what can healthcare learn from team training and other domains? david p. baker, ph.d. american...

What can Healthcare Learn from Team Training and Other

Domains?

David P. Baker, Ph.D.American Institutes for Research

TEAMSTEPPS 05.2Mod 1 05.2 Mod 1 06.2 Page 2

Session Objectives

Demonstrate the importance of teamwork in healthcare

Review the evidence on the effectiveness of team training

Present guidelines for implementing effective team training programs

Describe current initiatives in medical team training


Teamwork and Healthcare

In most all cases, the delivery of healthcare involves: Two or more individuals (RNs, MD, PharmDs, etc.) Performing distinct tasks Working interdependently Ensuring a safe outcome (i.e., common goal)

The delivery of healthcare requires teamwork! Team members come from different backgrounds,

disciplines, and are seldom trained together


What Do Effective Healthcare Teams Look Like?

…have members who anticipate each other.

…can coordinate without the need to communicate overtly.

…can recognize and adjust their strategy under stress.

…manage conflict well-team members confront each other effectively.

…backup and fill in for each other.


…communicate often "enough”.

…effectively “span” boundaries with stakeholders outside the team.

…regularly provide feedback to each other, both individually and as a team (“de-brief”).

…have members who understand each others’ roles and how they fit together.

What Do Effective Healthcare Teams Look Like?


Producing Effective Teams

Team membership-selection (Klimoski & Jones, 1995)

Modify team tasks, workflow, structure (Campion et al, 1995)

Provide support, resources, performance aids

Build team member knowledge, skill, and attitude competencies (KSAs) - TRAINING (Salas & Cannon-Bowers, 2001)


Targets of Team Training

Team Members

Cognitions

Knowledge

“Think”

Behaviors

Skills

“Do”

Attitudes

Affect

“Feel”


Team Process

Mutual Trust

Shared Mental Models

TeamOrientation

Team Leadership

Close LoopComm.

Back-UpBehavior

MPM

Adaptability

THE CORE


Meta Analysis Results (Salas)

Team Training leads to improvements in: Attitudes Knowledge Skills

Findings consistent across military, aviation, and emerging in healthcare

Cross training, team self-correction, TDT, CRM Little evidence for organizational impact

Guidelines for Effective Team Training in Healthcare


Guideline 1Engage Leadership (Physicians)

If physicians do not believe that teamwork is critical it will be an uphill battle

Physicians need to be included as team members and leaders

Physicians must be champions for teamwork and training

Physicians must value and reinforce team principles


Guideline 2Develop Training Systematically

Training development requires: Needs analysis

Specification of objectives that are linked to desired outcomes

Content development

Delivery

Evaluation

Preparing the transfer environment


Guideline 3Training Should be Scientifically Rooted

There is a science of team performance and training (Baker et al. 2005, Advances in Patient Safety)

There are principles, tools and strategies that have been shown to work


Guideline 4Determine if Staff are Ready for Training

Teamwork and training must be valued

Trainees must be motivated to learn – negative pre-training experiences increase motivation

Past experiences with training in the organization shape pre-training expectations

Self efficacy is important


Guideline 5Prepare the Learning Environment

The organization must communicate that team training is important

There should be systems in place to:

Reinforce learned principles

Transfer trained skills

Establish coaches at the sharp end of care


Guideline 6Incorporate Opportunities for Practice

Practice is essential when developing team skills

Simulation is an excellent tool for skills practice

Simulation must incorporate sound learning strategies like scenario-based training

Practice must be structured and paired with measurement and feedback to be effective


Guideline 7Evaluate Training at Multiple Levels

Evaluation involves systematic review of the training program to ensure it produces the desired outcome

There are 4 levels of evaluation: Reactions (Did they like it? Find it useful?) Learning (What do they know?) Behavior (What can they do?) Outcomes (What impact has there been on the

organization?)


Guideline 8Training is not a One-Time Event

Refresher training is required

Medicine is an evolving field

More and more research is focused on healthcare teams

New training strategies are being develop, tested and validated

Want to produce a learning organization


Guideline 9Training Must be Aligned

Team training will reduce but not eliminate error

Human failure is inevitable

Team training must align with the organization’s broader patient safety program


TeamSTEPPSTM

• Evidenced – based• Scientifically rooted• Customizable• Publicly available• Multiple strategies• Evaluation tools


Course Summary TOOLS and

STRATEGIESBrief

Huddle DebriefSTEP

Cross MonitoringFeedback

Advocacy and AssertionTwo-Challenge Rule

CUSDESC ScriptCollaboration

SBARCall-Out

Check-BackHandoff

OUTCOMES

Shared Mental Model

Adaptability

Team Orientation

Mutual Trust

Team Performance

Patient Safety!!

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


Kick-Off planSenior Leadership involvementExecutive Sponsor & Change Team Mentor and Role-model BehaviorsTraining ClassesMetric Reinforcement through Post-training AssessmentEssentials course for support staffWeb-based teamwork updatesLearning Action Network for follow-up and Information Sharing

Kick-Off planSenior Leadership involvementExecutive Sponsor & Change Team Mentor and Role-model BehaviorsTraining ClassesMetric Reinforcement through Post-training AssessmentEssentials course for support staffWeb-based teamwork updatesLearning Action Network for follow-up and Information Sharing

Pre-Training Assessment-Readiness

Train-the-Trainer: Train the Participants

Implementation & Sustainment

Selection of Instructors/CoachesSupporting training materials providedTrain-the-Trainer

•Fundamentals Course•Implementation Workshop•Culture Change Workshop

Practice teachingEstablishment of Training and Implementation TimelinesImplementation Roll-out PlanObservation Toolkits

Selection of Instructors/CoachesSupporting training materials providedTrain-the-Trainer

•Fundamentals Course•Implementation Workshop•Culture Change Workshop

Practice teachingEstablishment of Training and Implementation TimelinesImplementation Roll-out PlanObservation Toolkits

Site assessmentAHRQ Hospital Survey on Patient Safety CultureExecutive Brief to gain Senior Leadership buy-inSelection of Executive Sponsor and Change Team MembersEstablishment of Goals/ValuesCommunication CampaignPre-training (baseline) AssessmentImplementation plan

Site assessmentAHRQ Hospital Survey on Patient Safety CultureExecutive Brief to gain Senior Leadership buy-inSelection of Executive Sponsor and Change Team MembersEstablishment of Goals/ValuesCommunication CampaignPre-training (baseline) AssessmentImplementation plan

Three Critical Phases


“Report Card”“Report Card”

ImprovedPatient Outcomes

Improved Staffand Patient Satisfaction

Improved Processes

StaffRetention

ImprovedPatient Outcomes

Improved Staffand Patient Satisfaction

Improved Processes

StaffRetention

Level IV Evaluation

Level IV Evaluation

Pre-TrainingMeasurement

-Knowledge-Skills-Attitudes

Pre-TrainingMeasurement


Intervention Intervention

Training Transfer

Training Transfer

MethodsMethods

TrainingTraining

Training Objectives

Level III EvaluationLevel III EvaluationLevel II EvaluationLevel II Evaluation

ToolsTools

Post-TrainingMeasurement


Post-TrainingMeasurement


Level II EvaluationLevel II Evaluation

Competencies


Competencies

-Knowledge-Skills-Attitudes Level I EvaluationLevel I Evaluation

TRANSFORMATIONAL CHANGE FACTORSTRANSFORMATIONAL CHANGE FACTORS

Safety CultureTransparency/Trust

Systems-EfficacyLearning Environment

Pre-training ExperienceSelf Efficacy

Training Motivation

Org LevelOrg Level

Leadership LevelLeadership Level

Individual LevelIndividual Level

Lead the WayEstablish the Sense of Urgency Create a Vision or Gain-Plan & PrepareDevelop a Coalition-Assess Environment

Communication ProcessEnable Change to LastImprove Systems and Structures

Sentinel Event


David P. Baker, PhD

American Institutes for Research

1000 Thomas Jefferson Street, NW

Washington, DC 20007

202-264-0659

[email protected]

what can healthcare learn from team training and other domains? david p. baker, ph.d. american...

Documents

team tasks

medical team training

effectiveness of team

team principles

healthcare slide

t eam stepps

training physicians

team member knowledge