Implementing TeamSTEPPS to Improve Patient & Staff Safety

1. Implementing TeamSTEPPS to Improve Patient & Staff Safety Texas Health Resources Marcie Williams RN, MS, FASHRM, CPHRM, CPPS, CLNC Vice President, Safety & Risk Management

2. Objectives • Understand the importance of Leadership in successfully implementing TeamSTEPPS • Explain the importance of early metrics selection • Describe 3 pilot site selection criteria for successful TeamSTEPPS implementation • State 3 implementation success factors for TeamSTEPPS and how they can be applicable to your healthcare system or hospital

3. Texas Health Resources 24 centers in North Texas(14 wholly owned hospitals) Over 4,100 licensed beds 133,903 inpatient discharges 1,238,929 outpatient encounters 469,309 ER visits 89,452 surgeries 27,200 deliveries 5,500 active physicians 21,775 employees

4. Importance of Effective Communication Communication failure has been identified as a 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

5. Patient Safety Movement Institute for Healthcare Improvement 100K lives Campaign TeamSTEPPS “To Err is Human”IOM Report National Implementation of TeamSTEPPS JCAHO National Patient Safety Goals DoD MedTeams® ED Study Patient Safety and Quality Improvement Act of 2005 Executive Memo from President Adoption by Military Health System from 2007-2011 1995 1999 2001 2003 2004 2005 2011 2006 2008 Medical Team Training 5

6. Medical Team Training Johns Hopkins Johns Hopkins Beth Israel Deaconess Medical Center OB/GYN

7. WHO Surgical Checklist“Checklist Manifesto” Annals of Surgery, Sept 2010 Medical Team Training Supports Improvement in Dept Performance, Reduced Complications, Increased Staff and Physician Communication & Satisfaction

8. TeamSTEPPSImplementation Considerations • Be ready for the resistors – get Sr. Leaders on board early • Training materials free, easily accessed via internet – copying fees for education materials • Cost for distributing teaching aids • Vendor Selection – needed or not?

9. Metrics Selection • Patient Safety Culture Survey pre implementation results vs post implementation results • Direct on site observations pre and post implementation using the TS observation tool - THR added to each metric observation criteria or questions to ask during the interview process to provide consistency and observer reliability • Pre and post implementation HCAHPS scores • Stories sell – collect them and share

10. TeamSTEPPS framework builds on team skills The TeamSTEPPS tools include many things we already do... but also adds new team skill sets to assure effective communication Performance Leader-ship Situationmonitoring Communi-cation Mutualsupport Patient care team Skills Attitudes Knowledge

11. Learning the Language Leadership • 1. Briefs • 2. Huddles • 3. Debriefs SituationMonitoring • 4. Situational awareness • – Cross monitoring Mutual Support • 5. Task assistance • 6. CUS • 7. SBAR • 8. Call-outs • 9. Check-backs • 10. Hand-offs Communication 11

12. IMPLEMENTATION PLAN

13. Approach Overview 10 Months 90 days 2 years Baseline and pilot preparation Pilot implementation Large scale rollout Vision Setting Pilot Selection • Comprehensive baseline • Pre observations • PS Culture Survey • Satisfaction Results Pilot execution Pilot preparation and design Pilot monitoring and refinement Large scale rollout plan Rollout – Wave 1 Rollout – Wave 2 Pre Obs Ongoing monitoring and refinement Leadership meetings Non-Clinical 2012 Pilot Post Obs Mst Trainer Ed Corp Approval Pre Observations Pilot Launch Pilot Mid year Check Progress check Post Obs PSC Survey

14. Pilot Site Selection Criteria Must haves Variables

15. Direct Observation Tool • Observer – Master or Champion trained • Developed to ensure observer objectivity and consistency • When completing a Service Line takes 4-6 hours • When completing a Dept takes 2-3 hours • Complete all shifts so the staff understand this is not just for one shift

16. Perinatal Pilot • Meeting with Formal leaders • Patient Safety Culture Survey • Trained hospital Risk Managers/Patient Safety as the facilitators • Pre-implementation Observations • Selection of Champions (3-5 from each dept within the service line)

17. Perinatal Pilot • Champion training • Formal and informal leaders from each shift • Educators to maintain the focus • Staff Education slides with talking points • Mid year sampling observations • Champion meeting connecting the dots between patient safety programs and TeamSTEPPS • Shared stories with Leadership and staff • End of year post implementation observations

18. Pilot Results Strengths Opportunities for Improvement Early Sr. leadership engagement Improve physician engagement Ensuring use of the TS common language Consistent debriefings Good leadership needed in the service line to set the expectation that TS is 24/7 Shorten length of pilot • Effectively using TS tools in critical situations in early implementation • Successful shift briefs with dept leaders in the service line • Consistent use of SBAR and handoffs • Improved intercollaborative discharge briefings in certain departments • Use of the word “concern” stops the line

19. 0 = expected but not observed or found in discussions with staff 1 = observed/discussions but poor 2 = observed/discussions but marginal 3 = observed/discussions and acceptable 4 = observed/discussions and good

20. PG Patient Satisfaction Scores Post TeamSTEPPS Implementation OB/GYN

21. System Implementation

22. Operationalize TeamSTEPPS • Develop education for several levels • Need a committed leader • Physician engagement – elevator speech for brief conversations or info in lounges • Large hospitals - implement per Service Line • Small hospitals – Single kick off as staff are cross trained to different departments • Implement clinical and non-clinical

23. Levels of TeamSTEPPS Education • Facilitator Education (Master Trainer Level) • Master Trainers (system Super Users) • Champions Training (4 hours session) • Staff Training – 1 hour by Champion, all received the TeamSTEPPS Pocket Guide • Executive Training (1 hour, basic concepts) • Physician Training (20 minutes, what is needed the most for their participation)

24. TeamSTEPPS Performance Adaptability, Accuracy, Productivity, Efficiency, Safety Key Benefits TeamStrategies and Tools to Enhance Performance and Patient Safety • Improve patient outcomes • Actively promote teamwork and communication • Create tools so as to communicate effectively Leadership Articulate clear goals through briefs, huddles & debriefs Outcomes Communication Speak clearly using SBAR, read back, handoff, call out Situationmonitoring Ensure all team members are on same page Legend Skills MutualSupport Ask for and offer task assistance, CUS Patient Care Team Knowledge Shared mental model Attitudes Mutual trust, Team Orientation

25. TeamSTEPPS Language Definitions CUS

26. TeamSTEPPS Team Strategies and Tools to Enhance Performance and Patient Safety What is it? TeamSTEPPS is an evidence-based communication toolkit to improve team performance across the health care delivery system. Team Competency Outcomes Knowledge – how to understand being on the “same page” Attitudes – the importance of “team” orientation” Performance – improve safety and outcomes in your daily practice This is not a new program but a framework in which we can communicate more effectively with each other.

27. Integrating TeamSTEPPS into Patient Safety Initiatives • Not just another program • Presented as a framework for many existing communication activities • Added to the annual goals for Dept Managers • TeamSTEPPS prior to Safe Surgery Initiative • Integrated into job descriptions • Integrated into event investigations • Integrated into electronic health record’s procedural and surgical checklists

28. TeamSTEPPS Corporate Implementation Checklist

29. TeamSTEPPS Hospital Implementation Checklist

30. Implementation Success Factors Topic Key success factors Implementation philosophy & approach • TeamSTEPPS is consistently used throughout THR as the communication and patient safety language. • An understanding exists that good teamwork results in reducing preventable errors, better patient outcomes, reducing length of stay, etc. • Constantly engage physicians and diverse stakeholders recognizing the value of interdisciplinary teams. Initiative leadership • Executive and department leaders visibly endorse and support TeamSTEPPS. • Physician department leaders support utilization of the TeamSTEPPS tools. Improve Satisfaction • Patient Satisfaction responses improve for the question “Staff works together to provide patient care”. • Reduce turnover times in the OR and Procedural areas • SBAR used to communicate critical patient information via the phone. Stakeholder engagement • Stories shared to demonstrate TeamSTEPPS successes. • Direct observations reflect engaged stakeholders in the TeamSTEPPS process. • Publicize progress (e.g., newsletters, publications, state or national conferences, hospital Patient Safety newsletters, etc.) Sustained performance • Improved performance in the Patient Safety Culture Survey with all hospitals at no less than the 75th %tile in all categories. • Direct observations during the observation survey reflect active implementation of the TeamSTEPPS tools. • TeamSTEPPS training provided to all new employees. • Annual performance review demonstrates assessment of using the TS tools & team competencies.

31. Comments or QuestionsContact Information:MarcieWilliams@TexasHealth.org