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Summary Pulling it All Together

Summary Pulling it All Together. “The truth of the matter is that you always know the right thing to do. The hard part is doing it.” –Norman Schwarzkopf. Day 1 Objectives. Explain the theoretical framework and evidence base that supports the use of team skills to improve safety culture.

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Summary Pulling it All Together

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  1. Summary Pulling it All Together “The truth of the matter is that you always know the right thing to do. The hard part is doing it.” –Norman Schwarzkopf

  2. Day 1 Objectives • Explain the theoretical framework and evidence base that supports the use of team skills to improve safety culture. • Learn the team skills that enhance performance and patient safety.

  3. Mutual Performance Monitoring The Theory Team Leadership Team Orientation Back-up Behavior Shared Mental Models Mutual Trust Adaptability Team Effectiveness Big 5 Salas, Sims, Burke. Is there a “Big Five” in teamwork? Small Group Research. 2005; 36:555-599. Coord. Mechanism Closed Loop Communication

  4. The Framework: What Comprises Team Effectiveness? KnowledgeCognitions“Think” AttitudesAffect“Feel” …team performance is a science…consequences of errors are great… SkillsBehaviors“Do”

  5. More Evidence • Exploding Literature • Patient Care Team + Evidence-Based Practice = 1,128 • Patient Care Team + Evaluation Studies = 843 • Studies in diverse patient populations demonstrate relationship between teamwork and • Improved clinical processes • Reduction in medical errors • Improved surgical team performance • Increased adherence to guidelines • Decreased length of stay • Increased functional status • Decreased mortality Salas et al. What are the critical success factors for team training in health care? Jt Comm Jrnl Qual Safe. 2009;35:398-405.

  6. The Bottom Line…. The knowledge, skills, attitudes, language, and coordinating mechanisms inherent in teamwork1 create the flexibility team members need to manage complexity2 and learn from experience.3-5 • Salas E, Sims DE, Burke CS. Is there a "Big Five" in teamwork? Small Group Research. 2005;36:555-599. • Cannon-Bowers JA, Salas E. Team performance and training in complex environments: Recent findings from applied research. CurrDirPsychol Sci. 1998;7:83-87. • SengePM. The Fifth Discipline: The Art & Practice of the Learning Organization. New York, NY: Doubleday; 1990. • Edmonson AC. Learning from failure in health care: Frequent opportunities, pervasive barriers. QualSaf Health Care. 2004;12(Suppl II):ii3-ii9. • Salas E, Rosen MA, Burke CS, Goodwin GF. The wisdom of collectives in organizations: An update of the teamwork competencies. In: Salas E, Goodwin GF, Burke CS, eds. Team effectiveness in complex organizations: Cross-disciplinary perspectives and approaches. New York, NY: Routledge/Taylor & Francis Group; 2009:39-79.

  7. Barriers, Tools/Strategies, Outcomes TOOLS and STRATEGIES Brief Huddle Debrief STEP I’M SAFE Checklist Cross Monitoring Feedback Advocacy and Assertion Two-Challenge Rule CUS DESC Script Collaboration SBAR Call-Out Check-Back Handoff OUTCOMES • Shared Mental Model • Adaptability • Team Orientation • Mutual Trust • Team Performance • Patient Safety!! Team Goals BARRIERS • Inconsistency in Team Membership • Lack of Time • Lack of Information Sharing • Hierarchy • Defensiveness • Conventional Thinking • Complacency • Varying Communication Styles • Conflict • Lack of Coordination and Follow-Up with Co-Workers • Distractions • Fatigue • Workload • Misinterpretation of Cues • Lack of Role Clarity

  8. The Constraints

  9. Identifying Opportunities to Use TeamSTEPPS Tools and Strategies Insert video Vig aLg001

  10. Discussion • What were the barriers to communication? • Lack of information sharing, lack of follow-up, lack of role clarity, misinterpretation of cues, workload • Which TeamSTEPPS tools and strategies could have been used? (Consult your Pocket Guide) • STEP, huddle, SBAR • What is the biggest issue in terms of teamwork skills?

  11. Using TeamSTEPPS Tools and Strategies Insert video Vig 2bLg001

  12. Case Analysis • Divide yourselves into groups of 4 - 5 • Discuss the scenario in your team • Identify the barriers to teamwork that occurred • Identify tools, strategies to address the barriers • Report out to the whole group

  13. Summary During this training, we learned that teamwork strategies and tools— • Create a safety net for fallible human beings (human factors) • Do not come naturally…must be learned (evidence-based training) • Create the flexibility we need to manage complexity and learn from experience What we didn’t learn… for Master Trainers • One shot didactic lectures can not change people’s behavior • Human beings and organizations adopt new behaviors in stages as a result of a change strategy

  14. “To improve teamwork in support of patient safety, what small change can you commit to?” “The achievements of an organization are the results of the combined effort of each individual.” –Vince Lombardi

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