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Reducing Risks Through Effective Communication:AHRQ’s TeamSTEPPS®

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Objectives

At the conclusion of this program, you should beable to:

• Identify the role of communication inhealthcare litigation.

• List three essential elements for makingTeamSTEPPS effective.

• Evaluate your organization’s likelihood ofeffectively implementing TeamSTEPPS.

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Registration polling results

Registration polling results will be sharedduring the live webinar.

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Today’s program

Christine is a registered nurse. She earned her bachelor of science and master of science degreesfrom Nebraska Methodist College of Nursing and Allied Health. Additionally, Christine is a member ofthe American Society for Healthcare Risk Management and holds a certificate in healthcare riskmanagement and completed the TeamSTEPPS master trainer curriculum.

Today’s speaker is Christine M. Hoskin, RN, MS, CPHRM, SeniorPatient Safety & Risk, MedPro Group(Christine.Hoskin@medpro.com)

Christine provides comprehensive risk management services to healthcaresystems, hospitals, clinics, and doctors in Colorado, Nebraska, Oklahoma,Iowa, and Kansas.

Christine has been involved in risk and quality management throughout hercareer, providing oversight of clinical education, epidemiology, safety,accreditation, risk management, quality improvement, and nursing. Shehas experience in a range of care settings — including both inpatient andoutpatient facilities, primary care, specialty care, dental care, andrehabilitation — and with various patient populations.

These opportunities have enabled Christine to develop a strong understanding of the challengesand opportunities facing healthcare providers and organizations.

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Today’s program

MaryAnn earned her RN degree from St. Mary’s School of Nursing in Rochester, Minnesota. Shecompleted her bachelor of science degree in health education from the University of New Mexico andher master of science degree in healthcare administration from the University of St. Francis in Joliet,Illinois.

MaryAnn is a member of the American College of Healthcare Executives (ACHE), and she has servedon the Board of Directors of the Voluntary Hospitals of America (VHA) Southwest, the New MexicoHospital Association, and numerous community agencies.

Today’s speaker is MaryAnn Digman, RN, MSHA, Senior PatientSafety & Risk Consultant, MedPro Group(Maryann.Digman@medpro.com)

MaryAnn brings a wealth of education and more than 25 years ofprogressive clinical and operational healthcare leadership experience toher responsibilities at MedPro Group.

Her previous roles in large integrated systems, academic medicalcenters, community hospitals, and rural healthcare facilities in public,not-for-profit, and investor-owned systems — and her experience as aCOO/CEO ― are invaluable to her clients as they develop effective business strategies.

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Patient safety movement

Patient Safetyand Quality

ImprovementAct of 2005

Executivememo fromPresident

DODMedTeams®

ED Study

Institute forHealthcare

Improvement100K livesCampaign

“To ErrIs Human”IOM Report TeamSTEPPS®

1995 1999 2001 2003 2004 2005

JCAHO NationalPatient Safety

Goals

2006

TeamSTEPPSreleased to the

public

2007

TeamSTEPPSNational

ImplementationProgram began

2008

NationalImplementation

of CUSP

Centers forMedicare &

Medicaid ServicesPartnership for

Patients Campaign

2011

Medical Team Training

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Why are we still talking about patient safety?

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Date

68%

50%47%

39%

35% 35% 33% 33%29%

23%

0%

10%

20%

30%

40%

50%

60%

70%

80%

36% of all MedPro claims closed between 2005 and 2014 involve communication as a contributing factor.Of these, 59% were associated with outpatient settings, and 41% were associated with inpatient settings.

Source: MedPro Group closed claims, 2005-2014

Communication as a risk factor by allegation category

Perc

enta

ge

of

Alle

gation

Cate

gories

With

Com

munic

ation

Note

das

aContr

ibuting

Fact

or

Within the top 10 allegation categories, as shown here, patient monitoringcases had the highest percentage of communication issues identified(68%). These cases include allegations of inadequate monitoring ofpatient conditions/symptoms after treatments or procedures.

NOTE: Communication is both an allegationcategory and a contributing factor.

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Date

15%

11% 10%

9% 9%9% 9%

6% 6%

5%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Communication as a risk factor by responsible service

Source: MedPro Group closed claims, 2005-2014

Communication issues are a common theme across all provider types, withfamily/internal medicine cases accounting for the highest percentage.

Perc

enta

ge

of

Cla

ims

With

Com

munic

ation

as

aContr

ibuting

Fact

or

by

Resp

onsi

ble

Serv

ice ENT and plastic surgery account for half of the surgical

specialties; cardiology and neurology account for almost half ofthe medicine specialties.

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Date

Communication as a risk factor by specific issue

Source: MedPro Group closed claims, 2005-2014

57%

52%

3%1%

0%

10%

20%

30%

40%

50%

60%

Communication betweenproviders and

patients/families

Communication amongproviders

Telephone/email/fax-related Internet/telemedicine

Communication factorsoccur almost evenlybetween providers andpatients/families and amongproviders. Technology issuesare beginning to make theirway into claims involvingcommunication as well.

Perc

enta

ge

of

Cla

ims

With

Com

munic

ation

as

aContr

ibuting

Fact

or

by

Speci

fic

Com

munic

ation

Issu

e

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13

Date

Communication as a risk factor between providers & patients/families

31%

23% 23%

0%

5%

10%

15%

20%

25%

30%

35%

Inadequate informed consent Education (including dischargeinstructions)

Poor rapport

Source: MedPro Group closed claims, 2005-2014

Issues with informed consent and patient education,as well as poor rapport, drive communicationbreakdowns between providers and patients/families.

Perc

enta

ge

of

Cla

ims

With

Com

munic

ation

Issu

es

Betw

een

Pro

vid

ers

and

Patients

/Fam

ilies

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Date

Communication as a risk factor among providers

82%

13%

3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Regarding patient’s condition Failure to read medical record Poor professionalrelationship/rapport

Source: MedPro Group closed claims, 2005-2014

Communication during handoffs, consults, andreferrals is a major driver in claims involvingcommunication issues among providers.

Perc

enta

ge

of

Cla

ims

With

Com

munic

ation

Issu

es

Am

ong

Pro

vid

ers

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15

Date

It’s a problem — how do we fix it?

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What does TeamSTEPPS stand for?

Team

S

T

E

P

P

S

Strategies

Tools

Enhance

Performance

Patient

Safety

&

and

to

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What is TeamSTEPPS?

TeamSTEPPS is an evidence-basedteamwork system designed to optimizepatient outcomes by improvingcommunication and teamwork skillsamong healthcare professionals.

The TeamSTEPPS framework andcompetencies are based on knowledge,attitudes, and performance.

The program includes a comprehensiveset of ready-to-use materials and atraining curriculum to successfullyintegrate teamwork principles into anyhealthcare system.

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Key principles of TeamSTEPPS

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Evidence that TeamSTEPPS works

More success stories: http://teamstepps.ahrq.gov/implementationstories.htm

Capella, et al. (2010)

• Trauma resuscitation teamimplementation

• Pre- and post-TeamSTEPPStraining results:

• Team performance improvedacross all teamwork skills:leadership, situationmonitoring, mutual support,communication

• Significantly decreased timesfrom arrival to CT scanner,endotracheal intubation, andoperating room

Thomas & Galla (2013)

• System-wide implementation

• Pre- and post-TeamSTEPPStraining results:

• Significant improvementin HSOPSC scores on feedbackand communication abouterror, frequency of eventsreported, hospital handoffs andtransitions, and teamworkacross units

• Incremental changes evidentthrough reduction ofnosocomial infections, falls,birth trauma, and other incidents

Capella, J, et al. Teamwork training improves the clinical care of trauma patients . Journal of SurgicalEducation 2010 Nov-Dec;67(6):439-43.

Thomas, L., Galla, C. Building a culture of safety through team training and engagement. PostgradMed Journal, 2013; 89:1053 394-401.

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High-performing team?

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Characteristics of high-performing teams

High-performing teams:

• Hold shared mental models

• Have clear roles and responsibilities

• Have clear, valued, and shared vision

• Optimize resources

• Have strong team leadership

• Engage in a regular discipline of feedback

• Develop a strong sense of collective trust and confidence

• Create mechanisms to cooperate and coordinate

• Manage and optimize performance outcomes

Baker, D., Day, R, & Salas, E. Teamwork as an Essential Component of High Reliability Organizations. HealthServices Research. 2006 Aug; 41 (4Pt 2): 1576-1598.

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How does TeamSTEPPS work?

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Resources

Assessment

Team development

Leadership engagement

Defining the problem

Action planning worksheets

Creating change teams

And the list goes on

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Tools & strategies summary

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 coworkers

• Distractions

• Fatigue

• Workload

• Misinterpretation of cues

• Lack of role clarity

TOOLS/STRATEGIES

• Communication: SBAR, call-out, check-back, handoff

• Leading teams: brief, huddle,debrief

• Situation monitoring: STEP,I’M SAFE

• Mutual support: taskassistance, feedback, assertivestatement, two-challenge rule,CUS, DESC Script

OUTCOMES

• Shared mental model

• Adaptability

• Team orientation

• Mutual trust

• Team performance

• Patient safety!

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Tools — communication

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Communication — additional handoff tools

ANTICipate

• Administrative data; new clinical information; tasksto be performed; illness severity; contingency plansfor changes

I PASS

• Illness severity; patient summary; action list for thenew team; situation awareness and contingencyplans; synthesis and “read back” of the information

SHARQ

• Situation; history; assessment; recommendations/result; questions

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Tools — leadership

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Tools — situation monitoring

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Tools — mutual support

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Video vignettes

• Based on tools

• Variety of practicesettings

• Free

• Additional videosYouTube/Internet-based

http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/videos/index.html

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Program training options — AHRQ

• Train-the-trainer. This 2-day training course isdesigned to create a cadre of teamwork instructorswith the skills to train and coach other staff members.

• Fundamentals. This curriculum includes 4−6 hoursof interactive workshops for directpatient care providers.

• Essentials. This curriculum is a 1- to2-hour condensed version of theFundamentals Course and is specificallydesigned for nonclinical support staff.

• Online and in-person options areavailable.

Register for free training or learn more: http://teamstepps.ahrq.gov/

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Tailoring your program

• Limited English proficiency

• Dental

• Primary care

• Medical specialties

• Long-term care

• Rapid response

• CUSP toolkits

• CLABSI tools

• Chronic care

• Shared decision-making

• Rapid response systems

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Medpro Group commitment

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Recap of phases

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Phase 1

• Complete siteassessment evaluation

• Review data

• Provide feedback onworksheets/plans

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Phase 2

• Review action plan

• Review training plan

• Troubleshoot whencomplications occur

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Phase 3

• Review outcomes

• Recommendadjustments toaction plans

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The real world — interview with a TeamSTEPPS facility

CASS COUNTY HEALTH SYSTEM

Atlantic, Iowa

Jennifer Arp, BSN, RN, CPHQ

Performance Improvement Director

Quality/Risk Mgmt./Safety/Infection Control

Employee Health/Care Coordination

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What questionsdo you have?

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Disclaimer

The information contained herein and presented by thespeaker is based on sources believed to be accurate at thetime they were referenced. The speaker has made areasonable effort to ensure the accuracy of the informationpresented; however no warranty or representation is madeas to such accuracy. The speaker is not engaged inrendering legal or other professional services. If legaladvice or other expert legal assistance is required, theservices of an attorney or other competent legalprofessional should be sought.