Executive Briefing

1. Executive Briefing

2. What is TeamSTEPPSTM? • An evidence-based teamwork system • Designed to improve: • Quality • Safety • Efficiency of health care • Practical and adaptable • Provides ready-to-use materials for training and ongoing teamwork

3. Why Use TeamSTEPPS? • Goal: Produce highly effective medical teams that optimize the use of information, people and resources to achieve the best clinical outcomes • Teams of individuals who communicate effectively and back each other up dramatically reduce the consequences of human error • Team skills are not innate; they must be trained

4. Why Invest in TeamSTEPPS? • Cost of TeamSTEPPS is minimal compared to savings • Annual cost is approximately 98,000 lives and $17-29 billion • Errors can be reduced by changes to the health care system; specifically by providing interdisciplinary team training Reference: Kohn LT, Corrigan, JM, Donaldson, MS. Eds. To err is human: Building a safer health system. Washington, DC: Committee on Quality of Health Care in American, Institute of Medicine, National Academy Press, 2000.

5. What Can TeamSTEPPS Do for Us? • Clinical Units in a Medical Center2 • After implementation of SBAR to improve communication among clinical caregivers: • • Reduced rate of adverse drug events (from 30 to 18 per 1,000 patient days). • • Improved medication reconciliation at patient admission from 72% to 88% and at discharge from 53% to89%. • Emergency Department1 • After implementation of multiple medical • team training programs: • Improved observed team behaviors. • Enhanced staff attitudes toward teamwork. • Reduced observedclinical errors. • Morey, JC, Simon, R, Jay GD, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: Evaluation results of the MedTeams project. Health Serv Res. 37:1553-1581, 2002 • Haig, K., Sutton S, Whittington, J. SBAR: A shared mental model for improving communication between clinicians. JL Comm J Qual Patient Saf 32(3):167-75, March 2006.

6. What Can TeamSTEPPS Do for Us? Labor and Delivery Units1 After implementation of multiple teamwork strategies and tools: - A 50% reduction in the Weighted Adverse Outcome Score (WAOS). The WAOS describes the adverse event score per delivery. - A 50% decrease in the Severity Index, which measures the average severity of each delivery with an adverse event. • Intensive Care Units (ICU)2 • After implementation of a “Patient Daily Goals” form to facilitate staff communication: • A 50% decrease in mean ICU length of stay from 2.2 days to 1.1 days. • Mann, S, Marcus, R, Sachs, B. Lessons from the cockpit: How team training can reduce errors on L&D (Grand Rounds) Contemporary OB/Gyn v51 i1:34(8), January 2006. • Pronovost, P, Berenholtz, S, Dorman, T, Lipsett, PA., Simmonds, T, Haraden, C. Improving communication in the ICU using daily goals. J Cri Care 18(2):71-5, Jun 2003.

7. What Can TeamSTEPPS Do for Us? • Operating Rooms (OR) • After implementation of a “pre-op” brief: • Increased OR communication.1,2 • Increased administration of properly timed prophylactic antibiotics prior to incision from 84% to 95%.1 • Increased pre-op deep vein thrombosis prophylaxis prior to induction from • 92% to 100%.1 • Error avoidance: Pre-op brief revealed seven patients (3.3%) with previously unidentified severe surgical risks — surgery cancelled.1 • A 16% reduction in nursing turnover rate.2 • A 19% increase in OR employee satisfaction.2 • Awad, SS, Fagan, SP, Bellows, C., Albo, D, et al. Bridging the communication gap in the operating room with medical team training. Am J Surg 190(5): 770-4, Nov 2005. • Leonard, M,, Graham, S, Bonacum, D. The human factor: The critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 13 Suppl 1:i85-90, Oct 2004.

8. What Makes TeamSTEPPS Different? • Evidence-based and field-tested • Comprehensive • Customizable • Easy-to-use teamwork tools and strategies • Publicly available

9. What Will Our Teams Learn?

10. How Does TeamSTEPPS Work? • I. Assessment • Clearly define the need • II. Planning, Training, and Implementation • Plan to sustain the effort • Train individuals • Implement and test the strategies • III. Sustainment • Integrate into daily practice • Monitor and measure programs

11. What Do We Need to Make This Work? • Clearly define the need • Focus on enhancing teamwork and establishing a teamwork and safety culture • Support from senior leadership • Allocatesufficient resources • Personnel • Time • Resources • Measure success • Reward and reinforce teamwork

12. What Does Training Cost?Key to Table Figures • $A = Trainer preparation costs -Trainers’ time x trainers’ hourly rate • $B = Travel costs related to any of the train the trainer sessions • $C=Trainer costs to conduct training - Trainers’ time x trainer hourly rate • $D = Trainee costs -Number of staff to be trained x (number of training hours) x staff hourly rate • $E = Other training expenses -Food, senior leadership time for kickoff, etc. • $F = Trainer costs for ongoing support- Number of “areas” participating X (hours of support) x trainer/coach hourly rate • $G = Optional cost for staff time discussions - As normal course of business • $H = Other ongoing support costs • $I, $J, $K = Total - The estimated costs at bottom of each column

13. What Does Training Cost?

14. How Do We Start? • Create a sense of urgency • Pull together the guiding team • Formulate a change vision and strategy • Communicate your vision for understanding and buy-in • Send trainers to one of the TeamSTEPPS National Implementation Project Training Resource Centers

15. Training for the Guiding Team • Training is available until 9/1/09 • Training is available on a “first come – first served” basis • Contact the National Implementation Project for TeamSTEPPS and apply • Complete the readiness assessment • Submit the statement that indicates they have completed the readiness assessment and contact info by email: tsteppstrainingapps@air.org • For answers to qualification questions, call: • (877)-6STEPPS (678-3777)

16. The following slides (16 – 21) are slides that can support the briefing and may be integrated into slides 1 – 14 as appropriate. Backup Slides

17. National Teamwork Initiatives Accreditation Council for Graduate Medical Education (ACGME) and the Association for American Medical Colleges (AAMC) include aspects of communication, coordination, and collaboration in physician competencies National Quality Forum (NQF) included teamwork training, skill building and teamwork interventions in Safe Practices for Better Health Care: A Consensus Report (2006 Update) The Joint Commission has increasingly included elements of teamwork in their National Patient Safety Goals and accreditation standards Centers for Medicare & Medicaid Services (CMS) included TeamSTEPPS in the 9th Scope of Work

18. Importance of Communication • Communication failure has been identified as the leading root cause of sentinel events over the past 10 years (Joint Commission) • Communication failure is a primary contributing factor in almost 80% of more than 6000 root cause analyses of adverse events and close calls (VA Center for Patient Safety)

19. What Does it Cost? • Costs can be modified by obtaining materials and having trainers teach themselves • Based on the National Implementation of TeamSTEPPS Project, we estimate that a Change Team Member will spent 10% FTE (200 hrs) on this effort

20. Resources Available TeamSTEPPS resources include: • Three teamwork training curricula • Course Management Guide • Multimedia course materials • TeamSTEPPS Implementation Guide • Measurement tools • Web site for updated resources and information: http://teamstepps.ahrq.gov/