Dora Anne Mills, MD, MPH, FAAP
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1 Dora Anne Mills, MD, MPH, FAAP Vice President for Clinical Affairs UNE Karen Pardue, PhD, RN Associate Dean of Westbrook College of Health Professions, UNE
2 Learning objectives for today. From the abstract: Participants will be able to define interprofessionalcollaborative practice is and describe why it is important to address patient safety. Participants will be able to demonstrate the use of the core TeamSTEPPStools that are associated with effective interprofessionalcollaborative practice. Our plans for this hour. 2
3 First, why do we need effectiveinterprofessionalpractice? 1999: To Err Is Human, IOM report estimated up to 98,000 in the U.S. die from hospital medical errors every year 2010: Office of the Inspector General for U.S. DHHS estimated 180,000 deaths from hospital mistakes among Medicare recipients alone 2013: Journal of Patient Safety a study by John T. James, a toxicologist with NASA and who runs an organization called Patient Safety America, estimates the number of hospital deaths due to errors to be 210, ,000. This number has been supported by several prominent patient safety experts, including Harvard s Lucian Leape, MD. 3
4 If medical errors in U.S. hospitalswere countedas anofficialcause of death, it would be the 3 rd leading cause of death,even if the low end (210,000 deaths) was the most accurate. 4
5 Rootcause analysis of deaths due to medical errors shows that 80% are due to poor: communication (60%), collaboration, or coordination. In other words,poor team work. Resources: 46 (shows root causes of hospital sentinel events, with ~65% due to communication issues) Bedell S, Deitz DK, Leeman D, Delbanco T. Incidence and characteristics of preventable iatrogenic cardiac arrests. Journal of American Medical Association 1991;265: LeapeL, LawthersA, Brennan T, Johnson W.Preventing medical injury. Quality Review Bulletin 1993;8: Bates DW, Cullen D, Laird N, Petersen LA,Small SD, ServiD, et al. Incidence of adverse drug events and potential adverse drug events:implications for prevention. Journal of American Medical Association 1995;274:29-34.
6 Teachingteamwork is critical. Lucian Leape, MD, the Harvard physician known as the father of the patient safety movement calls training in teamwork the most critical ingredient for addressing patient safety (NEJM 2014;370: , March 13, 2014, DOI: /NEJMe ) Numerous studies also reinforce the critical aspect of team: Peter J. Pronovost, MD, PhD from Johns Hopkins rts/research_faculty/bios/pronovost.html and numerous others. Baker D.P., Day R., Salas E.: Teamwork as an essential component of high reliability organizations. Health ServRes 41(4 pt. 2): , Aug SorberoME, Farley DO, MattkeS, Lovejoy S. Outcome measures for effective teamwork in inpatient care (RAND technical report TR-462-AHRQ). Arlington, VA: RAND Corporation, Friedman D.M., Berger D.L.: Improving team structure and communication: a key to hospital efficiency. Arch Surg139: , Nov
7 Definition of IPCP Evidencethat it works: it reducescosts, improves quality, and improves the patient experience as well as that of providers. Specifically, IPCP reduces: Total client complications; Length of hospital stay; Tension and conflict in caregivers; Staff turnover; Hospital admissions; Clinical error rates; and Mortality rates.ippractice is based on relational-centeredpractice, which is focused on the importance of the interaction among people as the foundation of any therapeutic or health activity. Relationships are critical to the care provided a source of satisfaction and positive outcomes for patients and practitioners Cochrane Review of 15 studies on the evidence of Interprofessional Educationhttp://summaries.cochrane.org/CD002213/training-health-and-social-careprofessionals-to-work-together-effectivelyIndicatespositive outcomes on healthcare processes and on patient health outcomes 2009 Cochrane Review. Interprofessionalcollaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Six Things Every Physician in the OR Needs to Know About Teamwork Training and Checklists, Captain Stephen W. Harden sts.pdf 7
8 UNE teaches to the National IPEC competencies What UNE does...- in classroom and in clinical settings 8
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10 3 2 1 Exercise Thinkback to a team you were a part of that was exemplary a health care team or sports team or other team. What were the characteristics that made it an exemplary team? Share as many of those characteristics as possible: over 3 minutes in pairs; 2 minutes with others at your table; and in 1 minute we ll quickly name as many of them from the various tables. Or just ask the audience members to share directly to the rest of the audience. 10
11 Team Strategies & Tools to Enhance Performance & Patient Safety Effective teamwork does not come easily, but much of it can be trained. Several tools exist, we like the TeamSTEPPStools. AHRQ-funded, materials low cost or free Initiative based on evidence derived from team performance leveraging more than 25 years of research in military, aviation, nuclear power, business and industry to acquire team competencies Some of the critical components: Situational Monitoring-ME Being aware of what is going on around you and understanding what the information means Communication-YOU SBAR (Out) Closed-Loop Communication (IN) Shared Mental Model-US Common understanding of the situation and the plan 11
12 TeamSTEPPShas several modules inpatient, primary care, long term care, dental offices, improving safety for patients with limited English proficiency. Our focus today is the primary care module. TeamSTEPPSrecognizes these barriers to effective teams. 12
13 TeamSTEPPS teaches a variety of tools, in 4 areas: leadership, situation monitoring, mutual support, and communication. Although there are a number of tools, we will review a few of them, to provide you an idea of what they re like. One way to assess leadership of a team is to ask: Do all members understand and agree upon the goal? Are all members roles and responsibilities understood? 13
14 These are 3 of the leadership tools taught, probably terms you re all familiar with, though TeamSTEPPSdefines them and provides a framework for them that may be different from what you may be used to. 14
15 We won t go through all of these, but to give you an idea, here are the steps for a brief, which is a suggested strategy before every outpatient practice session, for instance. 15
16 TeamSTEPPSeven provides a checklist for these tools. These are especially helpful when a team is learning TeamSTEPPS. 16
17 Besides leadership, active situation is the second category of tools. Is situation monitoring present at all times by everyone? CROSS-MONITORING: A process of monitoring unfolding actions against the established plan of care to avoid errors Helps maintain accurate situation awareness Way of watching each other s back Gives team members a way to monitor patient care and give constructive feedback 17
18 Again, as with leadership, situation monitoring is broken down into components that can be taught, trained, and demonstrated. 18
19 Everyonehas everyone else s 6 s got each others backs. Team members foster a climate in which it is expected that assistance will be actively soughtand offeredas a method for reducing the occurrence of error. Some of the mutual support tools taught by TeamSTEPPSinclude how to provide effective feedback. Good Feedback is TIMELY RESPECTFUL SPECIFIC DIRECTED toward improvement Helps prevent the same problem from occurring in the future CONSIDERATE Feedback is where the learning occurs. 19
20 Besides leadership, situation monitoring, and mutual support, the 4 th category of tools is communication. 20
21 There are a number of communication tools taught by TeamSTEPPS, including: Check back closed-loop communication and SBAR. 21
22 Here is a list of tools taught by outpatient TeamSTEPPStraining. 22
23 This exercise, you re going to team up with the other people at your table and complete a team-building activity. Demonstrate how to make the chains as you explain: Do you remember making paper chains as a youngster or with your children? That is what we are going to do. This is a timed event with the goal to see which team can construct the longest chain. Here are the ground rules: Place your dominant hand behind your back. To make the chains, take the strips of construction paper, make links by tapingtogether the ends of a strip, then loop the next strip through it. Continue this process to make a chain. You have 2 minutes.-go! After 30 seconds remind them they have 1 ½ minutes left. After 2 minutes, have participants display the length of their second chains. Now debriefwith the team. Ask questions such as the following: How did you work together? What worked well? What was most challenging? What kinds of communication and leadership tools were used? Was there situation monitoring occurring? What about mutual support? What did you learn about yourself? What did you learn about your team? 23
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