connecting theory to practice the rbc model...t eam stepps 05.2 mod 1 05.2 page 2 introduction mod 1...
TRANSCRIPT
Slide 1
Ohio League for Nursing Pre-Summit 2015
From Evidence to Action: Effective Integration of
TeamSTEPPS Strategies and Resources
in Nursing Education
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Slide 2
TEAMSTEPPS 05.2Mod 1 05.2 Page 2
Introduction
Mod 1 06.2 Page 2
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Facilitators:
Robert L. Smith, Ph.D., Clinical Psychologist Director, Medical Staff Assistance Program, MetroHealth
System, Cleveland, Ohio Director, MetroHealth TeamSTEPPS® Regional Master
Training Center, Cleveland, Ohio
Patricia A. Sharpnack DNP, RN, CNE, NEA-BC, ANEF Dean and Strawbridge Professor Ursuline College, The Breen School of Nursing, Pepper Pike,
Ohio TeamSTEPPS Master Trainer
Laura Goliat DNP, RN, FNP-BC Associate Dean and Assistant Professor Ursuline College, The Breen School of Nursing, Pepper Pike,
Ohio TeamSTEPPS Master Trainer
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Slide 3
Connecting Theory to Practice
The RBC Model
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Slide 4
TEAMSTEPPS 05.2Mod 1 05.2 Page 4
Introduction
Mod 1 06.2 Page 4
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Metro Health Medical Center
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Slide 5
TEAMSTEPPS 05.2Mod 1 05.2 Page 5
Introduction
Mod 1 06.2 Page 5
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Conference Objectives
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1. Recognize the importance of developing effective teams for the provision of high quality and safe patient care
2. Comprehend the five constructs essential for realizing high-functioning teams as defined in the TeamSTEPPS® Program
3. Explore ways to integrate TeamSTEPPS®
resources in the academic setting.
4. Develop an action plan for incorporating TeamSTEPPS® strategies into classroom and/or clinical instruction
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Slide 6
TEAMSTEPPS 05.2Mod 1 05.2 Page 6
Introduction
Mod 1 06.2 Page 6
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Conflict of Interest and Disclosures
• Neither the planner(s) or presenter(s) have
any real or perceived vested interest that
relate to the presentation
• TeamSTEPPS® materials used in this study
were of public domain accessed from the
AHRQ website: http://teamstepps.ahrq.gov
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Slide 7
TEAMSTEPPS 05.2Mod 1 05.2 Page 7
Introduction
Mod 1 06.2 Page 7
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Schedule of Activities: Morning
8:30 am to 9:00 am Overview and Sue Sheridan Video
9:00 am to 9:30 am Leadership and Team Structure Session
9:30 am to 9:45 am Activity and Discussion
9:45 am to 10:00 am Break
10:00 am to 10:30 am Simulation: Team Formation & Debriefing
10:30 am to 11:00 am Communication Session
11:00 am to 11:30 am Simulation: Action Plan in SBAR Format
11:30 to 12: 15 pm Lunch
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TEAMSTEPPS 05.2Mod 1 05.2 Page 8
Introduction
Mod 1 06.2 Page 8
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Schedule of Activities: Afternoon
12:15 pm to 12:45 pm Simulation: CUS Exercise and Debriefing
12:45 pm to 1:30 pm Situation Monitoring – Activity/ Discussion
1:30 pm to 2:15 pm Teach back Preparation: Assigned Topic
2:15 pm to 2:30 pm Break
2:30 pm to 3:30 pm Teach back Presentation
3:30 pm to 3:45 pm Implementation Planning
3:45 pm to 4:00 pm Debrief and Discussion of Implementation
4:00 pm Evaluation and Certificates
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Slide 9
TEAMSTEPPS 05.2Mod 1 05.2 Page 9
Introduction
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Academic - Practice Gap
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TEAMSTEPPS 05.2Mod 1 05.2 Page 10
Introduction
Mod 1 06.2 Page 10
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Call for a Radical Transformation
“A significant gap exists between today’s nursing practice and the education for that practice, despite some considerable strengths in nursing education.”
--Dr. Patricia Benner and her co-authors wrote in the Carnegie report, Educating Nurses: A Call for Radical Transformation.
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TEAMSTEPPS 05.2Mod 1 05.2 Page 11
Introduction
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Nursing Education Criteria for Institutional Standards
• Emerging new competencies in decision making,
quality improvement, systems thinking, and team
leadership must become part of every nurse’s
professional formation from pre-licensure through the
doctoral level.
• Nurses are being called on to lead care
coordination team efforts and should
have the competencies requisite for this
task.
IOM (2010). The Future of Nursing: Leading Change, Advancing Health
• Nurses have key roles to play as team
members and leaders for a reformed and
better-integrated, patient-centered health care
system.
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TEAMSTEPPS 05.2Mod 1 05.2 Page 12
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Teamwork Is All Around Us
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TEAMSTEPPS 05.2Mod 1 05.2 Page 13
Introduction
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® Problem
Little emphasis placed on teamwork and communication skills (Musson & Heimreich, 2004)
More emphasis placed on individual accomplishments (Reuben et al., 2004)
Team instruction lags dramatically behind practice needs (AACN, 2011; Frenk et al., 2010)
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TEAMSTEPPS 05.2Mod 1 05.2 Page 14
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®Educators as Role Models
When I was in medical school I spent
hundreds of hours looking into a microscope—
a skill I never needed to know or ever use.
Yet, I didn’t have a single class that
taught me communication and teamwork skills—
something I need every day I walk into the hospital.”
-Pronovost & Vohr, 2010
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TEAMSTEPPS 05.2Mod 1 05.2 Page 15
Introduction
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15
2006
Patient Safety
and Quality
Improvement
Act of 2005
Patient Safety Movement
Executive
Memo from
President
DoD
MedTeams®
ED Study
Institute for
Healthcare
Improvement
100K lives
Campaign
“To Err
is Human”
IOM Report TeamSTEPPS
1995 1999 2001 2003 2004 2005
JCAHO
National Patient
Safety Goals
Medical Team Training
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Slide 16
TEAMSTEPPS 05.2Mod 1 05.2 Page 16
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®TEAM Strategies and Tools to Enhance Performance and Patient Safety
http://teamstepps.ahrq.gov
• Evidence-based team instruction program
• Derived from >25 years of research in military
aviation, nuclear power
• Tailored for healthcare
• Constructs: Leadership, Situation Monitoring,
Mutual Support, Communication
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Slide 17
TEAMSTEPPS 05.2Mod 1 05.2 Page 17
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Sue Sheridan Video
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Slide 18
Team Structure
The ratio of We’s to I’s is the best
indicator of the development of a
team.
–Lewis B. ErgenNEXT:
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Teamwork?
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Slide 20
TEAMSTEPPS 05.2Mod 1 05.2 Page 20
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® Discussion
What was your reaction to this video.
What did the team do well?
What could they do better?
What are the responsibilities of team members?
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Slide 21
Leadership
®
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Slide 22
TEAMSTEPPS 05.2Mod 1 05.2 Page 22
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What are the characteristics that you
believe make a positive team leader?
Effective Team Leaders
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Example of Leadership?
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TEAMSTEPPS 05.2Mod 1 05.2 Page 24
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® Discussion
Who was the leader?
Did you see any of the following concepts of TeamSTEPPS?
Leadership, Communication, Situational Monitoring, Mutual Support?
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TEAMSTEPPS 05.2Mod 1 05.2 Page 25
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Team Events
Briefs – planning
Huddles – problem solving
Debriefs – process improvement
Leaders are responsible to assemble the
team
and facilitate team events
But remember…
Anyone can request a brief, huddle, or debrief
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TEAMSTEPPS 05.2Mod 1 05.2 Page 26
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Brief
Occurs just prior to activity or event.
In a medical setting it would be just before a procedure or outpatient session.
Example: multiple meetings prior to today’s seminar. Clarifying roles, forming outlines, equipment, supplies, PowerPoint, etc.
Earlier today, we held a brief to review our plans, equipment and supplies, clarify roles and responsibilities and address any concerns, etc.
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Brief
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Slide 28
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Huddle
Problem solving
Hold ad hoc, “touch-base” meetings to regain situation awareness
Discuss critical issues and emerging events
Anticipate outcomes and likely contingencies
Assign resources
Express concerns
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Huddle
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Huddle occurs during the activity or event. The plan needs to be modified due to a new development.
Example: Supplies are missing for activity; video is not playing on PowerPoint; or one of the presenters is ill.
Discuss needed changes, revise plan, reassign duties, address questions and concerns
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Slide 30
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Huddle
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Debrief
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Occurs immediately after the activity or event if possible.
Goal is to identify opportunities for improvement
Record ideas and to share with Team
Present ideas to Team and implement the positive changes.
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Slide 32
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Debrief
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Slide 33
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Barriers to Brief, Huddle and Debrief
Do not have time for this!
Too hard to pull everyone together. We are all scattered and busy with our own duties.
Cultural issue vs. process issue.
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Standing, facing our
flag, hand over our
hearts and singing
along with our
National Anthem.
Part of Our Culture.
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Slide 35
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Prepare for Team Activity
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Slide 36
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Team Activity
Divide into teams of 5 or 6
Activity will highlight TeamSTEPPS concepts:
Assigning tasks
Making requests
Cross-checks
Check-backs
Call outs
Task prioritization
Mutual support
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Activity #1
Goal of the exercise is to create the longest paper chain with the materials provided.
Longest chain = most consecutive links.
On the leader’s command, everyone will be given 2 minutes to create their chain.
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Debrief
What went well?
What could you have done better?
What components of TeamSTEPPS did you use?
Did someone assume the leadership role?
Were there clearly defined team roles?
What did you notice about the communication?
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Activity #2
Each group is to identify a leader.
Leader meets with exercise leader for instructions.
Goal is to create the longest paper chain.
Everyone has 2 minutes to create their chain.
Team Members CANNOT SPEAK.
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Activity #3
Each group is to identify a leader.
Leader meets with exercise leader for instructions.
Goal is to create the longest paper chain.
Everyone has 2 minutes to create their chain.
Team Members CANNOT SPEAK
and
CANNOT USE THEIR DOMINANT HAND.
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Slide 41
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Break
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Slide 42
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Simulation Group A
Develop a plan to incorporate TeamSTEPPS tools and strategies into your academic curriculum
Identify ways that you, as a faculty member, will model and demonstrate these skills in the classroom and with your colleagues.
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Simulation Group B
Develop a plan to incorporate TeamSTEPPS tools and strategies into the clinical rotations for your students.
Identify ways that you and the other clinical staff will model and demonstrate these skills during the clinical rotations.
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Simulation Tasks
Form a team
Clarify the strengths, experience, etc. of the members of the team
Identify a leader
Identify a recorder for the team
Begin forming an action plan
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Slide 45
Communication
Assumptions
Fatigue
Distractions
HIPAA
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Joint Commission Goals That Relate To Communication
National Patient Safety Goals (NPSGs) related to communication:
Improve the effectiveness of communication
Read-Back Handoff
Accurately and completely reconcile medications and other treatments across the continuum of care
Address specifically during handoff
Encourage the active involvement of patients and their families in the patient’s care, as a patient safety strategy
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The process by which information is exchanged between individuals, departments, or organizations
Effective when it permeates every aspect of an organization
Communication is…
Assumption
s
Fatigue
Distractions
HIPAA
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Miscommunication
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Communication Strategies
Situation–Background– Assessment–Recommendation (SBAR)
Call-Out
Check-Back
Handoff
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SBAR provides…
A framework for team members to effectively communicate information to one another
Communicate the following information:
Situation―What is going on with the patient?
Background―What is the clinical background or context?
Assessment―What do I think the problem is?
Recommendation―What would I recommend?
Remember to introduce yourself…
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Standards of Effective Communication
Complete
Communicate all relevant information
Clear
Convey information that is plainly understood
Brief
Communicate the information in a concise manner
Timely
Offer and request information in an appropriate timeframe
Verify authenticity
Validate or acknowledge information
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Call-Out is…
A strategy used to communicate important or critical information
It informs all team members simultaneously during emergency situations
It helps team members anticipate next steps
…On your unit, or your school, what
information
would you want called out?
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Call-out
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Check-Back is…
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HandoffThe transfer of information (along with authority and responsibility) during transitions in care across the continuum; to include an opportunity to ask questions, clarify, and confirm
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Handoff
Optimized Information
Responsibility– Accountability
Verbal Structure
Checklists
IT Support
Acknowledgement
Great opportunity for
quality and safety
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Handoff
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Please Use CUS Wordsbut only when appropriate!
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CUS
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Two-Challenge Rule
1 2
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Two Challenge Rule Gone Wrong
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Communication Challenges
Language barrier
Distractions
Physical proximity
Personalities
Workload
Varying communication styles
Conflict
Lack of information verification
Avoid assumptions and perceptionsamong the team
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Speak UP!!
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Simulation Part #2
Continue working on your Team’s action plan
Construct a summary for the Dean of the Nursing School
Each member writes the action plan in SBAR format
Team members share their SBAR memos with their Team
Members give feedback regarding SBAR format and compose final SBAR for their Team
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Groups A and B are encouraged to collaborate in the development of their curricula.
Groups A and B are paired (forming large groups of 16-20)
The new large group is directed to develop one action plan and SBAR to submit to the Dean.
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Lunch
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Lunch
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Simulation Part #3
Participants return to their new larger group
The Dean’s responded to their SBAR is shared. The Dean indicates that he/she has decided to cancel this project.
The explanation is that it will be too time consuming and costly.
Finally, the Dean states that he/she believes that the faculty are not interested or committed to teaching interdisciplinary teamwork.
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Team Response
Groups are expected to CUS and each participant is to write a CUS and then share it with the larger group. Emphasis is upon the feelings of Concern, being Uncomfortable, and that this could compromise the Success of the curriculum.
“Speaking truth to power.”
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Slide 70 Situation Monitoring
“Attention to detail is one of the most important details ...”
–Author Unknown
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® Would you notice?
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A Continuous Process
Situation
Monitoring
(Individual Skill)
Situation
Awareness
(Individual
Outcome)
Shared
Mental Model
(Team Outcome)
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Process of actively scanning behaviors and actions to assess elements of the situation or environment
Fosters mutual respect and team accountability
Provides safety net for team and patient
Includes cross monitoring
Situation Monitoring(Individual Skill)
… Remember, engage the patient
whenever possible.
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Video Test of Situational Monitoring
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Process of monitoring the actions of other team members for the purpose of sharing the workload and reducing or avoiding errors
Mechanism to help maintain accurate situation awareness
Way of “watching each other’s back”
Ability of team members to monitor each other’s task execution and give feedback during task execution
Cross Monitoring is…
Mutual performance monitoring has been
shown to be an important team competency.(McIntyre and Salas 1995)
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A Shared Mental Model is…
The perception of, understanding of, or knowledge about a situation or process that is shared among team members through communication.
“Teams that perform well hold
shared mental models.”
(Rouse, Cannon-Bowers,
and Salas 1992)
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Shared Mental Model?
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What Do You See?
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Mutual Support
“A chain is only as strong as its
weakest link.”
–Author Unknown
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Mutual Support
Mutual support is the essence of teamwork
Protects team members from work overload situations that may reduce effectiveness and increase the risk of error
Ask for help, offer help (& accept help)
Feedback
Advocacy & Self-Assertion
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Conflict ResolutionD-ESC Script
A constructive approach for managing and resolving conflict
D—Describe the specific situation
E—Express your concerns about the action
S—Suggest other alternatives
C—Consequences should be stated
Ultimately, consensus shall be reached.
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Have timely discussion
Frame problem in terms of your own experience
Use “I” statements to minimize defensiveness
Avoid blaming statements
Critique is not criticism
Focus on what is right, not who is right
D-ESC-It
Let’s “DESC-It!”
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Teach Back Exercise
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Curricular IntegrationThree-Phased Approach:
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Curricular Integration-TeamSTEPPS Toolkit
Level I: Beginning Foundations
(100 series)
Level II: Intermediate Application
(200 series)
Level III: Advanced Application
(300 series)
T-INE® Three-Phased Approach:
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Level One- 100 SeriesLEVEL TS MODULES TOOLS APPLICATION
100 Introduction
Team Structure
Communication
Situation Monitoring
Mutual Support
Intro to Leadership
SBAR
Brief
Huddle
Debrief
• Paper Chain Exercise
• Team Roles and Responsibilities
• “A” (Assessment)-Exercise; Role Play
• Clinical Reports; Handoffs
• QSEN Quality & Safety Assessment-
Patient Room
• Clinical Role Assignments
• Trust Exercise
Observe:
• Team Brief (Pre-Conference)
• Team Updates (Huddle)
• Team Debrief (Post-Conference)
• Discuss followership requisites
• Discuss unit leadership qualities on
clinical sites
• Shadow charge nurse in clinicals
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Level Two- 200 SeriesLEVEL TS MODULES TOOLS APPLICATION
200 Communication
Situation
Monitoring
Mutual Support
Leadership
SBAR
CUS
Call Out
Cross
Monitoring
Feedback
Brief
Huddle
Debrief
• S-B-A (Situation-Background-
Assessment) Exercises; Phone Call to
NP
• CUS Scenario Video Exercises
• Call Out: Scenario-BP decreasing
• QSEN Quality & Safety Assignment-
Nursing Unit
• Harm & Error Reduction Assignment
• Task Assistance/Feedback Videos
Participate In:
• Team Brief (Pre-Conference)
• Team Updates (Huddle)
• Team Debrief (Post-Conference)
• Assign students to “charge nurse” roles
in clinicals
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Level Three- 300 SeriesLEVEL TS MODULES TOOLS APPLICATION
300 Communication
Situation Monitoring
Mutual Support
Leading Teams
Pulling It All Together
SBAR
I’M-SAFE
2-Challenge
Rule
Brief
Huddle
Debrief
All Tools
• SBAR Practice in Clinicals
• IM-SAFE Checklist Assignment
• QSEN Quality & Safety Assignment-
Systems Approach (Hospital-Wide)
• Role play
• Video Exercises
Conduct: Team Leader in Clinicals
• Team Brief (Pre-Conference)
• Team Updates (Huddle)
• Team Debrief (Post-Conference)
Evaluation of Team Leaders
• Culminating Simulations/Role Play
• Code Workshop
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What would you do?
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What would you do?
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Exit Strategy Before Graduation
The TeamSTEPPS® Summative Intensive Workshop for Students including PP, Role Play Demonstrations, and
Simulation
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This Certificate Signifies that:Student’s Name
has competently completed
TeamSTEPPS® in Nursing EducationTeam Strategies and Tools to Enhance Performance and Patient Safety
SCHOOL
Date, Year
______________________________________Faculty, Master Trainer
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Action Plan-ClassroomAction Plan-Clinical
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Students…“I never thought about how I would speak up to address an unsafe
situation in practice…..I always thought I could speak up easily but when we had to role play during an unsafe scenario… I found out that I really didn’t know how to do that very well at all….This program gave me the language to use and confidence to know how to speak up in high stakes situations. I loved this program for that reason.”
“My only complaint is that we
didn’t have TeamSTEPPS®
earlier in the program!”
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Resources
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What If……..
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