overview: what are we getting into? · overview: what are we getting into? supported by: nebraska...
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Overview: What are we getting into?Supported by:Nebraska Office of Rural HealthNebraska Coalition for Patient Safety
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TeamSTEPPS
What works in a team training program? Team training improves team performance
Training accounts for 12% - 19% of the variability in team outcomes
What an organization does to sustain the effects of training accounts for the other 80%
Focusing on general teamwork (communication, mutual support behaviors) skills vs. taskwork has a greater impact on process outcomes and attitudes
Salas et al. Does team training improve team performance? A meta-analysis.Human Factors; Dec. 2008:903-933.Salas et al. Team training can enhance patient safety—the data, the challengeahead. The Joint Commission Journal;2011,37:339-340.
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TeamSTEPPS
What is TeamSTEPPSTM?Team Strategies and Tools to Enhance
Performance and Patient Safety An evidence-based teamwork system
Designed to improve Safety Quality Efficiency of health care
Practical and adaptable
Our Performance
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TeamSTEPPS
What is TeamSTEPPSTM? Publicly available
curriculum of multi-media materials
Course Management Course Materials Implementation Guide Measurement Tools Supported by National
Implementation Teamhttp://teamstepps.ahrq.gov/
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TeamSTEPPSNational Implementation Team
Duke TRC
Minnesota -TRC
North Shore Long I. TRC
Presbyterian St. Luke's
Tulane TRC
Washington -TRC
UNMC
1810
58 5
1
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TeamSTEPPS
Diffusion of TeamSTEPPS in NELarger Hospitals • BryanLGH• Columbus Community
Hospital• Good Samaritan• Mary Lanning• Omaha VA Medical Center• St. Elizabeth Regional
Medical Center• St. Francis Medical Center
Critical Access Hosp.• 52/65
UNMC• Physical Therapy• Nursing• Geriatrics• Emergency Dept• Medical students
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TeamSTEPPS
Why Use TeamSTEPPS? Develop effective health care teams that optimally
use information, people and resources to improve outcomes in clinical and nonclinical areas
Teams that communicate effectively and back each other up can reduce the frequency and consequences of human error
Team skills are not innate; they must be trained
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TeamSTEPPS
Why Invest in TeamSTEPPS? Cost of training is small
compared to potential savings… Prevent errors by creating
safety net for fallible human beings
Minimize consequences of errors
Decrease staff turnover Increase patient satisfaction
Change your system of care by investing in your mostimportant resource… your human capital
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TeamSTEPPS
Why Invest in TeamSTEPPS? Annual cost of medical errors approximately 98,000
lives and $17-29 billion1,2
13.5% of hospitalized Medicare beneficiaries experience an adverse event during hospitalization (from random sample discharged 10/2008)3
Addresses root causes of errors
1. Kohn et al., Eds. To err is human: Building a safer health system. Washington, DC: Committee on Quality of Health Care in American, Institute of Medicine, National Academy Press, 2000.
2. http://www.soa.org/files/pdf/research-econ-measurement.pdf3. http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf
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Why Invest in TeamSTEPPS? Joint Commission 2010 Leadership Standards for
hospitals (Standard LD.03.01.01) Leaders create and maintain a culture of safety Leaders evaluate the culture on a regular basis Leaders encourage teamwork; they create
structures, processes, and programs to support it Sentinel Event Alerts
Issue 40: Behaviors that undermine a culture of safety
Issue 43: Leadership committed to safety
http://www.jcrinc.com/common/Documents/OnlineExtras/JCLS09/JCLS09_H.pdfhttp://www.jointcommission.org/SentinelEvents/SentinelEventAlert/
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TeamSTEPPSWhat is the Evidence?
Exploding Literature Patient Care Team + Evidence-Based Practice = 890 Patient Care Team + Evaluation Studies = 3,519
Studies in diverse patient populations demonstrate relationship between teamwork and Improved clinical processes Reduction in medical errors Improved surgical team performance Increased adherence to guidelines Decreased length of stay Increased functional status Decreased mortality
Salas et al. What are the critical success factors for team training in health care? Jt Comm Jrnl Qual Safe. 2009;35:398-405.
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TeamSTEPPS
EVERY 5% Increase in team behaviors…. 11% in communication openness 15% in teamwork within departments 19% in exchange of information across depts 22% in exchange of important patient information
during shift change 24% in perception that hospital mgt is interested
in patient safety before adverse events 25% in perception that serious mistakes don’t
happen by chance
Evidence from NE
Jones KJ, Skinner AM, High R, Reiter-Palmon R. A theory-driven longitudinal evaluation of the impact of team training on safety culture in 24 hospitals. BMJ Qual Saf. 2013;22:394-404.
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TeamSTEPPS
What Makes TeamSTEPPS Different? Evidence-based and field-tested Comprehensive Customizable Easy-to-use teamwork tools and strategies Publicly available Evaluated using measures of
Structure--# of people trained, changes in job description & performance appraisals
Process—SBAR communication, briefs, huddles, debriefs Outcomes—time to give tPA, door to balloon time, HAIs,
overtime hours, % of DC meds reconciled Hospital Survey on Patient Safety Culture
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TeamSTEPPS
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AgendaDAY 1 Module 1—Introduction Module 2—Team Structure Module 3—Leadership Module 4—Situation
Monitoring Module 5—Mutual Support Module 6—Communication Module 7—Summary—
Putting It All Together
DAY 2 Coaching Workshop High Fidelity Simulation
Practice team skills Coach team skills Identify team skills
Webinars to Complete Requirements for Master Trainer Certification Wed. Oct. 16 10 - 11 a.m. Thurs. Nov. 21 2 – 3 p.m.
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TeamSTEPPS
SHIFT TOWARDS A CULTURE OF SAFETY
HOW DOES TEAMSTEPPS WORK?
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TeamSTEPPS
Phase 1 Pre-Training Assessment1. Identify a need for team training
• Adverse event and near-miss reports• Root causes analyses, FMEAs• Hospital Survey on Patient Safety Culture • Patient satisfaction• Staff satisfaction/engagement/turnover • Department/service line process or outcome measures
- Patient Flow - Pressure Ulcers- Hospital Acquired Infection Rates - Time to Event (tPA, balloon)- Core measures - Preventable Deaths- Medication Errors - 30 Day Readmission Rate
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TeamSTEPPS
Phase 1 Pre-Training Assessment2. Improving safety
culture is correct strategy
3. Timing is right4. Culture change
feasible/ acceptable
SENSEMAKING
TRUST
Teamwork is one of the four keycomponents of safety culture: reporting, just, teamwork, learning.—James Reason. Managing the Risks of Organizational Accidents.
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TeamSTEPPS
Phase 2 Training Advancing TeamSTEPPS through Simulation Sept. 12
- 13, 20131. Explain the evidence base and theoretical framework that
supports the use of team skills to improve safety culture. 2. Learn the team skills that enhance performance and patient
safety.3. Practice the team skills using high fidelity simulation and
debriefing.4. Coach members of your team to use team skills to improve
their performance during a high fidelity simulation.
Attend Webinars to complete requirements to become a Master Trainer Wed. Oct. 16 from 10 – 11 Implementation & Action Planning Thurs. Nov. 21 from 2 – 3 Culture Change
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TeamSTEPPS
Phase 2 Training Your training plan depends upon your goal…
transformational (whole hospital) vs. incremental change (one department or process)
Common elements of successful training strategy1. Obtain leadership support from senior leaders, medical staff,
board2. Train department heads in the tools emphasizing their role as
leaders to use briefs, huddles, debriefs, provide feedback3. Develop plan for coaching new behaviors4. Conduct training and make revisions based on feedback5. Successful training may be done in ½ day blocks or one hour
increments…whatever fits your needs
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Phase 3 Sustainment Monthly 30 min. conference calls led by UNMC will
resume in January 2014 Hardwire new behaviors
Measure and provide feedback about impact of behaviors on processes and outcomes
Change job descriptions and performance evaluations to include new behaviors
Orient new employees to the behaviors Provide refresher training on an annual basis Promote the behaviors…bulletin boards, contests, newsletter
Reassess with Hospital Survey on Patient Safety culture 18 – 24 mos.
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TeamSTEPPS
Complexity of Systems
and Patients
Competing Values &
Expectations: Efficient vs.
Safe, Effective
System Design with
Limited Resources
Behavioral Choices of
Fallible Human Beings
Desired Outcome: Safe, High
Quality Care
…provides choices for behavior
Adapted from David Marx
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TeamSTEPPS
National Recognition of Need Accreditation Council for Graduate Medical Education
(ACGME) and the Association for American Medical Colleges (AAMC) include aspects of communication, coordination, and collaboration in physician competencies
National Quality Forum (NQF) Safe Practice 3: Teamwork Training and Skill Building rventions in Safe Practices for Better Health Care—2010 Update: A Consensus Report
Joint Commission National Patient Safety Goals and accreditation standards
Centers for Medicare & Medicaid Services (CMS) included TeamSTEPPS in the 9th Scope of Work
Healthcare reform focus on Accountable Care Organizations and decreasing re-admission rates
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TeamSTEPPS
You are joining a community… UNMC Patient Safety Team is here to support
your journey Monthly conference calls Share tools, literature, evaluation strategies
Your participation contributes to the evidence base…how do team behaviors improve core measures, fall risk reduction, safety culture
TeamSTEPPS is being disseminated nationally to hospitals and academic medical centers
TeamSTEPPS is being integrated into healthcare professions education at UNMC
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TeamSTEPPSContact Information
Katherine Jones, PT, [email protected] 402-559-8913
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…Improved teamwork and communications…Ultimately, a culture of safety
Are you ready to be part of the transformation of health care?