a mandatory teams training program for medical...
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TeAMSA mandatory teams training program for
medical professionals
Saskia Peerdeman, neurosurgeon
Professor of Professional Developement
Basic concept of health care
Medical problem
Patient Doctor
Help, solution
Medical problem
Patient Doctor
Help, solution
Complex medical
problems
Help, solution
Doctor
Specialized doctor
DoctorSpecialized doctor
Increased knowledge and techniqueBasic concept of health care
Extra specialized doctor
Dokter
More and complex
medical problems
Team treatmentIncreased knowledge and technique
Patient
Part of
solution
Subspecialism A
Subspecialism B
Subspecialism C
Subspecialism D
Complexity of communication
Creswick et al. BMC Health Services Research 2009 9:247
Causes of 881 incidents
Human factorsorganisationtechnical pat
Oorzaken van incidenten en onbedoelde schade in Ziekenhuizen. Een systematische analyse met PRISMA op afdelingen Spoedeisende Hulp
(SEH), chirurgie en interne geneeskunde. Wagner,C et al. ©2008 EMGO Instituut en NIVEL
>80 %
Human factors
How to improve team
functioning
to improve patientcare?
How do other teams improve teamfunctioning?
Daily work
Analysis and
reflection
New
knowledge
Adjustment and
implementation
Kolb’s learning cycle
Kolb’s learning cycle
Team-training in
healthcare also works!
Hospital based training program
Mandatory for all medical specialists
VU University Medical Center
Awareness of team functioning
and training of non-technical skills
13
VUmc in numbers:
• 293.520 out-patient contacts
• 29.738 day treatment
• 23.488 admissions
• 515 medical specialists
• 7.138 employees
• € 710 milj turnover
Basic principles of the training
Logistic frame
• Training time : 4 hours
• Group size: max 15 persons
• Minimum of 3 different specialism
• Train the teams that work together
• Train only clinical scenarios that are relevant for those
teams
• Train skills that can be used the next day
Theoretical models for training
design
• Kolb’s learning cycle
• Crew resource management principles
Daily work
Analysis and
reflection
New knowledge
Adjustment and
implementation
Crew Resource Management
‘A management system which makes optimum use of all available human factors and other resourcesto promote safety and enhance efficiency’.
A combination is needed of
• Specific technical skills
• General non-technical skills:
Decision making,
Communication,
Leadership,
Situational awerness
The program
Patient-centered team situations
• Acute situations: simulation training
• Complex situations: communication training in complex
multidisciplinary situations
• Regular situations: multidisciplinary and interprofessional
patient conference training
TeAMS – acute situations:(Simulation) Teamtrainingen
Resucitation Trauma Intensive Care
Obstetrics /
Pediatrics
Pediatric
resucitationOR
Trauma simulation
Train the situations relevant for the team
Resuscitation on a ward
Train the teams that work together!
Loss of time
and energy
Frustration Loss of quality Complications
Complex
patient
Organisational
factors
Suboptimal communication and coordination
Technical factors
TeAMS - Complex situation
Complex
situation
© The insightsgroup Limited 2009
TeAMS regular situationMultidisciplinary meetings
Daily practice
New knowledge
Analysis and
reflectionAdjustment
and
implementation
bron: jmir.org/themes/159
………………………………
………………..Physical model
The MDM neuro-oncology room
Physical model
………………………………
………………..
………………………………
………………..
Adjustment of communication
J. Beem, masterthesis Delft University, 2016
………………………………
………………..
J. Beem, masterthesis Delft University, 2016
Goals 2015
• Average levels of satisfaction of participants >7,5 on a 10 point
scale
• Train at least 80% of the medical specialist in the hospital
• Investigate logistic elements in installing a hospital broad
program
• 25 Acute situation trainings
• 20 Complex situation trainings
• 25 Regular situation trainings
And…. What about outcome?
Prof. Donald Kirkpatrick
(1924 – 2014)
“If you deliver training for your team, then you know how
important it is to measure its effectiveness. After all, you
don't want to spend time or money on training that doesn't
provide a good return.”
Evaluation of quality and efficacy
Kirkpatrick DL. Evaluating Training Programs San Francisco: Berrett-Koehler, 1998.
Results 2015 F&F
• 19 SIM training sessions
• 15 Complex situation training sessions
• 7 MDM-training sessions
(60% of goal)
• 37 different medical specialism
• 6 different health-care professions
Results 2015 F&F
SIM CST MDO Total
Medical Specialist 63 79 40 182
Resident 44 38 6 88
Doctor 4 0 0 4
Nurse 21 6 2 29
Anesthesiology technicians 12 0 0 12
Other 7 2 1 10
Unknown 7 5 0 12
158 130 49 337
Results 2015 evaluation70% respons
0
20
40
60
80
100
120
140
1 2 3 4 5 6 7 8 9 10
rating of training by participants, overall
N=
0
20
40
60
1 2 3 4 5 6 7 8 9 10
SIM
0
20
40
60
80
1 2 3 4 5 6 7 8 9 10
CST
0
5
10
15
20
1 2 3 4 5 6 7 8 9 10
MDM
Mean rating: 8,1
Results 2015 evaluationnew knowledge
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
acquire newknowledge
apply newknowledge
total agreement
slight agreement
neutral
slightdisagreement
totaldisagreement
SIM
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
acquire newknowledge
apply newknowledge
total agreement
slight agreement
neutral
slight disagreement
total disagreement
MDM
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
acquire newknowledge
apply newknowledge
total agreement
slight agreement
neutral
slight disagreement
total disagreement
CST
Results 2015 evaluationrecommendation to others
0%
50%
100%
SIM CST MDO
No
Yes
Factors contributing to succes
• Strategic level: Board of directors
Participation is a performance indicator
• Tactical level: program committee
Experts from various stakeholders for quality monitoring
• Operational level: medical program leader and casemanagers
Evaluation of training, ambassadors, customizing
scenarios
• Patient centred recognizable clinical scenarios
• Expert trainers
Challenges
Resistance to change
Presence of participants of all specialism and disciplines at the
same time
Tension between daily tasks and presence for training
Advanced planning
Optimal customization of clinical situations and regular training
forms
Costs: appr 250.000 euro yearly for running the program
Conclusion
Improving integrated care by team training of all health workers in
an academic center is possible
Logistics and finance are challenging
Patient centered, clinical scenario team training
is highly appreciated
new knowledge is acquired and will be used
98 % will recommend it to a colleague
“ HEALTH AND CARE
- AN INTEGRATED SYSTEM ”
A concept based on Toyota thinking
E4 Achieving Integrated Care Quality & Safety in Healthcare Forum Gothenburg 14-04-16Steve Boam – KM&T
INTRODUCTION
WHAT IF…
GLOBAL HEALTHCARE
Source: The Huffington Post 2015Cost as a percentage of GDP
GLOBAL HEALTHCARE
Source: The Huffington Post 2015Each country was ranked on three criteria: life expectancy (weighted 60%), relative per capita cost of health care (30%); and absolute per capita cost of health care (10%). Countries were scored on each criterion and the scores were weighted and summed to obtain their efficiency scores.
GLOBAL HEALTHCARE
Source: commonwealth fund
DEMOGRAPHIC – GLOBAL
Global Issues Interference Breakthroughs
• Aging population • Long term conditions• End of life care• Funding (GDP)• Dilution of
skills/experience• System that has evolved
over time
• Politics • Leadership • Media
• Clinical outcomes & procedures
• Information (& big data)• Genomics • Infrastructure • Technology • Innovation • Partnerships • GDP % or funding
• Prevention measures
Understand, review, predict, forecast & change
Delete/remove or reduce Encourage, invest & nurture
INDUSTRY
• So how does it differ in industry?
• Just like healthcare, industry continually faces difficult challenges including:– Safety
– Quality
– Legislation & Regulation
– Customer ‘shift’ in thinking & behaviours
– Competition
– Cost pressures
Automotive Aerospace FMCG Fin Services
TOYOTA
INDUSTRY – TOYOTA
PROCESS
PEOPLE
• So how have Toyota managed to be successful?
COMPARISON – TOYOTA COROLLA
So what might an integrated
‘health & care’
system look like?(Based on Toyota Thinking)
THINKING DIFFERENTLY FOR HEALTHCARE
INTEGRATED SYSTEM - HEALTH & CARE
DISTRIBUTION - NHS
£113bn Spend
Case Study
‘health & care’ (Based on Toyota Thinking)
SYSTEM OPERATIONS (NERVE) CENTRE
"It is not necessary to change
Survival is not mandatory"
W. Edwards Deming – Quality Guru
PDCA (Plan Do Check Act)P
DC
A
PLAN
DOCHECK
ACT
SUMMARY
PDCA (Plan Do Check Act)
THANK YOU
http://www.kmandt.com/blog/88-health-care-how-it-needs-to-work-a-concept-based-on-toyota-thinking
Steve BoamKM&T GroupE:Steve.boam@kmandt.comW:kmandt.com
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