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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 of 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 •
What is TeamSTEPPS? trategies & ools 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”
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 Halo effect • • Interruptions Passenger syndrome • • Fatigue Hidden agenda • • Multi-tasking Complacency • • Failure to follow up High-risk phase • • Poor handoffs Strength of an idea • • Ineffective Task (target) fixation • • communication Not following protocol • Excessive professional • courtesy
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 of team members by ensuring that team actions are understood , changes in information are shared , and team members have the necessary resources
Management vs. Leadership Leadership Management Establishing direction • • Planning Aligning people • • Budgeting • Motivating people • Organizing • Inspiring • Staffing • Mobilizing people to • Measuring achieve astonishing • Problem Solving results • Doing what we know how Propelling us into the • to do exceptionally well future • Constantly producing reliable, dependable results
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 organize 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 occurrence 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 occurs.”
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 oncerned 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 VERIFY intended. The steps include the following: 1. Sender initiates the message 2. Receiver accepts the message and provides feedback SENDER RECEIVER 3. Sender double-checks through verification to ensure that the message was FEEDBACK received.
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
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