Brenda K. Zierler, PhD, RN, RVT University of Washington InCITE Faculty Development Workshop June 10, 2010 Objective of this talk Describe a research grant that focuses on interprofessional communication and teamwork Review TeamSTEPPS framework and communication tools Provide an example of knowledge, skills and attitudes of team collaboration using a QSEN Competency Framework Describe experiences with IPEP Interprofessional Education & Practice (IPER) with a focus on Communication Purpose To develop a simulation based, team training program to improve collaboration and communication Evaluate the impact of a simulation based team training program on students interprofessional communication skills To disseminate a validated training program to other health sciences schools by creating an exportable Interprofessional Training Toolkit 1
Interprofessional Education & Practice (IPER) with a focus on Communication Funding Josiah Macy Foundation $990,000 Hearst Foundation $250,000 History of IPER at the University of Washington HSPICE first Macy Grant CHSIE IPE Training Toolkit deliverables Customizable Web based assessment tool Interprofessional scenarios for team training Faculty development plan on how to use simulation in team training User s s guide for adapting training program at other medical, nursing and pharmacy schools Templates and authoring tools for interprofessional simulation based team training scenarios and An assessment tool for tracking teamwork and skillbased competencies and outcomes Workgroups Grant Related Communication Acute care events Error Disclosure Conflict resolution Chronic care coordination Curricular Mapping Faculty Development Literature Review Technology and Web Development Assessment tools 2
Curriculum Mapping Identify interprofessional competencies of teamwork, clinical topics/skills, health systems and practice improvement, professionalism, ethics, and health advocacy Determine best year and courses to teach TeamSTEPPS and Error Disclosure modules Explore opportunities where additional IPE learning activities may be integrated in current programs via a spiral curricular approach Mapping technologies across health science schools Interprofessional Education & Practice Six competency domains for interprofessional collaborative education and practice: National Framework in Canada Interprofessional communication Patient/client/family /community centered centered care Role clarification Team functioning Collaborative leadership Interprofessional conflict resolution JC Sentinel Events Context 3
SIMILARITIES BETWEEN AVIATION SAFETY AND PATIENT SAFETY the old way of communicating is no longer acceptable Adapted: Team Strategies and Tools to Enhance Performance and Patient Safety TeamSTEPPS: a multimedia, evidence based public domain curriculum from AHRQ/DoD to improve team coordination knowledge, skills, and attitudes TeamSTEPPS Framework Strategies and Tools to Enhance Performance And Patient Safety 4
Team Competencies and Outcomes Knowledge, cognitive Shared Mental Model Attitudes, affective Mutual Trust Team Orientation Performance, skills Adaptability Accuracy Productivity Efficiency Safety Teamwork Tools Operational Tools Briefs planning Debrief problem solving Huddle process improvement Hand Off I PASS THE BATON Situational Awareness Mutual Respect Communication Tools SBAR Cross Check Check Back Cross Monitoring Call Out CUS Tw0 Challenge Rule I m Safe These tools need to be taught within and across disciplines High Performing Teams Teams that perform well: Hold a shared mental model 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 5
What is A Shared Mental Model? QSEN Competency Definition (Similar to TeamSTEPPS) Teamwork and collaboration: Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care Nursing Outlook, May June 2007 Sample of Teamwork & Collaboration Objectives Knowledge Skills Attitudes Describe examples of the impact of team functioning on safety and quality of care Explain how authority gradients influence teamwork and patient safety Identify system barriers and facilitators of effective team functioning Follow communication practices that minimize risks associated with handoffs among providers and across transitions in care Assert own perspective (using SBAR or other team communication models) Participate in designing systems that support effective teamwork Appreciate the risks associated with handoffs among providers and across transitions in care Value the influence of system solutions in achieving effective team functioning Nursing Outlook, May- June, 2007 6
Shared Mental Model/Authority Gradient Communication Acute Scenarios Based on TeamSTEPPS communication framework Standardized scenario template Created by teams of interprofessional faculty and students Leadership/ Teammanship Communication Patient Mutual Support Situational Monitoring/Awareness Communication: non acute Discussion of Error, Planning for Disclosure, and Carrying out Disclosure Conflict resolution Delivering bad news Ethical dilemmas 7
IPE Experiences to Date Students Understanding IPE competencies Observing faculty Shadowing experiences Timing of interprofessional experiences Simulation lab (HPS/Web based/role playing) Capstone projects Service learning Exemplar: Applying Teamwork and Collaboration (focus on communication) Pilot project: Team training with nursing, medical, pharmacy and PA students (3 cases) Congestive heart failure case standardized pt SVT high fidelity simulator Asthma combination of simulator and standardized patient Focus on communication skills (hand offs, briefs, SBAR, team skills, patient family centered care) Funded by the Josiah Macy Foundation Develop tools for measuring effective team communication: Web assessment (Error Disclosure /Cognitive Skills) Observational assessment (Simulation) Team/self/peer assessment (Simulation) Assessment 8
AHA Moments AWESOME, really sucks that it is the last day of my program, this is the most rewarding thing that I have done all 4 years. 4 th year medical student after participating in team based training with pharmacy, nursing and PA students AHA Moments I didn t know how to communicate with you because I don t know your scope of practice. 4 th year nursing student speaking to PA student in a debriefing after participating in team based training AHA Moments I know my role when I am working as a nurse in the nursing skills lab, but I realized that I didn t know what my role was on a team. Nursing student comment after team training in the simulation lab with medical & pharmacy students 9
AHA Moments Now I know that I don t have to be afraid of physicians, I have something to offer the team. Comments from a pharmacy student after shadowing a highly effective medical ICU interprofessional team A medical student responded and asked at what point do other health care professionals begin fearing physicians because I am scared to death myself. AHA Moments I couldn t believe how much the ICU nurse knew about the patient. The Attending showed up and spent less than 10 minutes with the patient. How could the physician lead the team if he didn t know anything about the patient or family? Comments from a 2 nd year medical student after interprofessional shadowing experience Faculty IPE Challenges Understanding IPE competencies Creating learning opportunities Mentoring and Modeling effective communication and teamwork (starts in the classroom) Identifying appropriate technologies Students Understanding IPE competencies Observing faculty Shadowing experiences Timing of interprofessional experiences Simulation lab (HPS/Web based/role playing) Capstone projects Service learning 10
IPE Leadership Challenges Systems Academic institution volunteer faculty champions, ABB Budgeting, a university without a president Healthcare organization recognizing/quantifying value added for IPE in practice Build the business case and infrastructure to support for IPE, practice and research lack of buy in from all health science s deans IPE Successes To Date Academia Train the trainer Curricular changes (mapped curricula for 4 schools looking for opportunities to train students) Interprofessional day (2011) Healthcare lh System TeamSTEPPS Enterprise created and supported by UW RWJ Nurse Executive Program (build the business case and infrastructure to support IPE, practice and research) Lifelong learning (continuing education) Community partnerships established regional simulation collaborative 78 members representing 23 sites (hospitals/schools) National Initiatives steering member of new organization: American Interprofessional Healthcare Collaborative IPE Opportunities IHI Open School http://www.ihi.org/ihi/programs/ihiopenschool/ Canadian Interprofessional Health Collaborative American Interprofessional Health Collaborative http://blog.lib.umn.edu/cipe/aihc/ 11
Ongoing Work at UW Center for Health Sciences Interprofessional Education, Practice and Research Faculty Development Institute Facilitated learning (Lesley Bainbridge) TeamSTEPPS Enterprise (official training site) Interprofessional Day (2011) PBL Changing the culture Educational units, team training in clinical sites Interprofessional Education & Practice: Benefits Opportunities for students, practitioners, patients/families and communities to enable optimal health outcomes IPE communication supports collaborative work environment, integration of role clarification, team functioning, collaborative leadership, patient/client/family centered focus of care and services Listening and Interpreting What you Hear 12
Conclusion Interprofessional Education and Practice Communication Professional Development Use of Technologies Quality improvement and patient safety Patient Centered Care Cultural (health professions, gender, role) Sensitivity Thanks to Team Brian Ross, MD, PhD Sarah Shannon, PhD, RN Peggy Odegard, PharmD Sara Kim, PhD Thomas Gallagher, MD Doug Brock, PhD Grace Landell, PA Karen McDonough, MD Nanci Murphy, PharmD Dana Hammer, PhD Debra Liner, BA Kayla Roark, BS Chia Ju Chiu, PhD student (nursing) Erin Abu Rish, PhD student (nursing) Elizabeth Malik (Gonzaga Student) Educational technology staff (7) 6 nursing, 9 medical, 4 pharmacy, 2 PA students, 1 MHA, 1 bioengineering, 1 undergrad pre nursing 13