January 25, 2019 Christopher Hund, MFA Jen Braun, MPH

1. TeamSTEPPS: Practical Tools to Create a Better Environment for You, Your Teams and Your HRO to Thrive January 25, 2019 Christopher Hund, MFA Jen Braun, MPH

2. Today’s Facilitators Jennifer Braun, MPH Senior Program Manager AHA Center for Health Innovation Christopher Hund, MFA Director AHA Center for Health Innovation

3. Today, we’ll… • Learn how TeamSTEPPS principles and tools can be used both clinically and non-clinically. • Demonstrate an understanding of TeamSTEPPS principles and tools through interactive activities. • Connect TeamSTEPPS principles and tools to improve collaboration and strengthen HRO efforts. • Determine a plan for what you’ll do Today, Tomorrow and in Two Weeks.

4. Some Considerations • We’re covering a lot together • We’ll keep it super interactive • When you coach others try to connect the tools to what they are already doing • This shouldn’t be another initiative

5. Exercise #1 RULES • You have 90 seconds to build the tallest tower • You must follow the building pattern: one large, three small • No two of the same color may touch • There are: • RUNNERS – only can be runners • BUILDERS– only can be builders • ONLY 5 items per runner/per trip • All unused materials must be returned before ‘TIME’ is called

6. Debrief • What went well? • What could be improved? • If you had a chance to do this again, what would you do different?

7. Why is Teamwork Important? Two jumbo jet crashes/day • 29 airline passengers dying/hour • 688 airline passengers dying/day

8. Why TeamSTEPPS? • Joint Commission reports that 79% of adverse events are down to failures in • Leadership • Communication • Human factors • PCMH Certification focuses on • Care coordination • How effectively a primary care clinician and interdisciplinary team work in partnership with the patient

9. What’s Your Familiarity with TeamSTEPPS? • TeamStrategies and Tools to Enhance Performance and Patient Safety • Evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals • Communication • Leadership • Situation Monitoring • Mutual Support

10. High Performing Teams • What makes a high performing team? • Teams that perform well: • Hold shared mental models • Have clear roles and responsibilities • Have clear, valued, and shared vision • Optimize resources • Have strong team leadership • Engage in a regular discipline of feedback • Develop a strong sense of collective trust and confidence • Create mechanisms to cooperate and coordinate • Manage and optimize performance outcomes (Salas, et al., 2004)

11. Shared Mental Model on HROs • Sensitivity to Operations • Preoccupation with Failure • Deference to Expertise • Resilience • Reluctance to Simplify Interpretations

12. TeamSTEPPS Tools 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 Followup With Coworkers • Distractions • Fatigue • Workload • Misinterpretation of Cues • Lack of Role Clarity TOOLS and STRATEGIES Communication • SBAR • Call-Out • Check-Back • Handoff • Leading Teams • Brief • Huddle • Debrief • Situation Monitoring • STEP • I’M SAFE • Mutual Support • Task Assistance • Feedback • Assertive Statement • Two-Challenge Rule • CUS • DESC Script OUTCOMES • Shared Mental Model • Adaptability • Team Orientation • Mutual Trust • Team Performance • Patient Safety!!

13. Communication • Effective Communication must be: • complete: relevant information avoiding unnecessary detail • clear: standard terminology, minimize an acronyms • brief: be concise • timely: avoid delays, verify, validate or acknowledge

14. https://www.youtube.com/watch?v=yR0lWICH3rY

15. SBAR • A framework for team members to effectively communicate information to one another • Communicate the following information: • Situation―What is going on currently? • Background―What is the background or context? • Assessment―What do I think? • Recommendation/Request―What would I recommend or request?

16. Non-Clinical Ways to use SBAR • Report outs in meetings • 1:1 verbal communication • Emails • Presentations • Proposals • Handoff on tasks • Other creative ideas

18. SBAR Exercise (1-Table-All)

19. Strengthening Your HRO with SBAR • Encourages sensitivity to operations through • Use of a standardized communication format that is clear, brief, complete, timely • Allows for deference to expertise in the Assessment and Recommendation phases

20. Call-Outs and Check-Backs

21. Example https://www.youtube.com/watch?v=wT5VhOwfhSs

22. Strengthening Your HRO with Closed-Loop Communication • Encourages a sensitivity to operations as increased situational awareness leads to an improved shared mental model. • Improves resilience. This is a non-negotiable process that cuts down on crushing errors.

23. Ant video https://www.youtube.com/watch?v=PtLPt-whLNs

24. Leading Teams What are some key attributes of leading a team? • Identify and articulate clear goals • Facilitate information sharing • Model effective team work • Encourage team member to assist one another • Manage and allocate resources • Task assignment, prioritization, reassignment

25. Brief, Huddle, Debrief • Brief • Short sessions prior to the start of something (share the plan, discuss team formation, assign roles and responsibilities, establish expectations) • Huddle • Ad hoc meetings (re-establish situational awareness, reinforce plans and assess the need to adjust the plan) • Debrief • Review the team’s performance (what went well, what can be improved, what’s one thing you’ll do different next time)

26. Exercise #2 RULES • You have 15 seconds to conduct a brief • You have 75 seconds to build the tallest tower • No two of the same color may touch • There are: • RUNNERS who can only be runners • BUILDERS who can only be builders • Only 5 items per runner per trip • All unused material must be returned before time is called

27. Change of Plans!! • All runners have to become builders • All builders have to become runners

28. Debrief • What went well? • What could be improved? • If you had a chance to do this again, what would you do different?

29. Strengthening Your HRO with B/H/DB • Improving sensitivity to operations by understanding the work being done by those who do it • Supporting a healthy preoccupation with failure by providing time • Review and address • Plan and prepare to fix • In this way resilience is also supported

30. break

31. Mutual Support • Team members protect each other from work overload situations • Team members foster a climate where it is expected that assistance will be actively sought and offered • Team members are comfortable flagging errors or concerns

32. Mutual Support https://www.youtube.com/watch?v=WZ09paQRBnw

33. CUS (In the moment…) CUS Clinical I am CONCERNED! I am UNCOMFORTABLE! This is a SAFETY ISSUE! CUS Non-Clinical I am CONCERNED! I am UNCOMFORTABLE! This is a SUCCESS ISSUE!

34. A DESC (A bit later…) A constructive approaching for communicating and providing feedback A = Ask…is now a good time to talk? D = Describe the specific situation E = Express/Explain your concerns S = Suggest other alternatives C = Consequences should be stated • Does not need to be negative • Not meant to be an ultimatum or threat • C = Consensus/Conclusion

35. Strengthening Your HRO with CUS and DESC • Encourages a culture with a deference to expertise as it allows for someone to speak up and for the listener to hear them • Creates a more resilient environment • Strengthens a sensitivity to operations through the use of standardized language

36. Situation Monitoring Why is it important to monitor what is going on around you? • Ensures new or changing information is identified for communication and decision-making • Leads to effective support of fellow team members

37. Situation Monitoring • Situation Monitoring: the process of continually scanning and assessing a situation to gain and maintain an understanding of what’s going on around you. SituationMonitoring(Individual Skill) SituationAwareness(Individual Outcome) Shared Mental Model(Team Outcome)

38. A Situation Monitoring Tool Status of the patient: • Patient History • Vital Signs • Medications • Physical Exam • Plan of Care • Psychosocial Condition

39. Team Members • Fatigue • Workload • Task Performance • Skill Level • Stress Level

40. Environment • Facility Information • Administrative Information • Human Resources • Triage Acuity • Equipment

41. Progress Toward Goal • Call a Huddle! • Status of Team’s Patient(s) • Goal of Team • Tasks/Actions That Are or Need To Be Completed • Plan Still Appropriate?

42. Situation Awareness • Situation Awareness: the state of “knowing what’s going on around you.” SituationMonitoring(Individual Skill) SituationAwareness(Individual Outcome) Shared Mental Model(Team Outcome)

43. Shared Mental Model • Shared Mental Model: results from each team member maintaining situation awareness and ensures that all team members are “on the same page.” • Check for this in your briefs, debriefs, and huddles! SituationMonitoring(Individual Skill) SituationAwareness(Individual Outcome) Shared Mental Model(Team Outcome)

44. Shared Mental Model

45. Strengthening Your HRO with SA • Coming to that Hive Mind state is the ultimate sensitivity to operations • Everyone knowing what is going on with everyone leads to greater resilience

46. So, how do we get a SMM as a Team? When: • Briefs • Huddles • Debriefs How: • SBAR • Call-outs • Check-backs • CUS • DESC • STEP

47. What About Reluctance to Simplify? • Being reluctant to simplify doesn’t mean we shouldn’t have standardized language and processes. • It means also to continually ask questions and find the cause (5 whys) • Check for it in debriefs • Encourage it through all the ways you speak up

48. Exercise #3 • Each team will designate a leader. • Only the leader can view the algorithm. • The leader may not view the tower as it is being built. • You will have 30 seconds to brief. • You will have 2 minutes to build the tallest tower. • Runners may only take 5 items per trip. • Runners are not allowed to build and builders are not allowed to run. • Any unused materials that are not returned when time is called will be counted against the overall height of the tower.

49. Debrief • What went well? • What could be improved? • If you had a chance to do this again, what would you do different?

50. Today, Tomorrow, Two Weeks • What can you do after you walk out the door today? • What can you do tomorrow? • What do you want to accomplish two weeks from now?