Summary
Pulling it All Together
“The truth of the matter is that you
always know the right thing to do. The
hard part is doing it.”
–Norman Schwarzkopf
Summary—
Pulling it All
Together
Day 1 Objectives
1.
Explain the theoretical framework and evidence
base that supports the use of team skills to improve
safety culture.
2.
Learn the team skills that enhance performance
and patient safety.
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Summary—
Pulling it All
Together
The Theory
Mutual
Performance
Monitoring
Team
Leadership
Team
Orientation
Back-up
Behavior
Shared Mental
Models
Mutual
Trust
Adaptability
Big 5
Coord.
Mechanism
Mod 7 06.1 Page 3
Team
Effectiveness
Closed Loop
Communication
TEAMSTEPPS 05.2
Salas, Sims, Burke. Is there
a “Big Five” in teamwork?
Small Group Research.
2005; 36:555-599.
3
Summary—
Pulling it All
Together
The Framework:
What Comprises Team Effectiveness?
Knowledge
Cognitions
“Think”
Attitudes
Affect
“Feel”
Skills
Behaviors
“Do”
Mod 7 06.1 Page 4
TEAMSTEPPS 05.2
…team performance is a
science…consequences
of errors are great…
4
More Evidence
Summary—
Pulling it All
Together
 Exploding Literature
−
Patient Care Team + Evidence-Based Practice = 1,128
−
Patient Care Team + Evaluation Studies = 843
 Studies in diverse patient populations demonstrate
relationship between teamwork and
−
Improved clinical processes
−
Reduction in medical errors
−
Improved surgical team performance
−
Increased adherence to guidelines
−
Decreased length of stay
−
Increased functional status
−
Decreased mortality
Salas et al. What are the critical success factors for team training in
health care? Jt Comm Jrnl Qual Safe. 2009;35:398-405.
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Summary—
Pulling it All
Together
The Bottom Line….
The knowledge, skills, attitudes, language, and coordinating
mechanisms inherent in teamwork1 create the flexibility team
members need to manage complexity2 and learn from
experience.3-5
1.
Salas E, Sims DE, Burke CS. Is there a "Big Five" in teamwork? Small Group
Research. 2005;36:555-599.
2.
Cannon-Bowers JA, Salas E. Team performance and training in complex environments:
Recent findings from applied research. Curr Dir Psychol Sci. 1998;7:83-87.
3.
Senge PM. The Fifth Discipline: The Art & Practice of the Learning Organization. New
York, NY: Doubleday; 1990.
4.
Edmonson AC. Learning from failure in health care: Frequent opportunities, pervasive
barriers. Qual Saf Health Care. 2004;12(Suppl II):ii3-ii9.
5.
Salas E, Rosen MA, Burke CS, Goodwin GF. The wisdom of collectives in
organizations: An update of the teamwork competencies. In: Salas E, Goodwin GF,
Burke CS, eds. Team effectiveness in complex organizations: Cross-disciplinary
perspectives and approaches. New York, NY: Routledge/Taylor & Francis Group;
2009:39-79.
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6
Summary—
Pulling it All
Together
Barriers, Tools/Strategies, Outcomes
BARRIERS
 Inconsistency in Team
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
Membership
Lack of Time
Lack of Information Sharing
Hierarchy
Defensiveness
Conventional Thinking
Complacency
Varying Communication Styles
Conflict
Lack of Coordination and
Follow-Up with Co-Workers
Distractions
Fatigue
Workload
Misinterpretation of Cues
Lack of Role Clarity
Mod 7 06.1 Page 7
TOOLS and
STRATEGIES
Brief
Huddle
Debrief
STEP
I’M SAFE Checklist
Cross Monitoring
Feedback
Advocacy and Assertion
Two-Challenge Rule
CUS
DESC Script
Collaboration
SBAR
Call-Out
Check-Back
Handoff
TEAMSTEPPS 05.2
OUTCOMES
 Shared Mental
Model
 Adaptability
 Team Orientation
 Mutual Trust
 Team Performance
 Patient Safety!!
Team Goals
7
The Constraints
Competing
Values &
Expectations
Summary—
Pulling it All
Together
Complexity
of patients
and
systems
Desired
Outcomes
Limited
resources
Mod 7 06.1 Page 8
Behavioral
Choices of
Fallible
Human
Beings
TEAMSTEPPS 05.2
Summary—
Pulling it All
Together
Identifying Opportunities to Use
TeamSTEPPS Tools and Strategies
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Summary—
Pulling it All
Together
Discussion
 What were the barriers to communication?

Lack of information sharing, lack of follow-up, lack
of role clarity, misinterpretation of cues, workload
 Which TeamSTEPPS tools and strategies could have
been used? (Consult your Pocket Guide)

STEP, huddle, SBAR
 What is the biggest issue in terms of teamwork skills?
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TEAMSTEPPS 05.2
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Using TeamSTEPPS
Tools and Strategies
Summary—
Pulling it All
Together
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TEAMSTEPPS 05.2
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Summary—
Pulling it All
Together
Case Analysis
 Divide yourselves into groups of 4 - 5
 Discuss the scenario in your team
 Identify the barriers to teamwork that
occurred
 Identify tools, strategies to address the
barriers
 Report out to the whole group
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Summary
Summary—
Pulling it All
Together
During this training, we learned that teamwork
strategies and tools—

Create a safety net for fallible human beings (human
factors)

Do not come naturally…must be learned (evidencebased training)

Create the flexibility we need to manage complexity
and learn from experience
What we didn’t learn… for Master Trainers

One shot didactic lectures can not change people’s
behavior

Human beings and organizations adopt new
behaviors in stages as a result of a change strategy
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TEAMSTEPPS 05.2
13
Summary—
Pulling it All
Together
“To improve teamwork in support of
patient safety, what small change
can you commit to?”
“The achievements of an organization are the
results of the combined effort of each
individual.”
–Vince Lombardi
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