Implementing TeamSTEPPS to
Improve Patient & Staff Safety
Texas Health Resources
Marcie Williams RN, MS, FASHRM, CPHRM, CPPS, CLNC
Vice President, Safety & Risk Management
1
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
2
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
5,500 active physicians
21,775 employees
89,452 surgeries
27,200 deliveries
3
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
Patient Safety Movement
Institute for
Healthcare
Improvement
100K lives
Campaign
National
Implementation of
JCAHO National
Patient Safety
Goals
“To Err
is Human”
IOM Report
TeamSTEPPS
TeamSTEPPS
DoD
MedTeams®
ED Study
1995
Patient Safety
and Quality
Improvement
Act of 2005
Executive Memo
from President
1999
2001
2003
2004
2005
2006
Adoption by
Military Health
System from
2007-2011
2008
2011
Medical Team Training
5
Medical Team Training
OR Teamwork Climate and Postoperative Sepsis Rates
(per 1000 discharges)
18
Length of ICU Stay After Team Training
16
2.4
Avg. Length of Stay (days)
14
2.2
12
50
2
%
1.8
Group Mean
AHRQ National Average
10
Re
du
cti
on
Low Teamwork
Climate
8
6
1.6
Mid Teamwork
Climate
4
1.4
High Teamwork
Climate
2
1.2
1
0
June
July
August
Sept
Oct
Nov
Dec
Jan
Feb
March
April
Teamwork Climate Based on Safety Attitudes Questionnaire
Johns Hopkins
May
Low

High
Johns Hopkins
Adverse Outcomes
Indemnity Experience
Pre-Teamwork Training
Post-Teamwork Training
25
20
50%
Reduction
20
50%
Reduction
15
11
10
5
0
Malpractice Claims, Suits, and Observations
Beth Israel Deaconess Medical Center
OB/GYN
6
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
7
TeamSTEPPS
Implementation 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?
8
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
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TeamSTEPPS framework
builds on team skills
Performance
Leadership
Communication
Situation
monitoring
Mutual
support
Knowledge
Skills
Attitudes
The TeamSTEPPS
tools include many
things we already do...
but also adds new team
skill sets to assure
effective
communication
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Learning the Language
Leadership
Situation
Monitoring
1. Briefs
2. Huddles
3. Debriefs
4. Situational awareness
– Cross monitoring
Mutual Support
5. Task assistance
6. CUS
Communication
7. SBAR
8. Call-outs
9. Check-backs
10.Hand-offs
11
IMPLEMENTATION PLAN
12
Approach Overview
10 Months
90 days
Baseline and
pilot preparation
2 years
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
Corp
Approval
Leadership meetings
Pre Observations
Pilot Launch
Pilot
Mid year Check
Pilot Mst Ed
Post Obs Trainer
Ongoing monitoring and refinement
Non-Clinical PSC
Progress Post
2012
Obs
Survey
check
Pilot Site Selection Criteria
Criterion considered
Must
haves
Variables
Description
Leadership (Sr.)
• Leadership ready, willing and able to support initiative
Svc Line/Dept Size
• Needs to be large enough for multiple team players
Department Culture
• Culture open to change
• Positioned for success
Nurse leadership & support
• Likelihood of broad nursing participation / support and
availability of local champions
Willingness to communicate
openly
• Encourage feedback as to what works well, and what changes
are needed
• Dept open to honest feedback
Safety culture scores
• Strength of safety culture as measured by PSC survey
Adverse Events
• Willingness to report
Positive staff attitude
• Indicator of being open to team training and use of tools
Educator support
• Dedicated resource to train and reinforce tool utilization
14
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
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)
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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
17
Pilot Results
Strengths
• 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
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
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THR Perinatal TeamSTEPPS
Averages
Average PRE
Average POST
4
3
2
1
0
THA
THAM
THC
THD
THDN
THFW
THHEB
THP
THS
THSW
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
19
PG Patient Satisfaction Scores
Post TeamSTEPPS Implementation
OB/GYN
System Implementation
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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
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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)
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TeamSTEPPS
Team Strategies and
Tools to Enhance
Performance and
Patient Safety
Performance
Adaptability,
Accuracy, Productivity,
Efficiency, Safety
Leadership
Articulate
clear goals
through
briefs, huddles
& debriefs
Legend
Communication
Speak clearly using
SBAR, read back,
handoff, call out
Skills
Situation
monitoring
Key Benefits
 Improve patient
outcomes
 Actively promote
teamwork and
communication
 Create tools so as
to communicate
effectively
Ensure all team
members are on
same page
Mutual
Support
Outcomes
Knowledge
Shared mental model
Ask for and
offer task
assistance,
CUS
Attitudes
Mutual trust,
Team Orientation
TeamSTEPPS Language Definitions
Leadership
•Brief: Planned, assign roles, establish expectations, anticipate
outcomes
•Huddle: Gather as needed to discuss critical issues & emerging events
•Debrief: End of activity, discuss what went well and what we can do
better
Situation
monitoring
•Situation awareness: Know what is going on around you, including
cross monitoring your team members
Mutual support
•Task assistance: Ask for and offer support with all team members
•CUS: When appropriate, use a CUS word: I am C ONCERNED!
I am U NCOMFORTABLE!
This is a S AFETY ISSUE!
Communication
•SBAR: Summarize your critical messages in a standard format –
Situation, Background, Assessment, Recommendation
•Call-out: Communicate important information and inform team
members simultaneously during emergency situations
•Check-Back: Verbally confirm instructions – "closing the loop"
•Handoff: During transitions in care, clearly transfer both information
and accountability – make sure to offer opportunity for questions
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.
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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
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TeamSTEPPS Corporate Implementation Checklist
√
Responsible
√
√
Marcie
Marcie
√
Jeanne
Task
Comment
Deliverable Date
1-31
1-31
Email RMs note of Thank you
Email CQOs and CNOs their Master
Trainer Attendees and encourage
them. Have them ask about elevator
speech. How do they want to receive
training?
Checklist for RMs implementation
2-4
Marcie, Faye,
Jeanne
Physician Engagement Card
With the next printing do we need to add
check backs, call-outs as closing the loop
communication – something the BCG
consultants are discussing?
Marcie, Faye,
Jeanne
Redo Champion Slides with videos
inserted
Will revise when Champion books are
Check back on 4-30
gone. If Champion slides with notes are
revised to include only slides used then
good videos could be inserted. Check with
Jeanne on plans of revising them
Jeanne
HEB Video at beginning of Champion
Training discussing how well
Perinatal did.
Develop “Trainer Guide for Champion
Training” – take slide set and write
talking points
Jeanne to put in Champion slides used by
instructors
Marcie, Faye,
Jeanne, and
Patricia
2/5 Marcie done - to Jeanne
Next Printing
2-4
Discuss with
Patricia by 2-11
2/5 Faye almost done
Will slide set only have slides that are
discussed?
Can Patricia do these?
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TeamSTEPPS Hospital Implementation Checklist
√
Responsible
Task
Comment
Deliverable
Date
Meet with entity leadership for TS
implementation plan for service lines.
Contact Michelle Hutson with rollout
plan to schedule pre-observation for
service line.
Decide if entity wants specific
department pre-observations. Can
use the observation tool with Tier
II’s.
Approach the selected department
manager with TS overview.
Select department champions for
selected departments.
4 hour department champion training
for either at entity or system services.
Can use entity Master trainers.
Contact Jeanne Campbell to schedule
System Services MT to come to your
entity or to sign up for the 4 hour
training at THR.
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Implementation Success Factors
Topic
Implementation
philosophy &
approach
Key success factors
• 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 75 th
%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.
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Comments or Questions
Contact Information:
MarcieWilliams@TexasHealth.org