SummaryPulling 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

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Day 1 Objectives1. 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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The Theory

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Team Leadership

Team Orientation

Mutual PerformanceMonitoring

Back-upBehavior

Adaptability

Shared Mental Models

Mutual Trust

Team Effectiveness

Closed LoopCommunication

Salas, Sims, Burke. Is therea “Big Five” in teamwork?Small Group Research. 2005; 36:555-599.

Big 5

Coord. Mechanism

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The Framework: What Comprises Team

Effectiveness?

KnowledgeCognitions

“Think”

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

AttitudesAffect“Feel”

SkillsBehaviors

“Do”

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Summary— Pulling it All TogetherMore Evidence

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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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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Barriers, Tools/Strategies, Outcomes

TOOLS and STRATEGIES

BriefHuddle DebriefSTEP

I’M SAFE ChecklistCross Monitoring

FeedbackAdvocacy and Assertion

Two-Challenge RuleCUS

DESC ScriptCollaboration

SBARCall-Out

Check-BackHandoff

OUTCOMES

Shared Mental

Model

Adaptability

Team Orientation

Mutual Trust

Team Performance

Patient Safety!!

Team Goals

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

Follow-Up with Co-Workers Distractions Fatigue Workload Misinterpretation of Cues Lack of Role Clarity

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Summary— Pulling it All TogetherThe Constraints

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Identifying Opportunities to Use TeamSTEPPS Tools and Strategies

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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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Using TeamSTEPPS Tools and Strategies

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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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SummaryDuring 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 (evidence-based 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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“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