HANYS Teamwork

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HANYSTeamwork Technique Achieving Critical
Care Excellence

• A presentation by
• Capt. Stephen Harden

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Agenda

1. Quick review of CRM and its two key components
2. The five step formula for changing culture
3. Key components of the methodology to permanently
   improve teamwork and system processes
4. Identify the leaders in your organization who are
   critical to the success of your improvement
   project
5. The formula to recruit and win the support of
   project champions
6. How to explain the impact of your project to gain
   credibility and support

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• Our Systems are too complex to expect merely
  extraordinary people to perform perfectly 100 of
  the time. We, as leaders, have a responsibility
  to put into place systems to support safe
  practice.

James Conway, IHI Senior Fellow
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CRM is

• Crew
• Any team
• cockpit, maintenance, ATC, etc...
• ICU staff, ICU physicians, ECMO team
• Resource
• Other team members, equipment, procedures,
  systems
• Management
• Specific behavioral skills to lead, communicate,
  decide and catch errors before they become
  serious /fatal
• (Example Pilots working with ATC, conducting a
  readback of a new altitude clearance or ICU
  team transferring pt. to Step Down unit and
  conducting a readback of critical information)

Managing the Resources of the Crew
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CRM Teamwork Training Systems Approach

• Error is inevitable because of human limitations
• The key to safety is managing error
• Stop being surprised by it, and be prepared for
  it
• Aviation (and some hospitals) manages error by
  training specific team communication behaviors
  implementing systems that require those
  behaviors
• The behaviors and the systems supporting the
  behaviors is CRM

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Aviations Solution

• Technology

plus
Teamwork Skills
plus
Systems that Hardwire Teamwork into Daily
Operations
Software Hardware
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The Formula for Changing Culture

• Thoughts
• (training)
• Actions
• (system tools)
• Habits
• (leadership actions proof it works)
• Character
• Culture

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The Formula for Permanent Improvement
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How do you change the culture and go from Me to
We?
Leadership Development Prepare the System To
Succeed

• Philosophy
• Policy
• Procedures
• Practices

The 80/20 rule
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How do you change the culture and go from Me to
We?
Leadership Development Prepare the System To
Succeed
Skills Workshops Equip staff with error-catching
teamwork skills
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How do you change the culture and go from Me to
We?
Leadership Development Prepare the System To
Succeed
Skills Workshops Equip staff with error-catching
teamwork skills
Safety Tools Workshops Hardwire the behaviors
into daily operations
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How do you change the culture and go from Me to
We?
Leadership Development Prepare the System To
Succeed
Skills Workshops Equip staff with error-catching
teamwork skills
Safety Tools Workshops Hardwire the behaviors
into daily operations
Project Measurement Document Results
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How do you change the culture and go from Me to
We?
Leadership Development Prepare the System To
Succeed
Skills Workshops Equip staff with error-catching
teamwork skills
Safety Tools Workshops Hardwire the behaviors
into daily operations
Project Measurement Document Results
Sustainability Train-the-Trainer Become an
owner not a renter
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Aviations Solution

• Technology

plus
Teamwork Skills
plus
Systems that Hardwire Teamwork into Daily
Operations
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Tools in the Safety Toolkit

• Pre briefs pre-op time outs, morning huddles
• Checklists room set-up, holding room exit, line
  insertion protocol, pregnant trauma treatment
  flow,
• Hand-offs
• Debriefings post-procedure, conflict mediation,
  teaching moments
• Standardized communication formats

Hardwire the behaviors into daily
operations This is just the way we do business.
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SBAR

• A standardized format for hand-off communication
• Addresses a JCAHO Safety Goal for 2006
• Used by RNs, Attendings, and Housestaff

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Hybrid ORChecklist
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DebriefingChecklist
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Trauma Protocol

• Standardized, common approach to OB patients with
  severe trauma.
• Jointly developed by OB and Trauma Services
• Covers care in ER, LD and Trauma Units

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OB-GYN
Standardized Morning Huddle for complex LD
Unit with full-time faculty, mid-wives,
housestaff, Newborn Nursery and LD staff.
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Take Advantage of History

• Guerilla Campaign
• Secure Base of Operations
• Support of Strong Government
• Support of 15 of population

• Cultural Change Campaign
• Secure Base No end runs allowed, willing to
  impose consequences for non-compliance,
  leadership mandate
• Government Support Board support, Executive
  support, funding, Med Exec, Joint Commission, CMS
  
• Support of 15 Champions

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The Key Members of the 15...

• CEO or COO or President (funding)
• CMO or VPMA (Med Exec MD partnership)
• Chief of Service or Department Chair (Support of
  Tools)
• Director of Department (Daily reinforcement)
• Key departmental managers (Daily reinforcement)
• At least two physician champions (MD partners)
• Leaders from Quality/Safety/Risk Management
  (Measurement and feedback)

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Recruiting Champions

• Pages 1-12 and 1-13

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The Briefing Protocol

• Page 3 - 1

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Briefing the Implementation Process

• Page 3 - 3

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Objectives

• The five step formula for changing culture
• Key components of the methodology to permanently
  improve teamwork and system processes
• Identify the leaders in your organization who are
  critical to the success of your improvement
  project
• The formula to recruit and win the support of
  project champions
• How to explain the impact of your project to gain
  credibility and support

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FocusSimplicityFollow-upDiscipline
Focus on doing the simple things (follow the
formulas). Follow up after you do them. Have the
discipline to do them without fail.
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Thank Youwww.SaferPatients.com