSTEPPS 05. 2 27

Introduction SBAR-Q n Situation n Background n Assessment n Recommendations n Questions? Mod 1 06. 2 05. 2 Page 28 TEAMSTEPPS 05. 2 28

Introduction Critical Language (“CUS”) n. Concerned (I’m concerned about …) n. Uncomfortable (I’m uncomfortable proceeding without…) n. Safety (I don’t think it’s safe to…) Mod 1 06. 2 05. 2 Page 29 TEAMSTEPPS 05. 2 29

Introduction MUTUAL SUPPORT Mod 1 06. 2 05. 2 Page 30 TEAMSTEPPS 05. 2 30

Introduction Mutual Support n Protects team members from work overload situations n Help your fellow teammates by offering assistance n Task Assistance n Feedback n Advocacy and Assertion Mod 1 06. 2 05. 2 Page 31 TEAMSTEPPS 05. 2 31

Introduction DESC Script n D—Describe the specific situation or behavior; provide concrete data. n E—Express how the situation makes you feel/what your concerns are. n S—Suggest other alternatives and seek agreement. n C—Consequences should be stated in terms of impact on established team goals; strive for consensus. Mod 1 06. 2 05. 2 Page 32 TEAMSTEPPS 05. 2 32

Introduction Two Challenge Rule n When an initial assertive statement is ignored: It is your responsibility to assertively voice concern at least two times to ensure that it has been heard. n The team member being challenged must acknowledge that concern has been heard. n If the safety issue still hasn't been addressed: Mod 1 06. 2 05. 2 Page 33 n Take a stronger course of action. n Utilize supervisor or chain of command. TEAMSTEPPS 05. 2 33

Introduction Goals of presentation Mod 1 06. 2 05. 2 Page 34 n Become familiar with the use teamwork fundamentals and tools of Team. STEPPS n Provide a practice environment for teamwork improvement in your core teams n Provide a practice environment and strategies for improving teamwork between QI teams and departments TEAMSTEPPS 05. 2 34