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Strategies and Tools to Enhance Performance and Patient Safety. Teamwork Is All Around Us. Introduction. Evolution of TeamSTEPPS. Curriculum Contributors. Department of Defense Agency for Healthcare Research and Quality Research Organizations Universities Medical and Business Schools

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Strategies and tools to enhance performance and patient safety

Strategies and Tools to Enhance Performance and Patient Safety


Evolution of TeamSTEPPS

Curriculum Contributors

  • Department of Defense

  • Agency for Healthcare Research and Quality

  • Research Organizations

  • Universities

  • Medical and Business Schools

  • Quality Improvement Organizations

  • Nursing Homes

  • Hospitals—Military and Civilian, Teaching and Community-Based

  • Healthcare Foundations

  • Private Companies

  • Subject Matter Experts in Teamwork, Human Factors, and Crew Resource Management (CRM)

Initiative based on evidence derived from team performance…leveraging more than 25 years of research in military, aviation, nuclear power, business and industry…to acquire team competencies”


Strategies & Tools to Enhance Performance & Patient Safety

The components of resident safety
The Components ofResident Safety

Why do errors occur some obstacles
Why Do Errors Occur—Some Obstacles

  • Excessive professional courtesy

  • Halo effect

  • Passenger syndrome

  • Hidden agenda

  • Complacency

  • High-risk phase

  • Strength of an idea

  • Task (target) fixation

  • Workload fluctuations

  • Interruptions

  • Fatigue

  • Multitasking

  • Failure to follow up

  • Poor handoffs

  • Ineffective communication

  • Not following protocol

Medical errors still claiming many lives by elizabeth weise usa today
Medical Errors Still Claiming Many LivesBy Elizabeth Weise, USA TODAY



As many as 98,000 Americans still die each year because of medical errors despite an unprecedented focus on patient safety over the last five years, according to a study released today. Significant improvements have been made in some hospitals since the Institute of Medicine released a landmark report in 2000 that revealed many thousands of Americans die each year because of medical mistakes.

But nationwide, the pace of change is painstakingly slow, and the death rate has not changed much, according to the study in The Journal of the American Medical Association.

The researchers blame the complexity of health care systems, a lack of leadership, the reluctance of doctors to admit errors and an insurance reimbursement system that rewards errors — hospitals can bill for additional services needed when patients are injured by mistakes — but often will not pay for practices that reduce those errors.

"The medical community now knows what it needs to do to deal with the problem. It just has to overcome the barriers to doing it," says study co-author Lucian Leape of Harvard's School of Public Health.

The institute, a public policy organization, pushed key health care organizations to focus on patient safety, the new report says. As a result, reductions as much as 93% have been made in certain kinds of error-related illnesses and deaths.

Computerized prescriptions, adding a pharmacist to medical teams and team training in the delivery of babies are among the improvements medical centers are making, the study finds.

But "we have to turn the heat up on the hospitals," Leape says.

For example, 5% to 8% of intensive-care patients on ventilators develop pneumonia, the study says. But by strictly following a simple protocol of bed elevation, drugs and periodic breathing breaks, those outbreaks can be reduced to almost zero. "A little hospital in DeSoto, Miss., called Baptist Memorial did it, so it doesn't take a big academic medical center," Leape says.

Hospitals that eliminate infections should receive bonuses, Leape says. "If insurance companies paid 20% more for patients in (intensive-care units) where there were no infections, they'd cut costs substantially.

"We really need to rethink how we pay for health care. What we do now is pay for services, but what we should do is pay for care and outcomes."

Hospitals have taken steps to reduce medical errors and injuries.


  • Computerized prescriptions: 81% decrease in errors.

  • Including pharmacist in medical team: 78% decrease in preventable drug reactions.

  • Team training in delivery of babies: 50% decrease in harmful outcomes — such as brain damage — in premature deliveries.

    Source: Journal of the American Medical Association

…little progress towards the goal

Leape and Berwick,JAMA May 2005

Targets for Teamwork

Sentinel event information provided by Joint Commission

What comprises team performance
What Comprises Team Performance?




…team performance is a science…consequences of errors are great…

Outcomes of team competencies
Outcomes of Team Competencies

  • Knowledge

    • Shared Mental Model

  • Attitudes

    • Mutual Trust

    • Team Orientation

  • Performance

    • Adaptability

    • Accuracy

    • Productivity

    • Efficiency

    • Safety

Eight steps of change
Eight Stepsof Change

John Kotter

Roadmap to a culture of safety
Roadmap to a Culture of Safety

Monitor, Integrate, Continuous Process Improvement

Celebrate wins! Staying the courseSustaining

Implement Action Plan, Train, Empower Others


Test Intervention


I’m staying right here. Yeah they’ll be back.

What are they doing?

Jt. Comm.

Develop Action Plan

Status QUO

Why do we need change?



Prepare the Climate

Catalytic event drives need for change

Build team, strategy, buy-in, establish goals


  • Describe different types of team leaders

  • Describe roles and responsibilities of an effective team leader

  • Describe the leader’s role in resource management

  • Describe the delegation process

  • Describe strategies for team leaders to include briefs, huddles, and debriefs

  • Describe how effective team leaders facilitate conflict resolution

  • Identify the barriers, tools, strategies, and outcomes of leadership

Team leader
Team Leader

Two types of leaders:

  • Designated – The person assigned to lead and organize a designated core team, establish clear goals, and facilitate open communication and teamwork among team members

  • Situational – Any team member who has the skills to manage the situation at hand

Effective team leaders
Effective Team Leaders

  • Organize the team

  • Articulate clear goals

  • Make decisions through collective input of members

  • Empower members to speak up and challenge, when appropriate

  • Actively promote and facilitate good teamwork

  • Are skillful at conflict resolution

Resource management is
Resource Management is…

A strategy for achieving workload balance within and across teams in a unit

  • Refers to people, knowledge or information, materials, and time that can be drawn upon to accomplish a task

  • Goal is to prevent work overload situations that compromise situation awareness and increase the risk of error

Resource management
Resource Management

Core Team Leader

Coordinating Team Leader

  • Information

    • Resident and family

    • Plan of care

    • Facilities

  • Time

  • Equipment

  • Information

    • Administrative

    • Facilities

  • Time

  • Equipment

  • Residentflow

  • Otherdepartments



Team & Your Unit


Work Flow


  • Method of redistributing tasks or assignments

  • Process includes four steps:

    • Decide what to delegate

    • Decide to whom to delegate

    • Communicate clear expectations

    • Request feedback

Promoting and modeling teamwork
Promoting and Modeling Teamwork

Effective leaders cultivate desired team behaviors and skills through:

  • Open sharing of information

  • Role modeling and effective cuing of team members to use prescribed teamwork behaviors and skills

  • Constructive and timely feedback

  • Facilitation of briefs, huddles, debriefs, and conflict resolution

Team events
Team Events

  • Briefs – planning

  • Huddles – problem solving

  • Debriefs – process improvement

Leaders are responsible to assemble the team and facilitate team events

But remember…

Anyone can request a brief, huddle, or debrief



  • Form the team

  • Designate team roles and responsibilities

  • Establish climate and goals

  • Engage team in short- and long-term planning

Planning essentials for teams
Planning Essentials for Teams

  • Leader usually initiates the planning process

  • Team members are included in the planning process

  • Team members have a common understanding of the problem and their roles


Problem Solving

  • Hold ad hoc, “touch-base” meetings to regain situation awareness

  • Discuss critical issues and emerging events

  • Anticipate outcomes and likely contingencies

  • Assign resources

  • Express concerns


Process Improvement

  • Brief, informal information exchange and feedback sessions

  • Occur after an event or shift

  • Designed to improve teamwork skills

  • Designed to improve outcomes

    • An accurate reconstruction of key events

    • Analysis of why the event occurred

    • What should be done differently next time







  • Shared Mental Model

  • Adaptability

  • Team Orientation

  • Mutual Trust


  • HierarchicalCulture

  • Lack of Resources or Information

  • Ineffective Communication

  • Conflict

Teamwork actions
Teamwork Actions

  • Empower team members to speak freely and ask questions

  • Useresources efficiently to maximize team performance

  • Balance workload within the team

  • Delegate tasks or assignments, as appropriate

  • Conduct briefs, huddles, and debriefs

  • Use conflict resolution techniques (i.e., Two-Challenge rule and DESC script)

Exercise leadership
Exercise: Leadership


  • Begin by selecting a leader and scribe for your group.

  • The group will have 10minutes to address the questions, record your answers, and report back to the group at large.