summary pulling it all together
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Summary Pulling it All Together. “The truth of the matter is that you always know the right thing to do. The hard part is doing it.” –Norman Schwarzkopf. Day 1 Objectives. Explain the theoretical framework and evidence base that supports the use of team skills to improve safety culture. - PowerPoint PPT PresentationTRANSCRIPT
SummaryPulling it All Together
“The truth of the matter is that you always know the right thing to do. The hard part is doing it.”
–Norman Schwarzkopf
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Day 1 Objectives1. Explain the theoretical framework and evidence
base that supports the use of team skills to improve safety culture.
2. Learn the team skills that enhance performance and patient safety.
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The Theory
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Team Leadership
Team Orientation
Mutual PerformanceMonitoring
Back-upBehavior
Adaptability
Shared Mental Models
Mutual Trust
Team Effectiveness
Closed LoopCommunication
Salas, Sims, Burke. Is therea “Big Five” in teamwork?Small Group Research. 2005; 36:555-599.
Big 5
Coord. Mechanism
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The Framework: What Comprises Team
Effectiveness?
KnowledgeCognitions
“Think”
…team performance is a science…consequences of errors are great…
AttitudesAffect“Feel”
SkillsBehaviors
“Do”
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Summary— Pulling it All TogetherMore Evidence
Exploding Literature− Patient Care Team + Evidence-Based Practice = 1,128
− Patient Care Team + Evaluation Studies = 843
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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The Bottom Line….The knowledge, skills, attitudes, language, and coordinating mechanisms inherent in teamwork1 create the flexibility team members need to manage complexity2 and learn from experience.3-5
1. Salas E, Sims DE, Burke CS. Is there a "Big Five" in teamwork? Small Group Research. 2005;36:555-599.
2.Cannon-Bowers JA, Salas E. Team performance and training in complex environments: Recent findings from applied research. Curr Dir Psychol Sci. 1998;7:83-87.
3.Senge PM. The Fifth Discipline: The Art & Practice of the Learning Organization. New York, NY: Doubleday; 1990.
4.Edmonson AC. Learning from failure in health care: Frequent opportunities, pervasive barriers. Qual Saf Health Care. 2004;12(Suppl II):ii3-ii9.
5.Salas E, Rosen MA, Burke CS, Goodwin GF. The wisdom of collectives in organizations: An update of the teamwork competencies. In: Salas E, Goodwin GF, Burke CS, eds. Team effectiveness in complex organizations: Cross-disciplinary perspectives and approaches. New York, NY: Routledge/Taylor & Francis Group; 2009:39-79.
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Barriers, Tools/Strategies, Outcomes
TOOLS and STRATEGIES
BriefHuddle DebriefSTEP
I’M SAFE ChecklistCross Monitoring
FeedbackAdvocacy and Assertion
Two-Challenge RuleCUS
DESC ScriptCollaboration
SBARCall-Out
Check-BackHandoff
OUTCOMES
Shared Mental
Model
Adaptability
Team Orientation
Mutual Trust
Team Performance
Patient Safety!!
Team Goals
BARRIERS
Inconsistency in Team Membership
Lack of Time Lack of Information Sharing Hierarchy Defensiveness Conventional Thinking Complacency Varying Communication Styles Conflict Lack of Coordination and
Follow-Up with Co-Workers Distractions Fatigue Workload Misinterpretation of Cues Lack of Role Clarity
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Summary— Pulling it All TogetherThe Constraints
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Identifying Opportunities to Use TeamSTEPPS Tools and Strategies
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Discussion
What were the barriers to communication?
Lack of information sharing, lack of follow-up, lack of role clarity, misinterpretation of cues, workload
Which TeamSTEPPS tools and strategies could have been used? (Consult your Pocket Guide)
STEP, huddle, SBAR
What is the biggest issue in terms of teamwork skills?
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Using TeamSTEPPS Tools and Strategies
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Case Analysis Divide yourselves into groups of 4 - 5
Discuss the scenario in your team
Identify the barriers to teamwork that occurred
Identify tools, strategies to address the barriers
Report out to the whole group
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SummaryDuring this training, we learned that teamwork strategies and tools—
Create a safety net for fallible human beings (human factors)
Do not come naturally…must be learned (evidence-based training)
Create the flexibility we need to manage complexity and learn from experience
What we didn’t learn… for Master Trainers
One shot didactic lectures can not change people’s behavior
Human beings and organizations adopt new behaviors in stages as a result of a change strategy
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“To improve teamwork in support of patient safety, what small change
can you commit to?”
“The achievements of an organization are the results of the combined effort of each individual.”
–Vince Lombardi