Team Training and Operating
R
Room
P
Performance
f
JD Bramble, Ph.D.
AcademyHealth Annual Meeting
Boston MA
Boston,
June 29, 2010
Acknowledgements
g



Armour Forse, MD
Kevin Fuji,
j , Pharm D
Robert J. McQullian, MD
Introduction

Improved components of teamwork can
reduce medical errors and improve patient
outcomes.
outcomes

Safe practices that improve teamwork and
communication as one way to decrease
medical errors
errors.

Teamwork includes four keyy components.
p

1) Leadership, 2) Communication, 3)Situation
monitoring , and 4) Mutual support
Objective
j

Determine if team training using a federallysponsored team training program improves
operating room performance and culture
Research Design:
g Subjects
j
& Environment


Perioperative area in an academic medical
center.
St d participants
Study
ti i
t included
i l d d allll perioperative
i
ti
caregivers; including:




Surgeons
Anesthesiologists
Nurses
Technicians
TeamSTEPPS Intervention

TeamSTEPPS curriculum




Developed by
y the DOD’s Patient Safety
y Program
g
in collaboration with AHRQ
Evidence-based teamwork curriculum
Improve communication and teamwork skills
Produce more effective medical teams that will
achieve the best clinical outcomes foe patients.
TeamSTEPPS Intervention

Train-the-Trainer



Key
y change
g agents
g
identified from the various
sub-disciplines in the perioperative area
Participated
p
in a 2-day
y training
g course to g
gain the
skill to help train and coach others
Fundamentals


Other personnel in the perioperative area
4 hours of workshops over two days
4-hours
days.
Measures & Data Sources

Measures of Communication and Teamwork




Employee
y Engagement
g g
Survey
y
Teamwork dimension included items such as
p y
in my
y department
p
work well together”
g
“Employees
Communication dimension include items such as
p y
in my
y department
p
work well together”
g
“Employees
Administered yearly in the fall.
Measures & Data Sources

Measures of Patient Satisfaction



Hospital conducted survey
y after discharge
g
Survey conducted by a third party
Measures on Clinical Outcomes



First case on-time starts
Mortality
Morbidity
Results
Employee Teamwork and Communication
100
year 1
year 2
% fa
avorable respons
ses
90
80
70
60
62.7
53.2
50
62.7
47 5
47.5
40
30
20
10
0
Teamwork
Communication
Results
Administration of Medication
97
100
91
90
% medicatiion admin
nistered
80
78
74
70
60
50
40
30
20
10
0
Antibiotic
VTE
year 1
year 2
Results
100
89.3
90
%
81
77
80
70
69
60
50
40
30
20
10
16.2
7.7
2.7 1
0
First Case Starts Morbidity
Mortality
Recommend
year 1
year 2
Results
100
89.3
90
%
81
77
80
70
69
80.8
69
60
50
40
30
16.2
11
7.7
20
10
2.7 1 1.8
0
1st-case Starts
Morbidity
Mortality
Recommend
year 1
year 2
year 3
Conclusions

The data add to the evidence that team
training can improve performance

The data also suggest the need to have
stable
bl champions,
h
i
coaches,
h
and
d trainers
i

There is a need for organization to “hard
hard
wire” these changes so the success of these
programs is
i nott dependent
d
d t on a ffew key
k
people