hanys teamwork – technique: achieving critical care excellence
TRANSCRIPT
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HANYS
Teamwork – Technique: Achieving Critical Care Excellence
HANYS
Teamwork – Technique: Achieving Critical Care Excellence
Teambuilding for Critical Care TeamsTeambuilding for Critical Care Teams
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ObjectivesObjectives• Use four leadership strategies to structure
the organization to permanently support and enable effective teamwork among caregivers
• State the benefits of effective teamwork among critical care teams;
• Use five key action steps to create and maintain great teamwork;
• Understand how to hardwire teamwork behaviors into daily operations;
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The 4 P’sThe 4 P’s• Philosophy
• Policy
• Procedure
• Practice
Four leadership strategies to structure the organization to permanently support
and enable effective teamwork among caregivers
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Understand that Great Teamwork (as a Key Component of Safety and Quality) in Critical Care
is a Function of Philosophy, Policy, Procedure, and Practice
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PhilosophyPhilosophy
An over-arching view of how the business of the hospital
will be conducted
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Sample Philosophy Statements
• “General Hospital provides care that is safe, efficient, patient-centered, timely, effective, and equitable. To do this, we will excel technically, be experts in teamwork, and follow our policies, procedures, and protocols to provide the highest standard of care.”
• “Memorial Hospital provides safe, efficient, compassionate care of the highest standard through teamwork, technical proficiency, and adhering to guidelines, policies, and procedures.”
• Notice that each statement has two parts: “What” and “How”
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PolicyPolicy
Broad specifications of the manner in which management
expects things to be done
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“All members of the surgical services team at Vanderbilt will be trained in CRM skills and are expected to use these CRM skills in their daily work and in their professional communication with other members of the Vanderbilt healthcare organization.”
Vanderbilt University OR Guidelines
Sample Policy StatementSample Policy Statement
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“All on-duty members of the NICU team at General Hospital are expected to attend and participate in the Morning Shift Briefing. The Briefing shall be conducted using the approved briefing guide.”
General Hospital NICU Guidelines
Sample Policy StatementSample Policy Statement
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ProceduresProcedures
An established or correct way of doing something
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Sample ProcedureSample
Procedure
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What the human operator actual does in the daily work environment
PracticesPractices
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PracticesPractices• Encompass every activity conducted in the
hospital:
• Correct execution of a procedure• Deviation from a procedure• Omission of a procedure• The use of a technique (authorized or not)
The human operator’s decisions and actions determine the system outcome
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• Conforming To, or Deviating From
• Cannot assume that teams will follow any given procedure dictated by management
–Must be checked or measured through “rounding” or data collection/analysis
PracticesPractices
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PracticesPractices
Team
Deviate
Deviate
Conform
Practices
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• Goal of Leadership/Management– Minimize deviations in Practices by…
• Promoting good practices by specifying coherent procedures
• Ensuring Procedures are consistent with Policy
• Ensuring Policy is consistent with Philosophy
PracticesPractices
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• Leadership Actions to Minimize Deviations
• Rounding (Checking)• Project Interviews• Reinforcing and Publicizing Positive Behavior• Dealing With Low Performers• Measuring
PracticesPractices
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Creating the “Chemistry” Needed for Great Teamwork
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• Study of 23 NBA teams from 1980 – 1994
• Results? Greater roster stability (fewer trades and player turnover) = better won/loss record (Berman et al, 2002)
Basketball is a “Chemistry Sport”
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Commercial Aviation is a “Chemistry Sport”
• Risk Factors • First day
• First flight
• Night time
• Visual approach flown by Captain
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VideoVideo
Does this team have the “Chemistry” for a safe flight?
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Is Healthcare a “Chemistry Sport?”
• Harvard study of 38,577 procedures by 203 surgeons in 43 hospitals• Compared outcomes at facilities where
surgeons do a lot of procedures vs. where they do fewer
• Surgical skill is “not portable”• Better pt. outcomes where surgeons
have more experience with their teams• “Familiarity helps the surgeon perform
better.” (Huckman & Pisano, 2006)
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The Value of Creating “Chemistry”
• Creating and tapping the “Collective Mind” to detect & correct potential errors• Relevant information• Mastery of tools and knowledge• Understanding of tasks (Liang et al, 1995)
• Better Care • Better teams have 12% fewer avoidable
complications and 21% fewer avoidable deaths (Gallop, 2006)
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How can you build team
chemistry in a reliable and
repeatable way?
How can you build team
chemistry in a reliable and
repeatable way?
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Building Team ChemistryBuilding Team Chemistry• Use inter-personal skills
• Introduce yourself
• Make eye contact when communicating
• Learn names so they can be used during the procedure or critical times during the shift
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Building Team ChemistryBuilding Team Chemistry• Clearly provide / understand the
big picture in a “Pre-Brief”• Outline the procedure / situation
• Discuss critical points
• Specify duties
• Anticipated outcome
• Plan / discuss most likely contingencies
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Building Team ChemistryBuilding Team Chemistry• Invite participation from the
Team• Explicitly ask team members to
provide information, express their concerns, and speak up when necessary
• Encourage the team to ask questions to verify their understanding
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Building Team ChemistryBuilding Team Chemistry
• Ask questions to check understanding and begin two-way communication
• Set up a “pattern of response”
• Ask questions that require more than a “Yes” or “No” response
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Building Team ChemistryBuilding Team Chemistry
• Acknowledge all communication
• Close the “loop”
• Confirms understanding
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Using these skills “at the bedside”• Implement an Expanded Briefing conducted
with a Checklist• Why?
• Better performance and care
• Kaiser Permanente reported 50% cut in unexpected delays, RN turnover from 19% to zero, elimination of wrong surgeries
(Defontes, 2004)
• “…useful quality improvement tool…” (Altpeter et al, 2007)
• “…effective tool in promoting teamwork among surgery staff members…”
(Makary et al, 2007)
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Model Briefing Format Offered by JACS
Names & roles of team members
Conduct Time Out procedures
Antibiotics
Review of critical steps
Review potential problems
Safety Statement*
Names & roles of team members
Conduct Time Out procedures
Antibiotics
Review of critical steps
Review potential problems
Safety Statement*
(Markary et al, 2007)
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Evaluate this team…Evaluate this team…
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Evaluate this team• Used interpersonal skills?
• Eye contact, body language, names, etc.
• Provided Big Picture – contingencies etc?
• Invited participation?• Asked open ended questions?• Acknowledged communications?
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Action ListAction List• Determine your philosophy of care – get it in
writing• Revise your P&P Manual or Department
Policies to support the teamwork behavior you desire
• Ensure your care givers are trained in the desired teamwork skills
• Create “hardwired tools” to require and support the use of those teambuilding behaviors
• Build a system of “rounding” to check and reinforce the desired behaviors
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