Does team training make a difference in delivering safe care?

Transcription

1 Does team training make a difference in delivering safe care? Mohammad-Ali HAMANDI Deputy Hospital Director Nursing Service Administrator Makassed Hospital 6/28/2006 AHP 1

2 Definition of a Team. Group: an assembly of individuals who are together due to common interest, skill or characteristic Team: a special work group whose members are joined together in a united and coordinated effort towards a goal and whose work is mutually dependant with mutual accountability. 6/28/2006 AHP 2

3 What is A Team? Teams consist of two or more individuals. 1. Team members have specific roles, perform specific tasks, and interact or coordinate to achieve a common goal or outcome. 2. Teams make decisions. 3. Teams possess specialized knowledge and skills and often function under conditions of high workload. 6/28/2006 AHP 3

4 What is A Team? The team functions by consensus decision making The team consistently carries out decisions jointly made Teams embody a collective action arising out of task interdependency. 6/28/2006 AHP 4

5 Benefits of a Team 6/28/2006 AHP 5

6 Primary Teamwork Behaviors 1. Communication 2. Cooperation 3. Consistency 6/28/2006 AHP 6

7 When to Form a Team A specific, measurable objective that is best achieved through the coordinate efforts of different people with different skills An organizational structure and culture that encourages and provides for the team concept Adequate time for needed training deliberation, and discussions Knowledge and use of various problem-solving and decision making techniques 6/28/2006 AHP 7

8 Team selection criteria Technical abilities: training, skills, experience Personal attributes: standards, values, initiatives, organizational identification Interpersonal behaviors: influence, sensitivity, supporting others, trustworthiness Communication skills: dialogue skills, presentation skills, writing skills, reading skills Administrative skills: planning, organizing, implementing, delegating, evaluating 6/28/2006 AHP 8

9 Different Types of Team Functional Team: maintaining functional processes involved in delivering a specific output Process Improvement: improving and/or optimizing processes by which a product or service is delivered New Product Design Team Project Team: design and implementation of special projects Problem Solving Team: analysis and elimination of an undesirable, unpredictable, or unworkable situation 6/28/2006 AHP 9

10 Team Roles Sponsor: supports, empowers team Leader/coordinator: organizes team activities Facilitator: helps team members function as team Evaluator: looks at the big picture Recorder: documents teamwork Team worker: engages in the task completion 6/28/2006 AHP 10

11 Team Competencies Team-related Knowledge: Principles and concepts underlying a team s s effective performance Team-related skills: learned capacity to interact with other team members Team-related attitudes: positive attitudes and mutual trust 6/28/2006 AHP 11

12 Team Training Meta-cognitive training: thinking abilities Stress exposure training: response to stressors Simulator training: Same conditions of work in the classroom (scenarios) Team training: Convey information Demonstrate teamwork behaviors Encourage practice Include feedback 6/28/2006 AHP 12

13 Team Training Cross-training: Trading roles and tasks among team members Crew Resource Management: Improve management skills and communication Team building: role clarification, goal setting, problem solving, and interpersonal relationships. Self-correction training. 6/28/2006 AHP 13

14 The Donabedian Model of Patient Safety 6/28/2006 AHP 14

15 Teams in The Health Care Fields 6/28/2006 AHP 15

16 ACGME The accreditation council for Graduate Medical Education (ACGME) required surgical residents in-training to demonstrate teamwork-related related competencies including: Effective communications with patients and families Patient counseling and education Cooperative work-sharing with other professionals Ability to instruct students and other professionals 6/28/2006 AHP 16

17 AAMC Association of American Medical Colleges funded a research to identify critical incidents during residency. Conclusion: Need to improve work-related related competencies: Interpersonal skills, interacting with patients and families, fostering a team environment, teaching students,.. 6/28/2006 AHP 17

18 Anesthesia Crisis Resource Management (ACRM) Program Designed to help anesthesiologists better manage crises by working in multidisciplinary teams Enable trainees to work with different personality types. Training takes place in a simulated OR environment (3 days) Result: very well respected that some malpractice insurers have lower premium for ACRM-trained anesthesiologists. 6/28/2006 AHP 18

19 Medteams Program Originally tailored to train U.S. Army helicopter crews and then tailored to emergency medicine. Responsibilities include: Making decision based on conflicting or incomplete information Required coordination with varied ranks and skills Relationship between poor team performance and potentially grave outcome (death?) 6/28/2006 AHP 19

20 Medteams Program Based on need analysis of previous ER records. Customized versions are being developed for labor and delivery, OR and ICUs. Offer annual refresher training to maintain competency 6/28/2006 AHP 20

21 Medteams Program Advantages Trained staff participate in development projects addressing intra and interdepartmental teamwork issues. Trainees are provided with physical tools (checklists, quick reference cards, flow diagrams) Has organizational structure promoting cooperation among MD, RN, and others. 6/28/2006 AHP 21

22 Medteams Program Effectiveness Evaluation over one year revealed by Morey and colleagues showed: The quality of team behaviors improved Workload was not increased Staff attitudes towards teamwork were enhanced Preparation of patients for admission from the ED improved The proportion of highly satisfied patients increased clinical errors were significantly reduced 6/28/2006 AHP 22

23 Medical Team Management (MTM) Program Has 2 major components: A 3 day instructor training course A military medical personnel course Graduates of the instructor course train their staff in human-factors principles Trainees are required to observe their own strengths and weaknesses and to discuss them with the team. 6/28/2006 AHP 23

24 Medical Team Management (MTM) Program Similar to MedTeams Teams are provided with human-factors concepts and specialized communication skills Aim to reduce medical errors 6/28/2006 AHP 24

25 Medical Team Management (MTM) Advantages Relatively little information on MTM training evaluations is available This training program has gained wide acceptance in the Air Force It is mandatory for all high-risk specialties More than 2,000 Air Force medical treatment facility personnel had received MTM training by February /28/2006 AHP 25

26 Team-oriented Medical Simulation (TOMS) Provides interdisciplinary team training to surgeons nurses, anesthesiologists and orderlies to reduce number and severity of OR medical errors Developed at the university of Basel (Switzerland) Aim: Reduce safety threats Better workload management Improved problem solving Improved decision making skills 6/28/2006 AHP 26

27 Dynamic Outcomes Management (DOM) DOM provides training to surgeons, nurses and anesthesiologists with: Team-building skills Adverse situation recognition techniques Stress reduction tactics Aim: Reduce medical errors Improve quality of care 6/28/2006 AHP 27

28 Geriatric Interdisciplinary Team Training (GITT) Sponsored by the Rhode Island Geriatric Research Center Similar to MedTeams Advantages: Better Communication abilities Team cohesion Attitudes towards health care teams 6/28/2006 AHP 28

29 Conclusions and Recommendations The medical field lacks a theoretical model of team performance The science of team performance and training can help the medical community to improve patient safety A number of proven instructional strategies are available for promoting effective teamwork 6/28/2006 AHP 29

30 Conclusions and Recommendations Team training strategies must be further adopted to suit medical needs The impact of medical teamwork on patient safety outcomes has not been fully determined 6/28/2006 AHP 30

31 THANK YOU 6/28/2006 AHP 31