TeamSTEPPS Implementation Guide

Transcription

1 TeamSTEPPS Implementatin Guide TABLE OF CONTENTS Implementatin Overview... 1 Shift Twards A Culture f Safety... 1 Phase I: Assessment... 2 Phase II: Planning (Actin Plan), Training, and Implementatin... 3 Phase III: Sustainment - Mnitr, Cach, and Integrate... 4 Guide t Develping a TeamSTEPPS Actin Plan Purpse f the Guide Intrductin Hw t Use the Guide Key Principles and Definitins The Ten Steps f Actin Planning Step 1. Create a Change Team... 8 Step 2. Define the Prblem, Challenge, r Opprtunity fr Imprvement... 9 Step 3. Define the Aim(s) f Yur TeamSTEPPS Interventin Step 4. Design a TeamSTEPPS Interventin Step 5. Develp Plan fr Testing the Effectiveness f Yur TeamSTEPPS Interventin Step 6. Develp an Implementatin Plan Step 7. Develp a Plan fr Sustained Cntinuus Imprvement Step 8. Develp a Cmmunicatin Plan Step 9. Putting It All Tgether: Write the TeamSTEPPS Actin Plan Step 10. Review Yur TeamSTEPPS Actin Plan with Key Persnnel Actin Planning Wrksheets Step 1. Create a Change Team Step 2. Define the Prblem, Challenge, r Opprtunity fr Imprvement Step 3. Define the Aims f Yur TeamSTEPPS Interventin Step 4. Design a TeamSTEPPS Interventin Step 5. Develp Plan fr Testing the Effectiveness f Yur TeamSTEPPS Interventin Step 6. Develp an Implementatin Plan Step 7. Develp a Plan fr Sustained Cntinuus Imprvement Step 8. Develp a Cmmunicatin Plan The Quick Reference Guide t TeamSTEPPS Actin Planning TeamSTEPPS Actin Planning At-A-Glance Checklist fr The Jint Cmmissin Requirements fr Actin Plans TeamSTEPPS Interventin Checklist TeamSTEPPS 2.0 Implementatin Guide - i

2 TeamSTEPPS Implementatin Guide Implementatin Overview A TeamSTEPPS Initiative ccurs in three cntinuus phases: Phase I Assessment; Phase II Planning, Training, & Implementatin; and Phase III Sustainment. A healthcare rganizatin r wrk unit can shift twards a culture f safety using team tls and strategies by prgressing thrugh each f the three phases and cmpleting the key actins within each phase. The TeamSTEPPS Initiative prvides guidelines, tls, and resurces fr cmpleting each phase and fr gathering data necessary fr prgressin t the next phase. Keys t success at each phase include invlvement f the right peple, the use f infrmatin-driven decisin making, and careful planning befre acting. The fllwing paragraphs prvide an verview f each f the phases including gals and bjectives, key actins, and recmmended tls and resurces. Shift Tward A Culture f Safety TeamSTEPPS 2.0 Implementatin Guide - 1

3 Phase I: Assessment Gals & Objectives: The gal f Phase I is fr an rganizatin (r wrk unit) t determine if it is ready t undertake a TeamSTEPPS Initiative. An rganizatin is ready if it has (a) a climate cnducive t change and (b) bjective infrmatin t supprt the need fr a TeamSTEPPS Interventin. A climate cnducive t change is characterized by leadership and key staff members wh are cmmitted t making a change and wh are willing and able t dedicate the necessary time, resurces, and persnnel. Objective infrmatin supprting the need fr a TeamSTEPPS Interventin culd riginate frm a variety f surces including adverse event and near miss reprts, reprts f rt cause analyses r failure mdes and effects analyses, AHRQ Patient Safety Culture Survey, Patient and Staff Satisfactin Survey, TeamSTEPPS Teamwrk Perceptins Questinnaire, and site specific prcess and utcme measures. During Phase I, an initial Change Team (the grup f individuals wh will drive the TeamSTEPPS Initiative), is frmed f leaders and key staff members. This Change Team then determines rganizatinal readiness fr a TeamSTEPPS Initiative by cnducting a Site Assessment and reviewing available rganizatinal data. Key Actins: Multiple actins ccur during Phase I t assess rganizatinal readiness fr a TeamSTEPPS Initiative. Teamwrk experts frm within r utside the rganizatin may be cnsulted fr assistance. The Guide t Develping a TeamSTEPPS Actin Plan, particularly steps 1 thrugh 3, prvides additinal guidance. Key actins fr Phase I include: 1. Leaders and staff members cmprising the initial Change Team cllabrate t c-determine and cmmunicate a visin fr enhanced medical team perfrmance. Available rganizatinal data, (e.g., adverse event and near miss reprts, AHRQ Patient Safety Culture Survey, Patient and Staff Satisfactin Survey, Team Assessment Questinnaire, and site specific prcess and utcme measures), are reviewed t identify pprtunities fr prcess imprvement with team strategies and tls. Leaders and staff begin t cultivate ideas and cllectively gain a shared fcus f the pprtunities fr imprvement within the rganizatin. Questins t discuss include: Why implement a TeamSTEPPS Initiative? D we have any data t supprt the need? Why nw? What prcess are we trying t fix? Wh will be invlved? Where will it ccur? What d we hpe t achieve with a TeamSTEPPS Interventin? Hw will we knw that we were successful? What measures will we use? Hw will we cnduct medical team training initial, newcmer, and refresher? Wh will d it? What resurces and persnnel can we allcate t this effrt? Is it feasible? Can we achieve ur gals in a timely fashin? Hw will we spread and maintain the change thrughut key areas f the rganizatin? 2. The initial Change Team cmpletes an internal site assessment t determine rganizatinal readiness. They gather additinal infrmatin t further answer the abve questins by eliciting input frm key persnnel, and gathering relevant bjective data. 3. Leaders may cnsult with TeamSTEPPS Master Trainers t discuss a team-driven culture f safety. The site assessment prvides an pprtunity fr leaders t gain a first-hand understanding f a teamwrk change initiative and secndarily t view their rle in spnsring, evaluating, enabling r mdifying the behavirs necessary t shape and maintain the targeted behavir changes. At the cmpletin f Phase I, an rganizatin decides that it IS r IS NOT ready fr a TeamSTEPPS Initiative. If the Change Team determines that the rganizatin IS NOT ready but believes that a TeamSTEPPS Initiative wuld likely benefit safety and quality f care, they shuld make effrts t mve the rganizatinal climate tward readiness and t cllect bjective data that wuld supprt the need fr the initiative. If the Implementatin Guide - 2 TeamSTEPPS 2.0

4 Change Team determines that the rganizatin IS ready fr a TeamSTEPPS Initiative, they will dcument preliminary answers t the discussin questins listed abve and then mve nt Phase II. Tls and Resurces: Guide t Develping a TeamSTEPPS Actin Plan Sizing Up the Culture Exercise Sheet Measurement tls: AHRQ Patient Safety Culture Survey (Hspital Survey n Patient Safety), Patient and Staff Satisfactin Survey, Team Assessment Questinnaire, Team Perfrmance Observatin Tl, and site specific prcess and utcme measures Phase II: Planning (Actin Plan), Training, and Implementatin Gals and Objectives: The gal f Phase II is fr the Change Team t develp a detailed Actin Plan fr their entire TeamSTEPPS Initiative and then t fllw that Plan t cnduct medical team training and t implement the TeamSTEPPS Interventin. Key Actins: Three key actins ccur during Phase II writing a TeamSTEPPS Actin Plan, cnducting medical team training, and implementing (and testing) the TeamSTEPPS Interventin. 1. Write an Actin Plan using the Guide t Develping a TeamSTEPPS Actin Plan. The first step in Phase II is the develpment f a cmprehensive TeamSTEPPS Actin Plan. The Actin Plan is a detailed reprt f exactly what an rganizatin intends t d during their custmized TeamSTEPPS Initiative. It dcuments the methdlgy fr the entire initiative. It describes the Change Team; the challenge t be tackled; the TeamSTEPPS interventin and what the Change Team hpes it will achieve; the plans fr medical team training; the plans fr testing, implementing, and mnitring the interventin; and the plans fr cmmunicating and sustaining the change. A carefully develped Actin Plan is critical t the success f a TeamSTEPPS Initiative. It establishes the strategy and fcus fr the entire effrt and prvides a hw-t guide fr each step f the Initiative. Time spent develping a detailed infrmatin-driven Actin Plan will prevent cuntless wasted hurs and setbacks thrughut the entire imprvement effrt. 2. Cnduct medical team training. The TeamSTEPPS system includes three different medical team training curricula and a cmplete suite f multimedia curse materials. The curses can be taught as is r mdified and presented in parts based n the rganizatin s specific teamwrk training needs and staffing/resurce infrastructure. Curse instructrs frm within the rganizatin r frm utside surces may be used. The Change Team s training plan dcumented in their custmized TeamSTEPPS Actin Plan will determine which curse(s) and teamwrk skills will be taught, t which staff members, and by whm. The Three TeamSTEPPS Curricula Train-the-Trainer: 2.5 days f didactics and interactive wrkshps designed t create a cadre f teamwrk instructrs amng the rganizatin s staff with the skills t train and cach ther staff members. Als familiarizes participants with all TeamSTEPPS materials and methdlgies and prepares them t facilitate a TeamSTEPPS Initiative. TeamSTEPPS Fundamentals. 4 t 6 hurs f interactive wrkshps intended fr direct patient care prviders. Intrduces attendees t the tls and strategies fr imprving teamwrk cmpetencies including leadership, cmmunicatin, mutual supprt, and situatin mnitring. TeamSTEPPS Essentials. A 1 t 2 hur cndensed versin f the Fundamentals Curse, specifically designed fr nn-clinical supprt staff. Prvides attendees with the basic tls t effectively cmmunicate essential infrmatin. TeamSTEPPS 2.0 Implementatin Guide - 3

5 3. Implement and test the TeamSTEPPS Interventin. Using their TeamSTEPPS Actin Plan as a guide, the Change Team implements and tests their TeamSTEPPS Interventin. TeamSTEPPS Interventin refers t the specific team strategies and tls and hw they will be used t address the targeted prblem, challenge, r identified pprtunity. The interventin is therefre analgus t a risk reductin strategy r a crrective actin. Implementatin f the interventin marks the frmal launch f the TeamSTEPPS Initiative. It shuld be frmally recgnized by executive leadership and cmmunicated as part f a cntinuus imprvement and quality-based prgram. Success f the interventin, measured by imprvements in medical team perfrmance and clinical prcesses and utcmes, shuld be rewarded by leadership and shwcased thrughut the rganizatin. Tls and Resurces: Guide t Develping a TeamSTEPPS Actin Plan Measurement tls: Team Assessment Questinnaire, Team Perfrmance Observatin Tl, Learning Benchmarks, and site specific prcess and utcme measures TeamSTEPPS Training Techniques, Sample Curse Evaluatin Phase III: Sustainment - Mnitr, Cach, and Integrate Gals and Objectives: The gal f Phase III is t sustain and spread imprvements in teamwrk behavir and in assciated clinical prcesses and utcmes resulting frm the TeamSTEPPS Initiative. Specific bjectives are t integrate teamwrk behavirs and tls int yur daily practice, mnitr the n-ging effectiveness f yur TeamSTEPPS Interventin, t identify pprtunities fr cntinued imprvement, and t spread psitive changes thrughut the rganizatin. Key Actins: The TeamSTEPPS Actin Plan written during Phase II prvides the hw-t guidelines fr the key actins that ccur during Phase III. Key actins include: 1. Teamwrk Caching. Leaders, champins, and caches cntinue t mnitr and cach teamwrk behavir amng staff members. 2. Integratin. The rganizatin r wrk unit integrates int existing nrmal rutines and prcesses key features f the TeamSTEPPS Initiative such as medical team training, teamwrk behavirs and tls, and effectiveness measures. 3. Reinfrcement and Rewards. Psitive teamwrk behavirs and imprvements in prcesses and utcmes are reinfrced and rewarded. Leaders, champins, and caches prvide n-ging feedback. Successes are frmally recgnized and shwcased thrughut the rganizatin. 4. Cntinuus Imprvement. A methd is established t cntinually measure the n-ging effectiveness f the TeamSTEPPS Interventin and t identify pprtunities fr further patient safety and quality imprvement. 5. Spread. A plan is develped t spread the psitive changes t ther wrkspaces demnstrating readiness fr the TeamSTEPPS Initiative. Tls and Resurces: Measurement Tls: AHRQ Patient Safety Culture Survey, Patient and Staff Satisfactin Surveys, TeamSTEPPS Teamwrk Perceptins Questinnaire, Team Perfrmance Observatin Tl, and site specific prcess and utcme measures. Guide t Develping a TeamSTEPPS Actin Plan Implementatin Guide - 4 TeamSTEPPS 2.0

6 Massud MR et al. A Framewrk fr Spread: Frm Lcal Imprvements t System-wide Change. IHI Innvatin Series white paper. Cambridge, MA: Institute fr Healthcare Imprvement; (Available n A Framewrk fr Spread: Frm Lcal Imprvements t System-wide Change ) Running a Successful Campaign in Yur Hspital, Hw-t Guide, Institute fr Healthcare Imprvement 100,000 Lives Campaign; 2006, (Available n Running a Successful Campaign in Yur Hspital, Hw-t Guide ) Getting Started Kit: Sustainability and Spread, Hw-t Guide, Institute fr Healthcare Imprvement 100,000 Lives Campaign; 2006, (Available n Getting Started Kit: Sustainability and Spread, Hw-t Guide ) TeamSTEPPS 2.0 Implementatin Guide - 5

7 Guide t Develping a TeamSTEPPS Actin Plan Purpse f the Guide The purpse f the Guide is t prvide healthcare rganizatins with an easy-t-use but cmprehensive tl fr develping an evidence-based TeamSTEPPS Actin Plan. The intent is fr the Change Team (the grup f individuals wh will drive the TeamSTEPPS Initiative), t write their Actin Plan by wrking thrugh each f the ten steps and then utilize it as a hw-t guide fr putting their TeamSTEPPS Initiative in place. The Guide is a recmmended strategy, nt a requirement. Hwever, the ten steps d address The Jint Cmmissin s requirements s that facilities may als use the Guide t develp TeamSTEPPS Actin Plans in respnse t sentinel events. Intrductin The TeamSTEPPS Actin Plan is a detailed written reprt f exactly what an rganizatin intends t d during their TeamSTEPPS Initiative. It dcuments the methdlgy fr the entire initiative. Bx 1 lists the elements f a cmprehensive TeamSTEPPS Actin Plan. Bx 1. Elements f a Cmprehensive TeamSTEPPS Actin Plan Identificatin f the Change Team, the grup f key leaders and staff members wh will make the TeamSTEPPS Initiative happen. Identificatin f the specific prblem, challenge r pprtunity fr imprvements that will be the target f the TeamSTEPPS Initiative. Stated aims f the TeamSTEPPS Interventin. * Detailed descriptin f the TeamSTEPPS Interventin - the team strategies and tls and hw they will be used t crrect the prblem (r make imprvements). Interventins are als knwn as risk reductin strategies, crrective actins, and imprvement actins.* A plan fr testing the effectiveness f the TeamSTEPPS Interventin including measures, methdlgies, target utcme ranges, and pilt testing as apprpriate * An implementatin plan fr the TeamSTEPPS Interventin including implementatin date and identificatin f persn(s) respnsible fr implementatin and versight * A mnitring plan fr n-ging assessment f the effectiveness f the TeamSTEPPS Interventin * A cmmunicatin plan t generate supprt fr the TeamSTEPPS Initiative, t keep majr stakehlders infrmed f prgress, and t maintain and spread psitive changes. Timelines * Nte: The (*) dentes cmpnents f an Actin Plan required by The Jint Cmmissin when the Actin Plan is generated in respnse t a sentinel event. (Reference: The Jint Cmmissin. Rt Cause Analysis in Health Care: Tls and Techniques, 2 nd ed. Oakbrk Terrace, IL: Jint Cmmissin Resurces; 2003.) A carefully develped Actin Plan is critical t the success f a TeamSTEPPS Initiative. It establishes the strategy and fcus fr the entire effrt and prvides a hw-t guide fr each step f the Initiative. Time spent develping a detailed infrmatin-driven Actin Plan will prevent cuntless wasted hurs and setbacks thrughut the imprvement effrt. Implementatin Guide - 6 TeamSTEPPS 2.0

8 Hw t Use the Guide The Guide is a tl fr develping a cmprehensive, evidence-based TeamSTEPPS Actin Plan. It cnsists f a series f ten steps, (see Bx 2) each presented with an bjective, key actins fr step cmpletin, recmmended tls and resurces, tips fr success, and a wrksheet. Users shuld wrk their way thrugh each f the ten steps in sequence, addressing the key actins and cmpleting the wrksheets. The wrksheets are designed t assist users thrugh each f the ten steps, and nce cmpleted, t functin as the Change Team s written TeamSTEPPS Actin Plan. The primary fcus f the Ten-Step Guide is n TeamSTEPPS Initiatives that will be implemented within the Change Team s wn clinical wrkspace. Hwever, the Guide may be mdified fr different applicatins, based n the needs f the user. Bx 2. Ten Steps t Develping a TeamSTEPPS Actin Plan 1. Create a Change Team. 2. Define the prblem, challenge, r pprtunity fr imprvement. 3. Define the aim(s) f yur TeamSTEPPS Interventin. 4. Design a TeamSTEPPS Interventin. 5. Develp a plan fr testing the effectiveness f yur TeamSTEPPS Interventin. 6. Develp an implementatin plan - fr medical team training and fr the Interventin. 7. Develp a plan fr Sustained Cntinuus Imprvement. 8. Develp a Cmmunicatin Plan. 9. Putting it all tgether - Write the TeamSTEPPS Actin Plan. 10. Review yur TeamSTEPPS Actin Plan with key persnnel, and mdify accrding t input. Key Principles and Definitins Prcess Imprvement. The Guide is based n the principle f imprving patient safety and quality f care by imprving healthcare prcesses. A prcess is a series f actins tward a desired endpint. Examples f prcesses include (a) admitting a patient, (b) administering a medicatin, and (c) transferring a patient frm ne unit t anther. The prcess imprvement methd includes the fllwing steps: Identify a recurring prblem r pprtunity fr imprvement that, if addressed, culd lead t better patient safety r quality f care. What is it specifically that yu want t fix r imprve? Flwchart r map the prcess during which the targeted prblem r pprtunity fr imprvement ccurs write dwn the prcess steps as they currently ccur and identify wh is ding what, when, and with what tls.) Study the prcess t identify weak pints where things culd g wrng and lead t a recurrence f the target prblem r pprtunity. These weak pints are called risk pints. Design and implement interventins aimed at eliminating r reducing the impact f the risk pints. This in turn will prevent the targeted prblem frm recurring (r lead t yur targeted imprvements). Test the interventin t ensure that it did in fact eliminate r reduce the target prblem (r result in yur targeted imprvement). If the test shws that the interventin was successful, mnitr interventin effectiveness, sustain psitive prcess changes, and identify pprtunities fr further imprvement. TeamSTEPPS 2.0 Implementatin Guide - 7

9 Medical Teamwrk. The TeamSTEPPS Initiative fcuses specifically n imprving prcesses by designing and implementing interventins that enhance medical team perfrmance. The primary gal f medical teamwrk is t ptimize the timely and effective use f infrmatin, skills, and resurces by teams f healthcare prviders fr the purpse f enhancing the quality and safety f patient care. Specifically, medical teamwrk aims t ensure that the RIGHT INFORMATION is prvided t the RIGHT PERSON(S) at the RIGHT TIME resulting in the RIGHT ACTION(S). T meet that aim, medical teams require ptimal: Team Structure: cmpsitin, size, distributin - the right peple with the right skills in the right place Leadership: ability t crdinate, resurce, and facilitate ptimal team perfrmance Awareness: clear understanding at all times f team gals, f task respnsibilities, and f situatinal infrmatin critical t gal achievement, such as status f patient, f self, f team members, f perating envirnment, and f prgress tward the gal having the right infrmatin at the right time Team Skills: (a) Situatin Mnitring: ability t cntinually gather and assess situatinal infrmatin t maintain awareness; (b) Mutual Supprt: ability t prvide timely mutual supprt/back-up, bth verbal and task-related, t team members; (c) Cmmunicatin: ability t exchange infrmatin amngst team members - gathering and cmmunicating the right infrmatin at the right time t the right persn(s) resulting in the right actins Team STEPPS Initiative versus TeamSTEPPS Interventin. When used in this Guide, TeamSTEPPS Initiative refers t the medical teamwrk imprvement effrt in its entirety, frm identifying the Change Team thrugh the sustainment phase. TeamSTEPPS Interventin refers t the specific team strategies and tls and hw they will be used t address the targeted prblem, challenge, r pprtunity fr imprvement. The Ten Steps f Actin Planning Step 1. Create a Change Team Objective: T assemble a team f leaders and staff members with the authrity, expertise, credibility, and mtivatin necessary t drive a successful TeamSTEPPS Initiative. Key Actins: Select a multidisciplinary Change Team. Ensure representatin frm three different leadership levels: Senir Leadership, Clinical/Technical Expertise, and Frnt-line Leadership (see Step 1 Wrksheet). Ensure at least ne member is very knwledgeable f team strategies, tls, and training techniques. Ensure at least ne member has experience in prcess imprvement including perfrmance trending techniques. Relevant skills include data cllectin, analysis, and presentatin. Implementatin Guide - 8 TeamSTEPPS 2.0

10 Tls and Resurces: Step 1 Wrksheet - Creating A Change Team: Key Characteristics & Primary Rles f Essential Members Tips fr Success: The Change Team will fcus n imprving prcesses within its wn clinical wrkspace. Chse members with relevant clinical expertise, wrkplace lcatin, credibility, and direct invlvement in the prcesses that will be affected by the TeamSTEPPS interventin. Ideally, all Change Team members will attend team training. Optimal Change Team size is five r six individuals. Invlvement f bth physicians and nurses frm the clinical wrkspace is essential. The Change Team then prceeds thrugh Steps 2 t 10. Step 2. Objective: Define the Prblem r the Opprtunity fr Imprvement T specifically state the prblem, challenge, r pprtunity fr imprvement that will be targeted by yur TeamSTEPPS interventin; and t identify the invlved prcess. What is it specifically that yu want t fix r imprve? Key Actins: 1. Identify a prblem, challenge, r pprtunity fr imprvement that yu feel culd be bettered with enhanced medical teamwrk. Strategies include: Reviewing wrkspace perfrmance and safety data such as incident reprts, the AHRQ Patient Safety Culture Survey, the TeamSTEPPS Teamwrk Perceptins Questinnaire, the Team Perfrmance Observatin Tl, and site-specific prcess and utcmes measures. Reviewing reprts f rt cause analyses and failure mdes and effects analyses. Asking frnt-line staff, What are bad utcmes waiting t happen because f breakdwns in the transfer f critical infrmatin? What are the things that keep yu up at night? 2. Identify the prcess during which the prblem, challenge, r pprtunity ccurs by stating what the prcess is, wh is invlved, and when and where it ccurs. Example 1 f a Prblem Definitin 1. Identify the prblem: Subptimal telephne cmmunicatin f patient infrmatin between labr and delivery unit staff members. 2. Identify the clinical prcess: What: Telephne cmmunicatin f patient infrmatin Wh: Cmmunicatin frm staff L&D nurses t staff L&D physicians When: During nrmal daily peratins Where: On the L&D unit TeamSTEPPS 2.0 Implementatin Guide - 9

11 Example 2 f a Prblem Definitin 1. Identify the prblem: Subptimal cmmunicatin between surgical team members 2. Identify the clinical prcess: What: Cmmunicatin f critical infrmatin abut the patient and surgical prcedure Wh: Surgens, anesthesilgists, OR nurses, and scrub technicians in the General Surgery Service When: Just prir t first incisin Where: In the perating rm Tls and Resurces: These tls may be used t identify prblems and als t prvide baseline data fr measuring the effectiveness f a TeamSTEPPS Interventin. AHRQ Patient Safety Culture Survey TeamSTEPPS Teamwrk Perceptins Questinnaire Team Perfrmance Observatin Tl (requires an bserver trained in medical teamwrk) Staff and/r patient satisfactin surveys Tips fr Success: Change Teams may want t define three r fur prblems/pprtunities and then select the highest pririty fr the TeamSTEPPS Interventin. Lk fr prblems/pprtunities that meet the fllwing criteria: The assciated prcess ccurs frequently. Breakdwns in team perfrmance culd result in harm t patients. Prcess change is feasible and likely within the shrt-term. Administer the AHRQ Patient Safety Culture Survey and/r the TeamSTEPPS Teamwrk Perceptins Questinnaire prir t cnducting medical team training r implementing yur TeamSTEPPS Interventin. The results will prvide sme f the baseline data needed fr testing the effectiveness f the interventin. Step 3. Define the Aim(s) f Yur TeamSTEPPS Interventin Objective: T succinctly state in measurable terms exactly what yu hpe t achieve with the TeamSTEPPS Interventin what will be achieved, wh will be invlved, and when and where the change will ccur. Key Actins: 1. Develp ne t three measurable aims fr yur TeamSTEPPS Interventin, and state in ne r tw sentences what yu hpe will be achieved, wh will be invlved, and when and where the imprvements will ccur. Aims can be based n the prcess f the TeamSTEPPS Interventin itself r n the utcmes f that interventin. Implementatin Guide - 10 TeamSTEPPS 2.0

12 Team prcess aims fcus n hw well r ften yur staff carries ut yur TeamSTEPPS Interventin. Outcme aims fcus n changes that ccur because yur staff carries ut the interventin. These aims can be directed at changes in team perfrmance (team utcme aims) r in clinical results (clinical utcme aims). It is ideal (but nt necessary) t have a team prcess aim, a team utcme aim, and a clinical utcme aim. This becmes particularly imprtant when testing the effectiveness f yur TeamSTEPPS Interventin. Example 1 f Prcess and Outcme Aims The Prblem: Subptimal pre-p cmmunicatin between surgical teams in General Surgery Service Team Prcess Aims: Increase the percentage f unit staff wh has received training t at least 80% within 2 mnths f team training implementatin. Increase the rate f General Surgery cases with standardized pre-p briefings by 40% within 3 mnths f TeamSTEPPS Interventin implementatin. Team Outcme Aim: Increase the perceptin amng General Surgery Service staff f gd team behavir, as assessed by the TeamSTEPPS Teamwrk Perceptins Questinnaire, within 6 mnths f the TeamSTEPPS Interventin implementatin. Clinical Outcme Aim: Increase the percentage f surgical patients wh receive prphylactic antibitics apprpriately time prir t incisin rm current 85% t 100% within 4 mnths f the TeamSTEPPS Interventin implementatin. TeamSTEPPS 2.0 Implementatin Guide - 11

13 Example 2 f Prcess and Outcme Aims The Prblem: Subptimal telephne cmmunicatin f patient infrmatin frm staff labr and delivery (L&D) nurses t staff L&D physicians. Team Prcess Aims: 1. Increase the percentage f L&D nurses and physicians wh receive training n SBAR t at least 80% within ne mnth f medical team training implementatin. 2. Increase the use f SBAR by L&D nurses during telephne cmmunicatins t L&D physicians by at least 60% within 2 mnths f TeamSTEPPS Interventin implementatin. Team Outcme Aim: Increase the perceptin amng all L&D staff f gd team behavir, as assessed by the TeamSTEPPS Teamwrk Perceptins Questinnaire, within 6 mnths f TeamSTEPPS Interventin implementatin. Clinical Outcme Aim: Increase L&D physicians average rating f the quality f L&D nurses telephne cmmunicatin f patient infrmatin by at least 50% within 3 mnths f TeamSTEPPS Interventin implementatin. Tls and Resurces: Step 3 Wrksheet Tips fr Success: Develp aims that specifically address the target prblem identified during step 2. Put time and thught int defining the prblem and defining the aims f yur TeamSTEPPS Interventin since they are the mst imprtant steps in Actin Plan develpment. The target prblem and stated aims drive the develpment f all remaining cmpnents f the Actin Plan. Step 4. Design a TeamSTEPPS Interventin Objective: T design a TeamSTEPPS Interventin that will address yur targeted prblem r challenge, and achieve yur stated aims. Key Actins: T design yur TeamSTEPPS Interventin yu will use prcess imprvement techniques and systemsbased strategies fr human errr reductin. The fllwing key actins shuld be perfrmed in the rder they appear: 1. Flwchart r map the prcess during which the target prblem/challenge/pprtunity ccurs - write dwn the prcess steps as they currently ccur and identify wh is ding what, when, with what tls. 2. Study the prcess t identify risk pints where things culd g wrng and lead t a recurrence f the target prblem/challenge/pprtunity. 3. Identify where in yur prcess team strategies and tls might eliminate r mitigate the risk pints and prevent the prblem frm recurring. 4. Determine which team tls and strategies, such as the brief, huddle, debrief, STEP, SBAR, and I PASS the BATON, wuld wrk best t eliminate the prcess risk pints. Strategies include: Brainstrming with Change Team members and ther frnt-line staff; Implementatin Guide - 12 TeamSTEPPS 2.0

14 Eliciting input frm teamwrk experts; Reviewing the evidence-base and searching fr best practices. 5. Draft yur TeamSTEPPS Interventin. State what team tls and strategies will be implemented; wh will use them, when and where. 6. Evaluate yur TeamSTEPPS Interventin fr ptential benefits and negative effects: Flw-chart the redesigned prcess as yu imagine it wuld lk with yur TeamSTEPPS Interventin in place. Identify ptential failure pints in the redesigned prcess. Hw will yu reduce the prbability and/r severity f these failures? Identify ptential benefits and negative effects f the redesigned prcess n units utside yur wrkspace. Hw will yu cntrl ptential negative effects? 7. Evaluate yur TeamSTEPPS Interventin using the TeamSTEPPS Interventin Checklist, and mdify yur interventin based n the results. 8. Write a detailed descriptin f yur final TeamSTEPPS Interventin. State what team tls and strategies will be implemented; wh will use them, when and where. Tls and Resurces: Step 4 Wrksheet TeamSTEPPS Interventin Checklist Gdfrey M, Nelsn E, Batalden P, et al. Clinical Micrsystems Actin Guide. Hanver, NH: Trustees f Dartmuth Cllege; (available at Clinical Micrsystems Actin Guide). --- fr tls and techniques fr clinical prcess mapping and flwcharting and fr brainstrming Almeida SA and Almeida PA. A Primer fr Patient Safety: Evidence-based Requirements, Standards, and Recmmendatins fr Prgram Develpment and Implementatin, Third Editin. (Prepared under Cntract N. GBR-04-USUHS ) USUHS Publicatin. Bethesda, MD: DD CERPS at USUHS. March fr cncise summaries f evidence-based patient safety prgram requirements, standards, and recmmendatins frm the DD, The Jint Cmmissin, and leading gvernment and private sectr patient safety expert grups. (This infrmatin is available fr DD use nly.) Tips fr Success: Stay fcused n yur target prblem and yur stated aims. While designing the interventin, keep asking, Hw will it slve the prblem? Hw will it achieve ur aims? Elicit input frm the entire Change Team and frm ther key persnnel such as leaders, clinicians, frnt-line staff, subject matter experts, and persnnel mst impacted by the imprvement effrt. Keep it simple. Ideally, address ne prblem ne prcess ne team tl. Yur interventin will have a greater prbability f success if yu implement smaller changes, but d it very well. TeamSTEPPS 2.0 Implementatin Guide - 13

15 Step 5. Develp a Plan fr Testing the Effectiveness f Yur TeamSTEPPS Interventin Objective: T develp a methd t determine if yur TeamSTEPPS Interventin achieved yur aims. Did it wrk? Key Actins: Ideally, yu will test if yur TeamSTEPPS Interventin achieved each ne f the aims yu generated during Step 3. If time and resurces are limited, select nly ne aim fr testing. Base yur selectin n the imprtance f the aim and n the feasibility f testing it. Testing des nt need t be cmplicated. Basic perfrmance imprvement trending and tracking methds generally suffice. Fr each aim yu select, create a testing methd by perfrming the fllwing key actins: 1. Identify wh n yur Change Team will be respnsible fr data cllectin, analysis, and presentatin (generatin f graphs and charts). 2. Identify a measure and define target ranges fr that measure. The measure shuld answer whether yu achieved yur aim. 3. Create a study design: The mst cmmn study design fr clinical prcess imprvement is a simple pre- and pst-interventin study. With this design, yu (1) gather yur data befre implementatin f yur TeamSTEPPS Interventin, then (2) implement the interventin, then (3) gather the same data again at pre-determined time intervals after implementatin f the interventin, and finally (4) cmpare the results frm yur pre-interventin data t thse f yur pst-interventin data. The data yu cllect befre implementatin f yur interventin is knwn as yur baseline data r cntrl grup data. 4. Select test subjects r data surce. Fr measures that assess team prcess r team utcmes, yur test subjects generally are yur staff members whm yu want t use the team tls fr example, the nurses wh will use SBAR fr telephne cmmunicatin f patient infrmatin t staff physicians. Fr measures that assess clinical utcmes, cmmn data surces are patient health recrds r existing healthcare quality imprvement databases. 5. Identify a cmparisn r cntrl grup. The cntrl grup is a grup f individuals, similar in characteristics t the interventin grup, wh d nt receive the interventin. T demnstrate the effect f yur interventin yu must apply yur measures t bth a cntrl grup and t an interventin grup and then cmpare the results. Differences between the grups shw the effect f yur interventin. (Nte: Fr the pre- and pst-interventin study design described abve, the pre-implementatin data serve as the cntrl). 6. Determine methds fr data cllectin. Determine wh will cllect the data, when, where, and hw. 7. Determine methds fr data analysis and interpretatin. Yu may start by ding simple cunts f yur target events r clinical utcmes and displaying these cunts n a line graph by day, week, r mnth. Examples f cunts include (a) number f times staff nurses use SBAR fr telephne cmmunicatin f Implementatin Guide - 14 TeamSTEPPS 2.0

16 patient infrmatin t staff physicians, (b) number f cases during which the surgical team uses the pre-p brief, and (c) number f surgical cases administered prphylactic antibitics apprpriately timed prir t incisin. Hwever, t shw true change ver the test perid, yu will need t cnsider denminatr data r the number f times the event culd have ccurred. Rates (reprted as percentages) are simple data calculatins that accunt fr denminatr data. Rates are calculated by dividing the number f events that did ccur by the ttal number f pprtunities fr the event t ccur. T assess the effectiveness f yur interventin using a rate: (1) calculate the rate at baseline befre cnducting yur medical team training r implementing yur interventin; then (2) calculate the same rate again after implementing yur interventin; and then (3) cmpare the pre- and pst-interventin rates t determine any changes due t yur interventin. Examples f Prcess and Outcme Measures Using Rates Team Prcess Measures Number f cases during which surgical team perfrmed team brief Ttal number f surgical cases perfrmed by the surgical team = Rate f Team Briefing Adherence Number f times staff labr and delivery (L&D) nurses used SBAR fr telephne cmmunicatin f patient infrmatin t staff L&D physicians Ttal number f times staff L&D nurses cmmunicated patient infrmatin by telephne t staff L&D physicians = Rate f Nurse Telephne SBAR Usage Clinical Outcme Measures Number f surgical patients administered apprpriately-timed prphylactic antibitics prir t incisin Ttal number f surgical patients wh shuld have received apprpriately-timed prphylactic antibitics prir t incisin = Rate f Apprpriate Pre-Surgery Prphylactic Antibitic Administratin Number f patients admitted t labr & delivery wh incurred an adverse event r near miss Ttal number f patients admitted t labr & delivery Number f livebrn fullterm nenates with birth trauma (injury) Ttal number livebrn fullterm nenates = Rate f Labr & Delivery Adverse & Near-Miss Events = Rate f Nenatal Birth Trauma Statistics Tip: Chse measures that will likely result in at least 30 events (r cases) in yur numeratr within the timeframe f yur study. Anther simple data calculatin is time-t-event-ccurrence, r the elapsed time frm a defined starting pint t the ccurrence f a specific event. This measure is particularly useful fr clinical prcesses that shuld ccur within a limited perid f time. Examples include (a) the duratin f time between patient arrival at an emergency rm and evaluatin TeamSTEPPS 2.0 Implementatin Guide - 15

17 by a physician, and (b) the duratin f time between the arrival f a pre-term pregnancy n the labr deck and the cmmunicatin f this infrmatin t the respnsible pediatrics staff. Survey scres are a third easy-t-use grup f measurements. T assess the effectiveness f yur interventin using a survey scre: (1) administer the survey at baseline, befre cnducting yur medical team training r implementing yur interventin; then (2) administer the same survey again after implementatin f yur interventin, preferably t the same peple; then (3) calculate the scres fr the pre- and pst-interventin surveys; and finally (4) cmpare the scres frm the tw grups. Yu may use already develped surveys such as the AHRQ Patient Safety Culture Survey, the TeamSTEPPS Teamwrk Perceptins Questinnaire, r existing patient r staff satisfactin surveys. Or, yu may develp simple surveys f yur wn. Examples f Prcess and Outcme Measures Using Survey Scres Team Prcess Measure Team Outcme Measure Clinical Outcme Measure The frequency f use f SBAR by L&D nurses fr telephne cmmunicatin f patient infrmatin t L&D physicians L&D clinical staff s perceptin f medical team behavir as measured with the TeamSTEPPS Teamwrk Perceptins Questinnaire L&D physicians perceptin f the quality f telephne cmmunicatin f patient infrmatin by L&D nurses as assessed using a 5-pint Likert scale Fr each f these surveys, yur gal wuld be t find an increase in the scres after implementatin f yur TeamSTEPPS Interventin. T learn abut Likert scales, see Likert Scale Infrmatin. 8. Determine data presentatin methd. Determine hw yu will visually display yur results t shw that yu achieved yur aim(s). Simple line graphs, run charts, and bar graphs are usually very effective. Cntrl charts prvide mre infrmatin, but require mre skill t generate. 9. Determine resurces required (time, equipment, persnnel, expertise). 10. Determine timelines fr the test Fr baseline data: When will yu cllect it, analyze it, and display it? Fr pst-implementatin data: When will yu cllect it, analyze it, and display it? Tls and Resurces: Step 5 Wrksheet Team Perfrmance Measurement Tls: AHRQ Patient Safety Culture Survey, TeamSTEPPS Teamwrk Perceptins Questinnaire, Team Perfrmance Observatin Tl (requires an bserver trained in medical teamwrk) The Jint Cmmissin. Tls fr Perfrmance Measurement in Health Care: A Quick Reference Guide. Oakbrk Terrace, IL: Jint Cmmissin Resurces; Gdfrey M., Nelsn E., Batalden P. et al. Clinical Micrsystems Actin Guide. Hanver, NH: Trustees f Dartmuth Cllege; (available at Clinical Micrsystems Actin Guide) Institute fr Healthcare Imprvement website. (Institute fr Healthcare Imprvement ) (free tls and tutrials). Implementatin Guide - 16 TeamSTEPPS 2.0

18 Tips fr Success: Keep it simple. Select ne slid measure fr each aim. Ideally yu will have ne team prcess measure, ne team utcme measure, and ne clinical utcme measure. The team prcess measure will assess whether yur staff actually carried ut yur TeamSTEPPS Interventin. Fr example, hw ften did yur staff nurses use SBAR fr telephne cmmunicatin f patient infrmatin t staff physicians? The team prcess measure becmes particularly imprtant if yur utcme measures shw n imprvement with yur interventin. Failure t shw imprvement in team perfrmance r in clinical utcmes may be due t the staff s failure t implement the interventin and NOT t the ineffectiveness f the interventin itself. If yu will use any patient data, ensure yur plan adheres t all patient rights and privacy laws and regulatins. Check with yur gverning Institutinal Review Bard, Cmmittee fr the Prtectin f Human Subjects, r ther resident subject matter expert if yu are unsure. Use existing data surces whenever pssible. Determine what data yur facility r wrkspace already cllects that yu may be able t use. Step 6. Develp an Implementatin Plan Objective: Part A: T develp a plan fr training yur staff in the medical teamwrk knwledge and skills required t successfully implement yur TeamSTEPPS Interventin. Part A: Part B: T develp a plan fr putting yur TeamSTEPPS Interventin int place. Develp a Plan fr Medical Team Training Prir t implementing yur TeamSTEPPS Interventin, yu will need t prvide medical team training t staff members and ther persnnel wh will be invlved in the interventin. It is nt necessary t train all staff n all teamwrk cncepts and tls. Identify what yur staff needs t knw in rder t make yur TeamSTEPPS Interventin successful, and then select the TeamSTEPPS training materials and techniques that best meet yur specific training requirements. Cmplete the fllwing key actins t develp Part A f yur implementatin plan: Key Actins: 1. Identify yur trainee audience(s) and their training requirements. Determine wh (staff members within a targeted unit/department) needs t be trained n what medical teamwrk knwledge/skills and by when. 2. Identify the instructrs fr each audience. 3. Develp a training plan fr each audience, including: Wh will attend the training sessins What team knwledge, skills yu will train When the training sessins will ccur and fr hw lng Where the sessins will ccur Hw yu will train (methd f presentatin, tls, supplies) Lgistics such as schedules, equipment, impact f training n ther peratins, additinal resurces required, ntifying trainees and ther key stakehlders TeamSTEPPS 2.0 Implementatin Guide - 17

19 4. Determine if any f yur audiences will require refresher training. If s, repeat the abve actins fr refresher training. Part B: 5. Create yur training timelines. Key Actins: Include time fr develping yur materials and managing lgistics. Include initial, newcmers, and refresher training, if needed. Develp an Implementatin Plan fr the TeamSTEPPS Interventin Part B f the implementatin plan addresses hw yu will put yur TeamSTEPPS Interventin int place. Cmplete the fllwing key actins: 1. Identify persn(s) respnsible fr implementatin. 2. Determine hw yu will implement TeamSTEPPS Interventin in rder t achieve yur aims. Wh will use what team strategies and tls, when, and where? Will they need additinal resurces t implement the interventin? 3. Develp an implementatin timeline. Tls and Resurces (fr Part A and Part B): Step 6 Wrksheet TeamSTEPPS Training Techniques Tips fr Success: Cnsider pilt testing bth yur medical team training and yur interventin implementatin plans with a small grup prir t implementing the prgrams n a larger scale. Cnsider establishment f a TeamSTEPPS Learning Actin Netwrk fr fllw-up and infrmatin sharing. This wuld invlve scheduled cnference calls with sites that have implemented an Initiative. Calls are best held either bi-mnthly r quarterly. Step 7. Develp a Plan fr Sustained Cntinuus Imprvement Objective: T develp a plan fr cntinuus prcess imprvement with yur TeamSTEPPS Interventin, including plans fr n-ging assessment f the effectiveness f the interventin, fr sustainment f psitive changes, and fr identificatin f pprtunities fr further imprvements. Key Actins: 1. Develp a plan fr mnitring ver time the effectiveness f yur TeamSTEPPS Interventin. The purpse f the mnitring plan is tw-fld t determine if yur interventin cntinues t achieve yur aims and t identify pprtunities fr further prcess imprvement. Designing a mnitring plan is similar t designing a testing plan (Step 5). The mnitring plan is ften just a simplified versin f the testing plan with fewer and less frequent measurements. Fr yur mnitring plan, determine: measures & target utcmes Implementatin Guide - 18 TeamSTEPPS 2.0

20 test subjects and/r data surce (e.g., existing QI database) methds fr data cllectin methds fr data analysis and interpretatin resurces required (mney, time, equipment, persnnel, expertise) persn(s) respnsible fr implementatin and versight 2. Determine hw data frm yur mnitring plan will be used t cntinually imprve prcesses and perfrmance. 3. Develp a plan fr sustaining and spreading psitive changes. Tls and Resurces: Step 7 Wrksheet Cnsider a recgnitin and rewards prgram. Develp a plan fr timely cntinuus feedback n perfrmance and fr sharing lessns learned. Determine hw yu will mnitr teamwrk behavir and prvide n-ging teamwrk caching. Cnsider hw yu will spread psitive changes t ther wrkspaces r t ther prcesses within yur wrkspace. Massud MR et al. A Framewrk fr Spread: Frm Lcal Imprvements t System-wide Change. IHI Innvatin Series white paper. Cambridge, MA: Institute fr Healthcare Imprvement; (Available n A Framewrk fr Spread: Frm Lcal Imprvements t System-wide Change ) Running a Successful Campaign in Yur Hspital, Hw-t Guide, Institute fr Healthcare Imprvement 100,000 Lives Campaign; 2006, (Available n Running a Successful Campaign in Yur Hspital, Hw-t Guide ) Getting Started Kit: Sustainability and Spread, Hw-t Guide, Institute fr Healthcare Imprvement 100,000 Lives Campaign; 2006, (Available n Getting Started Kit: Sustainability and Spread, Hw-t Guide ) Tips fr Success: Integrate yur TeamSTEPPS Interventin int existing prcesses fr lng-term sustainment. Make it part f yur wrkspace s nrmal daily rutines. Examples f integratin include (a) incrprating team principles int staff meetings, QI cmmittees, Grand Runds; and (b) integrating mnitring measures int existing wrkspace databases and systems. Publicize yur successes. Examples include visibly displaying large wall charts in yur wrkspace shwing psitive perfrmance trends; writing articles in lcal publicatins and medical jurnals; giving presentatins n yur results at staff meetings and prfessinal medical meetings. Develp standardized prcedures fr integrating newly acquired staff. Step 8. Develp a Cmmunicatin Plan Objective: T create a cmmunicatin plan targeting majr stakehlders that will generate initial and nging supprt fr the TeamSTEPPS Initiative and prmte the maintenance and spread f psitive changes. Key Actins: 1. Identify yur stakehlders. TeamSTEPPS 2.0 Implementatin Guide - 19

21 Whse supprt will be imprtant fr achieving the aims f yur interventin and fr maintaining psitive changes? Cnsider rganizatin leaders, frnt-line leaders, staff directly invlved in the interventin, patients, supprt staff, and ther units impacted by the interventin. 2. Fr each f yur identified stakehlder grups, develp a cmmunicatin plan including: Gals fr cmmunicatin with this grup. What d yu want t achieve? Wh will get the infrmatin What infrmatin yu will cmmunicate When and hw ften yu will cmmunicate Hw yu will cmmunicate (e.g., reprts, presentatins, s) 3. Identify a persn n the Change Team wh will be respnsible fr implementatin and versight f the cmmunicatin plan. Tls and Resurces: Step 8 Wrksheet Tips fr Success: Stay fcused n yur gals fr cmmunicatin with each stakehlder grup. Keep asking, What d I hpe t accmplish fr the Initiative (e.g. buy-in, resurces, participatin) by cmmunicating with this grup? The gals will drive the develpment f yur cmmunicatin plan. Step 9. Putting it All Tgether: Write the TeamSTEPPS Actin Plan Objective: T generate a written Actin Plan, based n Steps 1 thrugh 8 that will functin as yur Hw-T Guide fr every cmpnent f yur TeamSTEPPS Initiative. Key Actins: If yu cmpleted each f the wrksheets fr Steps 1 thrugh 8, yu have already written yur TeamSTEPPS Actin Plan. Ensure that yur final Actin Plan includes all f the fllwing elements: 1. Identificatin f the Change Team 4. Identificatin f the prblem, challenge, r pprtunity fr imprvement that will be the fcus f the TeamSTEPPS Initiative 5. Stated aims f the TeamSTEPPS Interventin 6. Detailed descriptin f the TeamSTEPPS Interventin 7. A plan fr testing the effectiveness f the TeamSTEPPS Interventin 8. An implementatin plan fr bth medical team training and fr the TeamSTEPPS Interventin Implementatin Guide - 20 TeamSTEPPS 2.0

22 9. A mnitring plan fr n-ging assessment f the effectiveness f the TeamSTEPPS Interventin 10. A cmmunicatin plan t generate supprt fr the TeamSTEPPS Initiative, t keep majr stakehlders infrmed f prgress, and t maintain and spread psitive changes. 11. Timelines 12. Resurces required Tls and Resurces: Step 1 thrugh 8 Wrksheets (Yu have already created yur custmized TeamSTEPPS Actin Plan by cmpleting step 1 thrugh 8 wrksheets!) Ktter J and Rathgeber H. Our Iceberg is Melting.Changing and Succeeding Under Any Cnditins, Ktter & Rathgeber; Tips fr Success: Save yur riginal step wrksheets. They may cntain infrmatin and ideas yu might want later. Step 10. Review yur TeamSTEPPS Actin Plan with Key Persnnel Objective: T generate supprt and elicit ideas frm majr stakehlders, and t identify barriers t prgram implementatin. Key Actins: 1. Identify stakehlders wh culd cntribute significantly t the Actin Plan. Cnsider rganizatin leaders, frnt-line leaders, persns directly invlved in the interventin, and persnnel with special expertise such as facility data analysts. 2. Ask key stakehlders t review yur Actin Plan and t prvide input. Specifically request that they identify any ptential prblem areas and ffer slutins. 3. Mdify yur Actin Plan based n their input, if needed. Tls and Resurces: N/A Tips fr Success: Yu may want t ask sme stakehlders t review nly certain sectins f the Actin Plan. Actin Planning Wrksheets Actin Planning Wrksheets fr each step are cntained in the fllwing pages. TeamSTEPPS 2.0 Implementatin Guide - 21