diane brunson - teaching and learning in teams - integrating a … · 2013. 6. 20. · quality of...

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Diane Brunson, RDH, MPHDirector, Public Health

ADEA CCI Summer 2013 Liaisons MeetingJune 11, 2013

Describe the purpose of utilizing a modified TeamSTEPPS curriculum to develop student competency in team communication skills and situational monitoring;

http://teamstepps.ahrq.gov/

Discuss the development of cases involving various health professions for use with standardized patients.

Overview of the Anschutz Medical Campus IPE Program

Describe the TeamSTEPPS modified training Highlight the scenarios/cases developed Provide interactive exercises Feedback loop

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Values and ethics for interprofessional practice

Understanding roles and responsibilities Skills for interprofessional communication Teams/Teamwork

Initiative of the Interprofessional Education Task Force at the behest of Vice Chancellor for Health Affairs

Planning began 2007 Start-up funds from Josiah Macy Jr.

Foundation and the Colorado Health Foundation (2009)

Moving into campus sustainability

InterprofessionalOrientation (began 1997) Single day, campus-

wide

Bioethics (began 1997) One of the largest and

oldest interprofessional health sciences courses in the country

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One full day All 700 health

professional students Goal: introduce

concept and rationale for Interprofessional health care = better patient outcomes

Break down “myths” of the various professions

Team-building exercise in small groups = team contract

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Highlights the need for “intra-” as well as “inter-” professional education

Not every case is appropriate for all professions

Train faculty! Build evaluation into

planning

RPQ 1: How much collaboration does your role require?

1 Physician Assistants

2 Physical Therapists

3 Dentists

4 Nursing

5 Pharmacists

6 Physicians

Has a specific role which

involves little collaboration with

others

Has a specific role which involves little collaboration with others

8.71

8.08

6.19

9.10

7.53

8.60

AV

G

8.03

By

Rol

e

n=440

RPQ 7: How autonomous is your role?

1 Physician Assistants

2 Physical Therapists

3 Dentists

4 Nursing

5 Pharmacists

6 Physicians

Works

Autonomously

Has their practice or supervised by another profession

5.63

4.41

2.71

6.48

3.94

3.07

AV

G

4.3

7

By

Prof

essi

on

n=440

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Fundamentals of Collaborative Care– first two years

Ethics for the Health Professions – spring of 1st

year, fall of 2nd year – 10 weeks total Clinical Transformations – TeamSTEPPS Clinical Integrations – rotations, clinical

practice

Students group into IP teams of 6-7 Maintain same teams for Bioethics 2 sessions a semester x 4 semesters Outside preparation = online curriculum on

teamwork and human factors Conflict style and difficult conversations Self and peer evaluation Team performance measured Graded – Pass/Fail (with Team Honors

Designation)

Insert graphic of Fundamentals Logic Model

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Goal – Develop intentional IP

experiences in clinical settings that highlight the team based care and quality and safety processes

Develop capacity to provide and require these experience for all students

From here… To here?

An evidence-based teamwork system

Designed to improve: Quality Safety Efficiency of health

care Practical and

adaptable Provides ready-to-use

materials

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1. Demonstrate effective team communication skills in a simulated patient-care environment utilizing TeamSTEPPS fundamentals

2. Develop the participant’s capacity to provideleadership to a team from multiple professions

3. Effectively communicate with patient and family members/friends in a team environment

4. Reflect upon individual and team behavior5. Enhance effective teamwork behaviors to

provide a foundation for patient safety and quality of care

Two or more peoplewho interact dynamically,interdependently, andadaptively toward acommon and valued goal,have specific roles orfunctions, and have a time-limited membership

“Achieve a mutual goal through interdependent and adaptive actions”

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– Leadership– Situation Monitoring– Mutual Support– Communication

Designated – The person assigned to lead and organize a designated core team, establish clear goals, and facilitate open communication and teamwork among team members

Situational – Any team member who has the skills to manage the situation-at-hand

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4 STEPS TO THE DELEGATION PROCESS

1. Determine what to delegateConsider priorities, work requirements, and availability of resources

2. Determine to whom to delegateConsider skill, availability, scope of practice

3. Communicate clear expectations of what needs to be done.

Communicate the plan, as well as the tasks to be completed

4. Request feedbackVerify task completion and outcomesRecognize achievement

• Leadership• Situation Monitoring

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Task assistance is guided by situation monitoring because situation awareness allows team members to effectively identify the need for assistance by others on the team.

If you need help, ask for it.

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You should advocate for the patient even when your viewpoint is unpopular, is in opposition to another person's view, or questions authority.

When advocating, assert your viewpoint in a firm and respectful manner. You should also be persistent and persuasive, providing evidence or data for your concerns.

• Leadership• Situation Monitoring• Mutual Support• Communication

FIVE COMMUNICATION TOOLS:1. SBAR (situation, background,

assessment, recommendation)2. Call-Out 3. Call-Back/Check-Back4. Handoff5. Huddle

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Process Improvement

Brief, informal information exchange and feedback sessions

Occur after an event or shift Designed to improve teamwork skills Designed to improve outcomes

An accurate reconstruction of key events Analysis of why the event occurred What should be done differently next time

8 yr old airway obstruction 35 yr old previously undiagnosed diabetic 22 yr old obese female eclampsia 25 yr old female sepsis 24 yr old acute asthma 6 yr old closed head injury 45 yr old alcohol withdrawl 55 yr MI in a dental office 83 yr old physical impairment

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Summary_CAPE_ADEA.wmv

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Table A: team exercise

Team B: TeamSTEPPS evaluator Leadership situation monitoring Mutual support communication

Team C: High Performing Teams

What went well? Did a leader emerge? Did leadership change? What was challenging? Lessons learned?

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What will you take away with you from today?