teams, team communication and transitions of care overview

Teams, Team Communication Teams, Team Communication and and

Transitions of Care OverviewTransitions of Care OverviewQuality Colloquium: Healthcare Quality and Quality Colloquium: Healthcare Quality and

Patient Safety ConferencePatient Safety ConferenceHarvard - Cambridge, MAHarvard - Cambridge, MA

August 20, 2008August 20, 2008

Causes Sentinel EventsCauses Sentinel Events

Health Care and TeamworkHealth Care and Teamwork

Communication failures account for the overwhelming majority of adverse Communication failures account for the overwhelming majority of adverse eventsevents

Medical care is complex and human performance has inherent limitationsMedical care is complex and human performance has inherent limitations Effective teamwork can prevent mistakesEffective teamwork can prevent mistakes Embedding evidence-based training and team behaviors can enhance Embedding evidence-based training and team behaviors can enhance

safetysafetyLeonard, Graham, & Bonacum, 2004Leonard, Graham, & Bonacum, 2004

Team training has a positive impact on work force retentionTeam training has a positive impact on work force retentionPronovost in press Pronovost in press LeonardLeonard, , Graham in pressGraham in press

Train in Teams Those Who Are Expected to Work in Teams

...health care organizations should establish team training programs for personnel in critical care areas (e.g. the emergency department, intensive care unit, operating room) using proven methods such as the crew resource management techniques employed in aviation, including simulation.

In the Beginning there wasIn the Beginning there wasTo Err is HumanTo Err is Human

JCAHO Hospital JCAHO Hospital Accreditation StandardsAccreditation Standards

Standard HR.2.30Standard HR.2.30– Ongoing education, including in-services, Ongoing education, including in-services,

training, and other activities, maintains and training, and other activities, maintains and improves competenceimproves competence

Element of Performance (EP) for HR.2.30Element of Performance (EP) for HR.2.30– EP #5. On-going in-services, training, and EP #5. On-going in-services, training, and

other education incorporate methods of team other education incorporate methods of team training, when appropriate training, when appropriate

Whose on the TeamWhose on the Team

ProvidersProviders Patients ?Patients ?

Provider Centric SystemProvider Centric System

Health care has been designed for and by providersHealth care has been designed for and by providers Provider centric communicationsProvider centric communications Health literacy – training patient to talk to providersHealth literacy – training patient to talk to providers How about provider literacy – training providers to How about provider literacy – training providers to

communicate with patientscommunicate with patients Patient/provider communication a major source of Patient/provider communication a major source of

injury and harm injury and harm

Teamwork Is All Around UsTeamwork Is All Around Us

AHRQ/DoD InitiativesAHRQ/DoD Initiatives

Activities began in 2002Activities began in 2002 AHRQ issued PSO Task Order AHRQ issued PSO Task Order

Contract to American Institutes of Contract to American Institutes of Research (AIR)Research (AIR)

Expert PanelExpert Panel Comprehensive Literature ReviewComprehensive Literature Review Case Study AnalysisCase Study Analysis Journals/ArticlesJournals/Articles PresentationsPresentations Clinical Measures of Teamness Clinical Measures of Teamness

(RAND evaluation contract Mod)(RAND evaluation contract Mod) Medical Team Training Curriculum Medical Team Training Curriculum

TeamSTEPPSTeamSTEPPS Edited HandbookEdited Handbook

Evidence-Evidence-BasedBased

MethodsMethods

Tools forTools forTraining andTraining and

MeasurementMeasurement

Principles andPrinciples andGuidelinesGuidelines

Collaboration Products Collaboration Products

Teamwork in Teamwork in Professional Professional

EducationEducation

Relevant Evidence Relevant Evidence Teamwork in Teamwork in HealthcareHealthcare

Teamwork Teamwork & &

SimulationSimulation

Need for Public Domain Need for Public Domain Support MaterialsSupport Materials

Dueling Team Training in DoD elsewhere in Dueling Team Training in DoD elsewhere in HealthcareHealthcare

Training materials not readily availableTraining materials not readily available Materials developed by DoD not in Public DomainMaterials developed by DoD not in Public Domain Need to get evidence base into practiceNeed to get evidence base into practice Need to focus on actual training not development of Need to focus on actual training not development of

materialsmaterials

FLEXTRA KitFLEXTRA Kit A model for the development of resource materials to A model for the development of resource materials to

support instructor-delivered in service training and faculty support instructor-delivered in service training and faculty development development

Contains Contains – Instructors/Leader’s GuideInstructors/Leader’s Guide– Camera ready materials for handoutsCamera ready materials for handouts– Presentation materials (PowerPoint slides & videos) Presentation materials (PowerPoint slides & videos) – Evaluation instrumentsEvaluation instruments

Battles JB, Sheridan MM The FLEXTRA Kit: a model for instructor support materials. J Biocommunication; 1989:6;3;1-13.

The Components of a The Components of a Patient Safety ProgramPatient Safety Program

Patient Reporting SystemPatient Reporting System

Patients and family members can and often do identify Patients and family members can and often do identify risks and hazard that providers do not seerisks and hazard that providers do not see

Patient are the ones who experience transitions of Patient are the ones who experience transitions of care not providerscare not providers

Need to provide a mechanism for patients to report Need to provide a mechanism for patients to report patient safety events.patient safety events.

AHRQ will issue a contract to develop the AHRQ will issue a contract to develop the specifications for an IDEAL Patient Reporting Systemspecifications for an IDEAL Patient Reporting System

Impact of Improved Team Impact of Improved Team WorkWork

1

1.2

1.4

1.6

1.8

2

2.2

2.4

June July Augus t Sept Oct Nov De c Jan Feb March April May

Avg

. Len

gth

of S

tay

(day

s)

Length of ICU Stay After Team Training

50% Reduction

(Pronovost, 2003) Johns HopkinsJournal of Critical Care Medicine

OR Teamw ork Climate and P os toperative Seps is Rates (per 1000 discharges)

Group Mean

Low Teamwork Climate

Mid Teamwork Climate

High Teamwork Climate

0

2

4

6

8

10

12

14

16

18

AHR Q National Average

Teamw ork Climate Based on Safety Attitudes Questionnaire

Low High

Indemnity Experienc e

20

11

0

5

10

15

20

25

Malpractice Claims, Suits, and Observations

Pre-Teamwork Training Post-Teamwork Training

A dverse Outc omes

50%Reduction

50%Reduction

Patient Experience with CarePatient Experience with Care

Best way to improve patient satisfaction Best way to improve patient satisfaction and improve perception of careand improve perception of care

Improve your team workImprove your team work

Thank you and on with the good Thank you and on with the good stuffstuff

James B. Battles, Ph.D.James B. Battles, Ph.D.Senior Service Fellow for Patient SafetySenior Service Fellow for Patient Safety

Center for Quality Improvement and Patient Safety Center for Quality Improvement and Patient Safety (CQuIPS)(CQuIPS)

Email: James.Battles@ahrq.hhs.govEmail: James.Battles@ahrq.hhs.gov