ARMY DENCOMStrategic Plan for TeamSTEPPS Spread and Sustainment

MEDCOM PS Center

Implementing a Teamwork Initiative Department of Defense Patient Safety Program

Healthcare Team Coordination

Objectives

Describe components of TeamSTEPPSState outcomes of improved teamwork Describe the impact of ineffective vs. effective communicationDescribe the 3 phases to the TeamSTEPPS™ Initiative Identify TeamSTEPPS™measurement tools and how they can be utilized to monitor changeKnow the resources available to you

What is TeamSTEPPSTM?

An evidence-based teamwork system Designed to improve:

QualitySafetyEfficiency of health care

Practical and adaptableProvides ready-to-use materials for training and ongoing teamwork

Why Use TeamSTEPPS?Goal: Produce highly effective medical teams that optimize the use of information, people and resources to achieve the best clinical outcomesTeams of individuals who communicate effectively and back each other up dramatically reduce the consequences of human errorTeam skills are not innate; they must be trained

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What is a TEAM?Minimum of two or more individualsAssigned specific roles and tasksCommon purpose and shared goalsInterdependentactions among members

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High-Performing TeamsTeams that perform well:

Hold shared mental modelsHave clear roles and responsibilitiesHave clear, valued, and shared visionOptimize resourcesHave strong team leadershipEngage in a regular discipline of feedbackDevelop a strong sense of collective trust and confidence Create mechanisms to cooperate and coordinateManage and optimize performance outcomes

(Salas et al. 2004)

Team DynamicsEstablishing team structure, climate and implementing core team behaviors ensures:

Mechanism for briefing and debriefingPerformance and operations are standardizedCritical information flows to the key decision maker to inform high stress, high stakes, time compressed decisionsPlans of care are established; managed; monitored and modified, as necessary over timeEnvironment supports clinical operations

Essential elements of team information exchangeMinimal set of behavioral expectations for team and supporting personnel

What Makes TeamSTEPPS Different?

Evidence-based and field-testedComprehensiveCustomizableEasy-to-use teamwork tools and strategiesPublicly available

Teamwork Targets Root Causes

0%

10%

20%

30%

40%

50%

60%

Inadequate Communication

Policy/ Procedure Not Followed

Inadequate Documentation

Equipment Malfunction/ Unavailable

No Policy / Procedure in Place

Inadequate Training

2004

2005

2006

n=73

n=84

n=97

Top Contributing Factors of Sentinel Events from RCAs, FY04-08: DoD

Source: DoD Patient Safety Center NOTICE: This Document is Exempt from Discovery IAW Title 10 U.S.C., Sec.1102. Do Not Release Without Proper Authority.

2007

n=64

0405

06

07

n=48

2008

08

0%10%20%30%40%50%60%70%80%90%

Lack of communication among department staff

2004

2005

2006

n=43

n=50

n=53

Source: DoD Patient Safety Center NOTICE: This Document is Exempt from Discovery IAW Title 10 U.S.C., Sec.1102. Do Not Release Without Proper Authority.

2007n=30

04 05

07

Causal Factors Reported for Communication/Inadequate Information FY04-08: DoD

Lack of communication between services and departments

Lack of assertiveness in going up the chain of command

Lack of communication between nurse and physician

06

2008n=32

08

Indemnity Experience

20

11

0

5

10

15

20

25

Malpractice Claims, Suits, and Observations

Pre-Teamwork Training Post-Teamwork TrainingAdverse Outcomes

50%Reduction

50%Reduction

(Mann, 2006) Beth Israel Deaconess Medical CenterContemporary OB/GYN

1

1.2

1.4

1.6

1.8

2

2.2

2.4

June July August Sept Oct Nov Dec Jan Feb March April May

Avg

. Len

gth

of S

tay

(day

s)

Length of ICU Stay After Team Training

50% Reduction

OR Teamwork Climate and Postoperative Sepsis Rates (per 1000 discharges)

Group Mean

Low Teamwork Climate

Mid Teamwork Climate

High Teamwork Climate

0

2

4

6

8

10

12

14

16

18

AHRQ National Average

Teamwork Climate Based on Safety Attitudes Questionnaire

Low → High(Sexton, 2006)Johns Hopkins

(Pronovost, 2003)Johns HopkinsJournal of Critical Care Medicine

Team training yields proven results

What Comprises Team Performance and Outcomes?

Performance•Adaptability•Accuracy•Productivity•Efficiency•Safety

Knowledge•Shared Mental Model

Attitudes•Mutual Trust•Team Orientation

Initiative based on evidence derived from team performance… leveraging more than 25 years of research in military, aviation, nuclear power, business and industry…to acquire team competencies.

Cross walking DENCOM BSC and TeamSTEPPS

DENCOM BSC DoD PSP TeamSTEPPSCS 5.0 Improved Patient and Customer Satisfaction Patient centered care is the emphasis of the

TeamSTEPPS Program educating on the importance of including patients in their care

CS 6.0 Maximized Trust in Army Dentistry Fostering a culture of safety within the DENCOM will cultivate and develop a high reliability organization that can develop Trust, Transparency, and Team among it’s members and promote open communication to ensure the mission is met

IP 8.0 Improve Quality, Pt Safety, Outcome-Focused care and Services

Teamwork provides a concrete yet dynamic operations infrastructure from which to anticipate, contain and manage or mitigate the impact of human error

IP 14.0 Improve Internal Communication TeamSTEPPS is an evidence-based teamwork system aimed atoptimizing patient outcomes by improving communication and otherteamwork skills among healthcare professionals.

LG 18.0 Improve Professional training and Development

Core training refreshed, renewed, updated and modified with lessons learned and provide CE’s for providers and staff

DENCOM TeamSTEPPS Spread StrategyDENCOM TS training will follow in Regional waves:

Wave-1Train “New” Regions: ERDC, WRDC, SERDC

Dates: Sep 09 – ERDC *Nov-Dec 09 – WRDCJan-Feb 10 - SERDC

Resources- TMA, MEDCOM PSC, and DENCOM

Impact- Any Deployments? Realignments? Change of Commands

DENCOM TeamSTEPPS Spread Strategy

Wave 2Complete Regions w/Partial Training completed-

GPRDC, PRDC, NARDCDates: Mar 10 – GPRDC**

Apr 10 – PRDCJun 10 - NARDC

Resources: TMA, MEDCOM PSC, and DENCOM

Impact- Any Deployments? Continue Sustainment of DENTAC training

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Pre-training 2-3 months latertraining sessions

Ongoing coaching, monitor,reassess, spreads

DENCOM OIP Inspectable Area

Commander’s Guide

TeamSTEPPS specific checklist will be written for inclusion in the Patient Safety section of the Guide.

These items will be inspected for compliance during OIP visits from DENCOM personnel.

Feedback to be provided to DENTAC and RDC Commanders to facilitate improvement and focused local or online Sustainment Training.