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Strategies and Tools to Enhance Performance and Patient Safety Mary Agnes Argento Patty Ruddick WVMI

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Beth Israel Deaconess Medical Center. Contemporary OB/GYN (Sexton, 2006) ... Memorial did it, so it doesn't take a big academic medical center,' Leape says. ... – PowerPoint PPT presentation

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Title: Strategies and Tools to Enhance Performance and Patient Safety Mary Agnes Argento Patty Ruddick WVMI


1
Strategies and Tools to Enhance Performance and
Patient SafetyMary Agnes Argento Patty
RuddickWVMI WebExJanuary 15th 2 p.m. EST
2
Objectives
  • Describe the TeamSTEPPS training initiative
  • Explain your organizations patient safety
    program
  • Describe the impact of errors and why they occur
  • Describe the TeamSTEPPS framework
  • State the outcomes of the TeamSTEPPS framework

3
Sue Sheridan Video
4
Video Discussion
  • How are patients harmed as a result ofmedical
    errors?
  • How can we prevent medical errors?
  • What are the solutions?

Improved teamwork and communications Ultimately,
a culture of safety
5
Teamwork Is All Around Us
6
(Sexton, 2006) Johns Hopkins
(Pronovost, 2003) Johns Hopkins Journal of
Critical Care Medicine
(Mann, 2006) Beth Israel Deaconess Medical
Center Contemporary OB/GYN
7
Introduction
  • Evolution of TeamSTEPPS

Curriculum Contributors
  • Department of Defense
  • Agency for Healthcare Research and Quality
  • Research Organizations
  • Universities
  • Medical and Business Schools
  • HospitalsMilitary and Civilian, Teaching and
    Community-Based
  • Healthcare Foundations
  • Private Companies
  • Subject Matter Experts in Teamwork, Human
    Factors, and Crew Resource Management (CRM)

8
Team Strategies Tools to Enhance Performance
Patient Safety
  • Initiative based on evidence derived from team
    performanceleveraging more than 25 years of
    research in military, aviation, nuclear power,
    business and industryto acquire team
    competencies

9
Patient Safety Movement
TeamSTEPPS
To Err is Human IOM Report
JCAHO National Patient Safety Goals
Patient Safety and Quality Improvement Act of
2005
DoD MedTeams ED Study
Executive Memo from President
Institute for Healthcare Improvement 100K lives
Campaign
2006
1995
1999
2001
2003
2004
2005
Medical Team Training
10
The Components of a Patient Safety Program
11
Course Agenda
  • Module 1Introduction
  • Module 2Team Structure
  • Module 3Leadership
  • Module 4Situation Monitoring
  • Module 5Mutual Support
  • Module 6Communication
  • Module 7SummaryPulling It All Together

12
Why Do Errors OccurSome Obstacles
  • Workload fluctuations
  • Interruptions
  • Fatigue
  • Multi-tasking
  • Failure to follow up
  • Poor handoffs
  • Ineffective communication
  • Not following protocol
  • Excessive professional courtesy
  • Halo effect
  • Passenger syndrome
  • Hidden agenda
  • Complacency
  • High-risk phase
  • Strength of an idea
  • Task (target) fixation

13
Institute of Medicine Report
  • Impact of Error
  • 44,00098,000 annual deaths occur as a result of
    errors
  • Medical errors are the leading cause, followed by
    surgical mistakes and complications
  • More Americans die from medical errors than from
    breast cancer, AIDS, or car accidents
  • 7 of hospital patients experience a serious
    medication error

Federal Action By 5 years ? medical errors by
50, ? nosocomial by 90 and eliminate
never-events (such as wrong-site surgery)
Cost associated with medical errors is 829
billion annually.
14
Medical Errors Still Claiming Many Lives By
Elizabeth Weise, USA TODAY
05/18/2005
  • As many as 98,000 Americans still die each year
    because of medical errors despite an
    unprecedented focus on patient safety over the
    last five years, according to a study released
    today. Significant improvements have been made in
    some hospitals since the Institute of Medicine
    released a landmark report in 2000 that revealed
    many thousands of Americans die each year because
    of medical mistakes.
  • But nationwide, the pace of change is
    painstakingly slow, and the death rate has not
    changed much, according to the study in The
    Journal of the American Medical Association.
  • The researchers blame the complexity of health
    care systems, a lack of leadership, the
    reluctance of doctors to admit errors and an
    insurance reimbursement system that rewards
    errors hospitals can bill for additional
    services needed when patients are injured by
    mistakes but often will not pay for practices
    that reduce those errors.
  • "The medical community now knows what it needs to
    do to deal with the problem. It just has to
    overcome the barriers to doing it," says study
    co-author Lucian Leape of Harvard's School of
    Public Health.
  • The institute, a public policy organization,
    pushed key health care organizations to focus on
    patient safety, the new report says. As a result,
    reductions as much as 93 have been made in
    certain kinds of error-related illnesses and
    deaths.
  • Computerized prescriptions, adding a pharmacist
    to medical teams and team training in the
    delivery of babies are among the improvements
    medical centers are making, the study finds.
  • But "we have to turn the heat up on the
    hospitals," Leape says.
  • For example, 5 to 8 of intensive-care patients
    on ventilators develop pneumonia, the study says.
    But by strictly following a simple protocol of
    bed elevation, drugs and periodic breathing
    breaks, those outbreaks can be reduced to almost
    zero. "A little hospital in DeSoto, Miss., called
    Baptist Memorial did it, so it doesn't take a big
    academic medical center," Leape says.
  • Hospitals that eliminate infections should
    receive bonuses, Leape says. "If insurance
    companies paid 20 more for patients in
    (intensive-care units) where there were no
    infections, they'd cut costs substantially.
  • "We really need to rethink how we pay for health
    care. What we do now is pay for services, but
    what we should do is pay for care and outcomes."

Improvements
  • Hospitals have taken steps to reduce medical
    errors and injuries.
  • Examples
  • Computerized prescriptions 81 decrease in
    errors.
  • Including pharmacist in medical team 78
    decrease in preventable drug reactions.
  • Team training in delivery of babies 50 decrease
    in harmful outcomes such as brain damage in
    premature deliveries.
  • Source Journal of the American Medical
    Association

little progress towards the goal Leape and
Berwick,JAMA May 2005
15
JCAHO Sentinel Events
Targets for Teamwork
16
What Comprises Team Performance?
KnowledgeCognitionsThink
AttitudesAffectFeel
SkillsBehaviorsDo
team performance is a scienceconsequences of
errors are great
17
Outcomes of Team Competencies
  • Knowledge
  • Shared Mental Model
  • Attitudes
  • Mutual Trust
  • Team Orientation
  • Performance
  • Adaptability
  • Accuracy
  • Productivity
  • Efficiency
  • Safety

18
Teamwork Actions
  • Recognize opportunities to improve patient safety
  • Assess your current organizational culture and
    existing Patient Safety Program components
  • Identify teamwork improvement action plan by
    analyzing data and survey results
  • Design and implement initiative to improve
    team-related competencies among your staff
  • Integrate TeamSTEPPS into daily practice.

High-performance teams create a safety net for
your healthcare organization as you promote a
culture of safety."
19
Teamwork Encompasses CRM
  • DoD has led the way in team research and
    innovations
  • Non-Healthcare
  • Combat Information Centers
  • Joint Forces Operations
  • Emergency Management Communities
  • Army Special Forces
  • Tank, Submarine, and Air Crews
  • Healthcare
  • ED, OR, LD, ICU, Dental
  • Whole Hospital
  • Combat Casualty Care

TeamTraining
CRM
"Learning and Safety Culture"
striving to be a high reliability healthcare
system
20
Background US Army Aviation
  • Army aviation crew coordination failures in
    mid-80s contributed to 147 aviation fatalities
    and cost more than 290 million
  • The vast majority involved highly experienced
    aviators
  • Failures were attributed largely to crew
    communication, workload management, and task
    prioritization

21
US Navy Breakthroughs Tactical Decisionmaking
Under Stress (TADMUS)
  • Cross-Training
  • Stress Exposure Training
  • Team Coordination Training (CRM)
  • Scenario-Based Training and Simulation
  • Team Leader Training
  • Team Dimensional Training
  • Team Assessment

22
US Air Force CRM History
  • Mid to Late 80s AF bombers and heavy aircraft
    started CRM training
  • 1992 Air Combat Command developed Aircrew
    Attention Management /CRM Training
  • By 1998, CRM deployed uniformly across the AF
  • Steady decline in human factors based mishaps
    since CRM training deployed
  • AF Medical Service adapted training, rolled out
    in 2000

23
Eight Stepsof Change
John Kotter
24
Roadmap to a Culture of Safety
Monitor, Integrate, Continuous Process Improvement
Celebrate wins! Staying the courseSustaining
Implement Action Plan, Train, Empower Others
TeamSTEPPSChangeCoaching
Test Intervention (Outcomes)
Im staying right here. Yeah theyll be back.
What are they doing?
JCAHO
Develop Action Plan
Status QUO
Why do we need change?
FUTURE
Errorville
Prepare the Climate
Catalytic event drives need for change
Build team, strategy, buy-in, establish goals
25
Team Structure
The ratio of Wes to Is is the best indicator of
the development of a team. Lewis B. Ergen
NEXT
26
Objectives
  • Identify the characteristics of high-performing
    teams
  • Discuss benefits of teamwork and team structure
  • Describe components and composition of
    amulti-team system (e.g., Core Team,
    Coordinating Team, Contingency Team, Ancillary
    Services, and Administration)
  • Understand what defines a team
  • Define the roles and effectiveness of team members

27
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28
Partnering with the Patient
  • Embrace patients as valuable and contributing
    partners in patient care
  • Learn to listen to patients
  • Assess patients preference regarding involvement
  • Ask patients about their concerns
  • Speak to them in lay terms
  • Ask for their feedback
  • Give them access to relevant information
  • Encourage patients and their families to
    proactively participate in patient care

29
Why Teamwork?
  • Reduce clinical errors
  • Improve patient outcomes
  • Improve process outcomes
  • Increase patient satisfaction
  • Increase staff satisfaction
  • Reduce malpractice claims

30
High-Performing Teams
  • Teams that perform well
  • Hold shared mental models
  • Have clear roles and responsibilities
  • Have clear, valued, and shared vision
  • Optimize resources
  • Have strong team leadership
  • Engage in a regular discipline of feedback
  • Develop a strong sense of collective trust and
    confidence
  • Create mechanisms to cooperate and coordinate
  • Manage and optimize performance outcomes
  • (Salas et al. 2004)

31
Barriers to Team Performance
  • Inconsistency in team membership
  • Lack of time
  • Lack of information sharing
  • Hierarchy
  • Defensiveness
  • Conventional thinking
  • Varying communication styles
  • Conflict
  • Lack of coordination and follow-up
  • Distractions
  • Fatigue
  • Workload
  • Misinterpretation of cues
  • Lack of role clarity

32
Exercise Teams and Teamwork
  • Write down the names (or positions) of the
    peoplein your immediate work area or unit who
    contribute to successful patient care.

33
Multi-Team System (MTS) for Patient Care
34
A Core Team is
  • A group of care providers
  • who work interdependently
  • to manage a set of
  • assigned patients
  • from point of
  • assessment to
  • disposition

Core Team members have the closest contact with
the patient!
35
A Coordinating Team is
  • A team comprising those
  • work area members who are
  • responsible for managing
  • the operational
  • environment that
  • supports the
  • Core Team

36
A Contingency Team is
  • A time-limited team formed
  • for emergent or specific
  • events and composed
  • of members from
  • various teams

37
Ancillary Support Services provide
  • Ancillary Services provide direct,
    task-specific, time-limited care to patients.
  • Support Services provide indirect
    service-focused tasks which help to facilitate
    the optimal healthcare experience for patients
    and their families.

38
The Role of Administration is to
  • Establish and communicate vision
  • Develop policies and set expectations for staff
    related to teamwork
  • Support and encourage staff during
    implementation and culture change
  • Hold teams accountable for team performance
  • Define the culture of the organization

39
Example A Multi-Team System in the OR
40
Exercise Your Multi-Team System
?
?
41
Team Member Characteristics
42
Team Failure Video
43
Teamwork Failure Video Analysis
  • Did the team establish a leader?
  • Did the team assemble and assign roles and
    responsibilities to each member?
  • Did the team members communicate essential
    information to each other?
  • Did all team members contribute?
  • Did the team members demonstrate mutual respect
    toward one another?
  • Did the team address issues and concerns?
  • What are some specific actions that could have
    been taken to improve the outcome?

44
What Defines a Team?
  • Two or more people who interact dynamically,
    interdependently, and adaptively toward a common
    and valued goal, have specific roles or
    functions, and have a time-limited membership

45
Paradigm Shift to Team System Approach
Dual focus (clinical and team skills) Team
performance Informed decision-making Clear
understanding of teamwork Managed
workload Sharing information Mutual support Team
improvement Team efficiency
Single focus (clinical skills) Individual
performance Under-informed decision-making Loose
concept of teamwork Unbalanced workload Having
information Self-advocacy Self-improvement Individ
ual efficiency
46
Effective Team Members
  • Are better able to predict the needs of other
    team members
  • Provide quality information and feedback
  • Engage in higher level decision-making
  • Manage conflict skillfully
  • Understand their roles and responsibilities
  • Reduce stress on the team as a whole through
    better performance

Achieve a mutual goal through interdependent and
adaptive actions
47
Teamwork Actions
  • Assemble a team
  • Establish a leader
  • Identify the teams goals and vision
  • Assign roles and responsibilities
  • Hold team members accountable
  • Actively share information among team members
  • Provide feedback

Individual commitment to a group effortthat is
what makes a team work, a company work, a society
work, a civilization work. Vince Lombardi
48
Final Thoughts
  • How do you anticipate utilizing TeamSTEPPS in
    your organization?
  • What can WVMI provide to assist your organization
    in being successful with TeamSTEPPS? (WebEx or
    Self Study for the remaining Modules?)
  • Additional Questions
  • Mary Agnes Argento (margento_at_wvmi.org)
  • or
  • Patty Ruddick (pruddick_at_wvmi.org)
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