TEAMSTEPPS: Empowering Simulation Technology Specialists

1. TEAMSTEPPS: Empowering Simulation Technology Specialists Timothy C. Clapper, PhD

2. Conflicts of Interest • None to disclose

3. About the Keynote Speaker • Twenty years US Army Infantry….combat veteran. • Taught in affluent and socioeconomically disadvantaged high schools in NYC and Boston. Introduced to Brain based learning • Showed teachers a better way to reach their learners. • Entered clinical simulation as a Simulation Specialist and began to change simulation as we know it…

4. High Central line infection and complications The Problem Airway – Bad outcomes in ED Medical errors can occur because of a clinician’s conflict with themselves, other people, the environment, or any combination of these variables (Clapper, 2013). Clapper’s ConflictTheory of Medical Errors Based on what we know today medical errors can occur because of: 1. Inappropriate or inadequate skill performance at a particular time (Conflict with themselves) (Kohn, Corrigan, & Donaldson, 2000); 2. Inappropriate or inadequate team performance and communication at a particular time (Conflict with other people) (AHRQ, 2003); 3. Human factors issues: Conflict between humans and their equipment (Conflict with their clinical environment) (Reason, 2000); 4. A combination of any of these variables. Shoulder dystocia bad outcomes and litigation costs Unprepared Code Teams Incivility (across the healthcare profession) Clapper, T. C. (2013, in press). In Situ and Mobile Simulation: Lessons learned...Authentic and Resource Intensive. Clinical Simulation in Nursing. http://www.sciencedirect.com/science/article/pii/S1876139913000029

5. Brain based learning for simulationTM Inquire Gather Apply Process • Some alternatives: • “Scare and talk about it simulation” which has rarely made a difference for patient safety. • Rotational “show and tell” bootcamps. • We must ask ourselves • “How do they know it?” • “Where did they learn it?” (Clapper, 2013) Clapper, T. C. (2013, Spring). Saturation in Training, Patient Safety InSight. http://magazine.nationalpatientsafetyfoundation.org/magazine/spring2013-saturation-in-training

6. TeamSTEPPS® Concepts Shared Mental Model Four Competencies • Leadership (most clinicians do not receive formal training in this area)(Clapper & Kong, 2012) • Situational Monitoring • Mutual Support • Communication • A Clear Leader (Situational or Designated) (Only as effective as the team) • Group Huddle (Applied early) • SBAR (Applied early and throughout the case; assists with advocacy-inquiry/inquiry-advocacy and strengthening team awareness and capabilities) • CUS [Concerned – Uncomfortable – Safety (Stop the Line)] (Applied early and throughout the case. Each member of the team is empowered to act) • Closed-Loop Communication (Applied early) (“ Call for ____” “I called for ___as requested”) • Check-Back (“Do you mean suprapubic pressure?”) • Team Debriefing (What just happened?…How did this go?...Next steps…Improvements for next time)

7. The TeamSTEPPS Solution (and the problem…) Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) adopted at corporate level, including implementing Master Trainer Courses across 11 hospitals “Including TeamSTEPPS in simulation courses may solidify the teamwork and communication concepts in meaningful ways for clinicians while incorporating important Crew (or crisis) Resource Management and Human Factors principles” (Clapper & Kong, 2012). Problem: 2 ½ days of lecture-based instruction with little authentic training in the context that it will be used (Clapper & Ng, 2013) Learners must be shown how TeamSTEPPS may be applied to their own clinical settings in authentic ways…not through “death by lecture” (Clapper & Ng, 2013). It must be modeled for them… Clapper, T. C., & Ng, G. M. (2013). Why your TeamSTEPPS program may not be working. Clinical Simulation in Nursing,9(8),e287-e292. doi:10.1016/j.ecns.2012.03.007 Clapper, T. C., & Kong, M. (2012). TeamSTEPPS: The patient safety tool that needs to be implemented. Clinical Simulation in Nursing, 8(8), e367-e373. doi:10.1016/j.ecns.2011.03.002

8. Solution • Robust, research-based, simulation-based courses were developed using the Brain-Based Learning for SimulationTM model and TeamSTEPPS®. • Implemented and in some cases…developed best practices. • (This is where Sim Specialists are especially valuable!!!!) • Training included all levels to address gaps in knowledge, skills, and teamwork (Attendings, Chairs, Midwives, Residents, and Nurses training together). • BBL activated all of the learner’s senses and learning styles and involved real active learning…very little lecture…a lot of collaborative learning! • ALL courses included TeamSTEPPS, so learners could have the competencies (leadership-communication- situational monitoring-mutual support)modeled for them and could apply them in the context that they would be used (Clapper & Ng, 2013). Clapper’s Saturation in Training Model (Clapper & Ng, 2013) Train the greatest amount of people in the shortest period of time.

9. Let’s see how this TeamSTEPPS thing can work for us

10. TeamSTEPPS® Concepts Shared Mental Model Four Competencies • Leadership (most clinicians do not receive formal training in this area)(Clapper & Kong, 2012) • Situational Monitoring • Mutual Support • Communication • A Clear Leader (Situational or Designated) (Only as effective as the team) • Group Huddle (Applied early) • SBAR (Applied early and throughout the case; assists with advocacy-inquiry/inquiry-advocacy and strengthening team awareness and capabilities) • CUS [Concerned – Uncomfortable – Safety (Stop the Line)] (Applied early and throughout the case. Each member of the team is empowered to act) • Closed-Loop Communication (Applied early) (“ Call for ____” “I called for ___as requested”) • Check-Back (“Do you mean suprapubic pressure?”) • Team Debriefing (What just happened?…How did this go?...Next steps…Improvements for next time)

11. Departing Thoughts • Learn TeamSTEPPS! • Integrate TeamSTEPPS into all simulation - skill-based thru full scale • Integrate TeamSTEPPS into your simulation team - empower one another • Using the TeamSTEPPS competencies as a base, reflect and analyze current practices, to improve: • the learning environment (make it a place where people want to return for more) • the clinical skills of your learners AT ALL LEVELS • the teamwork and communication of your learners • the human factor issues that your learners are faced with • and of course, improve your own team working environment! Everyone is important… but especially you, SIM Specialist. Step up!

12. Timothy dot Clapper at gmail dot com