#LAERDALSUN Welcome Promoting Teamwork and Communication in - - PowerPoint PPT Presentation

Welcome - Atlantic City SUN Share your experience with

#LAERDALSUN

Welcome

Promoting Teamwork and Communication in Perinatal Care Part 2

Presenters: Julie Herges Gapstur, RN, BSN

• Synensys, Senior Consultant

Stan Davis, MD, FACOG

Promoting Teamwork and Communication in Perinatal Care Part 2

A difficult delivery may take on a variety

• f safety issues beyond birth. This

training and hands-on session will assist your teams in learning the TeamSTEPPS tools and strategies and applying them in an OB PPH Simulation

Learning Objectives:

• 1) Gain a basic understanding of the tools

and strategies in the TeamSTEPPS curriculum toolbox and applying it to the simulation experience.

• 2) Participate in a high risk PPH simulation

exercise

• 3) Discuss the role of the facilitator in a

simulation experience

• 4) Participate in a post simulation debrief

trategies &

• ols to nhance

erformance & atient afety

“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”

What is TeamSTEPPS?

Evidence-Based Benefits 25 Years Behavioral Research

• Reduce clinical errors
• Improve patient outcomes
• Improve process outcomes
• Increase patient

satisfaction

• Increase staff satisfaction
• Reduce malpractice claims

…Ultimately change the culture Advancing care and safety through teamwork

Why Do Errors Occur – Some 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

The Way Out

High performing TEAMS at every level in the hospital Paradigm shift from INDIVIDUAL performance to TEAM performance

Wizard of Oz – were these characters a team? Team Goals

Home Brain Heart Courage Broom

High –Performing Teams

Teams that perform well:

• Hold shared mental models –(follow the yellow brick road!)
• Have clear roles and responsibilities
• Have a shared vision (Go to see the Wizard!)
• Optimize resources
• Have strong team leadership
• Engage in a regular discipline of feedback
• Develop a strong sense of collective trust

(Salas et al. 2004)

High performing teams excel at…

Need all four….

Partnering with the Patient as a Member of your Team

Effective Team Leaders

• “Leaders get the behavior they

exhibit and they tolerate.”

• -Jim Collins
• Ability to maximize the activities
• f team members by ensuring

that team actions are understood, changes in information are shared, and team members have the necessary resources

Management vs. Leadership

Management

• Planning
• Budgeting
• Organizing
• Staffing
• Measuring
• Problem Solving
• Doing what we know how

to do exceptionally well

• Constantly producing

reliable, dependable results

Leadership

• Establishing direction
• Aligning people
• Motivating people
• Inspiring
• Mobilizing people to

achieve astonishing results

• Propelling us into the

future

Traits of Effective Leaders

Teamwork….

• Herding Teams

– Does it feel like this sometime?

Team Leader

Two types of leaders:

• Designated – The person

assigned to lead and

• rganize a designated core

team, establish clear goals, and facilitate open communication and teamwork among team members

• Situational – Any team

member who has the skills to manage the situation- at-hand

Leadership – Designated or Situational?

TeamSTEPPS Tools for Leaders

• Briefs – planning
• Huddles – problem

solving

• Debriefs – process

improvement

Briefing Essentials for Teams

• Leader usually

initiates the Briefing process

• Team members are

included in the planning process

• Team members have a

common understanding of the problem and their roles Know the Plan—Share the Plan!

Briefs

Planning

• Form the team
• Designate team roles

and responsibilities

• Share the Plan
• Use a checklist if

indicated

Huddle

Problem solving

• Hold ad hoc, “touch-base”

meetings to regain situation awareness

• Discuss critical issues

and emerging events

• Apply or design

contingency plans

• Assign or re-align

resources

• Express concerns

What are Debriefs?

Debriefs are team events used to: – Review individual and team performance – Identify errors made – Recognize best practices – Develop a plan to improve – Promote continuous learning and process improvement

Debrief Checklist

What went well and why? What didn’t go so well and why? What could we have done differently?

Situational Awareness is… Process of actively scanning and assessing situational elements to gain information or understanding, or to maintain awareness to support team functioning

The state of knowing the current conditions affecting the team’s work

Cross-Monitoring is…

• The process of monitoring the

actions of other team members for the purpose of sharing workload and reducing or avoiding errors

• Mechanism to help maintain

accurate situational awareness

I’ve got your back! And NO one sits down until everyone sits down!

Shared Mental Model The perception, understanding, or knowledge about a situation or process that is shared among team members through communication. Know the Plan! Share the Plan!

Shared Mental Model (Wizard of OZ)

Are we on the same page? Go find the wizard! Get Dorothy home! Used collective knowledge

Shared Mental Model?

Task Assistance Team members foster a climate in which it is expected that assistance will be actively sought and offered as a method for reducing the

• ccurrence of error.

“In support of patient safety, it’s expected!”

Effective Communication

Characteristics of Effective Feedback

Good Feedback is—

• TIMELY
• RESPECTFUL
• SPECIFIC
• DIRECTED toward

improvement

• Helps prevent the same

problem from occurring in the future

• CONSIDERATE

“Feedback is where the learning

• ccurs.”

Feedback Pearl

When giving Effective Feedback remember: “Perception is Reality”

Two-Challenge Rule – Verifying Information

• “Empower any member of

the team to “stop the line” if he or she senses or discovers an essential safety breach.”

• This is an action never to

be taken lightly, but it requires immediate cessation of the process and resolution of the safety issue.

Two-Challenge Rule

• Invoked when an initial

assertion is ignored…

• It is your responsibility to

assertively voice your concern at least two times to ensure that it has been heard

• The member being

challenged must acknowledge

• If the outcome is still not

acceptable you may need to go to a higher chain of command

Effective Communication – Using CUS

I am

• ncerned

I am ncomfortable This is a afety Issue

DESC Script A constructive approach for managing and resolving conflict

• Describe the specific situation
• Express your concerns about the action
• Suggest other alternatives
• Consequences should be stated

Ultimately, consensus shall be reached

Handoff

• Optimized Information
• Responsibility–

Accountability

• Uncertainty
• Verbal Structure
• Checklists
• IT Support
• Acknowledgement

Great opportunity for quality and safety

SBAR - As a Handoff Tool?

A framework for team members to effectively communicate information to one another

• Situation - What is going on with the patient?
• Background - What is the clinical background or context?
• Assessment - What do I think the problem is?
• Recommendations - What would I recommend?

Remember to introduce yourself I-SBAR

Effective Communication – Effective SBAR?

Check-Backs – “Closed Loop Communication”

This is the process of employing confirmed communication to ensure that information conveyed by the sender is understood by the receiver as

• intended. The steps include the

following: 1. Sender initiates the message 2. Receiver accepts the message and provides feedback 3. Sender double-checks through verification to ensure that the message was received.

SENDER RECEIVER

FEEDBACK VERIFY

The Power of a Team!

The Power of Debriefs

• Key Team Learning Events to improve

Healthcare Quality and Safety

Why Debrief

• Teams that debrief

effectively build shared understanding (mental models) and perform up to 40% better

• Teams that debrief are able

to uncover and identify problems earlier than other teams

Smith-Jentsch, et al., 2008

Why Debrief?

Debriefs are team events used to: – Review individual and team performance – Identify errors made – Recognize best practices – Develop a plan to improve – Promote continuous learning and process improvement

Opportunities for Team Debriefs

• Change of Shift
• After Critical Events

– Codes, RRT’s, resuscitations, patient mortality – Following team simulation events

• Post-procedure
• Patient discharge
• Post surgical

procedure

Example

NoCVA OB Collaborative Simulation and Debriefing to Reduce Harm

What approach did we use? Focus was on:

• Teamwork
• Communication
• Learning from errors
• Implementing change
• Debriefing as a

Learning tool

• Improving Safety

Culture

Tips for Leaders and Facilitators

• Empower all members to speak up during

the debrief. Junior members speak first.

• Treat Debriefs as a supportive learning
• pportunity
• Focus on process improvement, teamwork and

future performance – recognize positive performance too!

• Debrief as soon as possible
• Record for review and trending
• Track it, Trend it, Change it! Share it!

Tips for Implementing Debriefs

• Ensure debriefs are diagnostic

– Review strengths, weaknesses, and safe practices

• Create a supportive learning

environment – Empower junior members with ‘psychological safety’

• Train team leaders to recognize

positive team behavior

• Train leaders or facilitators to

provide guided correction

• The power of learning lies in

the Debrief!

Make Change Fun

Share your experience Share your experience with

#LAERDALSUN

Session Survey

Give us your feedback on this session!

Help us make SUN better for you!