Implement Teamwork and Communication Alternative Text

Slide Number and TitleSlide ContentContent for Alternative Text (Illustration)
Slide 1
Cover Slide
(CUSP Toolkit logo)The “Teamwork and Collaboration” module of the CUSP Toolkit. The CUSP toolkit is a modular approach to patient safety, and modules presented in this toolkit are interconnected and are aimed at improving patient safety.
Slide 2
Learning Objectives
  1. Recognize the importance of effective communication
  2. Identify barriers to communication
  3. Describe the connection between communication and medical errors
  4. Identify and apply effective communication strategies from CUSP and TeamSTEPPS®
 
Slide 3
Basic Components and Process of Communication2
  • Provider A – Sender and Receiver
    • Noise
    • A’s Context
    • Encoding and Decoding
  • Messages
    • Channel
  • Provider B – Sender and Receiver
    • Noise
    • B’s Context
    • Encoding and Decoding
Graphic description of the basic components and process of communication. The communication that takes place between two people is exposed to many roadblocks in between its transmission from one individual to another. First, the sender encodes, or creates, the message, which is influenced by the sender’s context, and then transmits the message to the receiver, who then must decode, or process, the message, based on the receiver’s context. While the message is being transmitted, it is exposed to noise interference that affects the context and clarity of the message that is sent and received.
Slide 4
Four Key Components of Effective Communication1
  • Complete
  • Clear
  • Brief
  • Timely
TeamSTEPPS logo and penguin
Slide 5
Elements That Affect
Communication and Information Exchange
  • Interruptions
  • Task absorption
  • Verbal abuse
  • Fatigue
  • Not following plan of care
  • Ambiguous orders or directions
  • Change in team members
  • Work load
Team members separated by barrier representing possible disruptions to effective communication.
Slide 6
Communication Breakdowns Cause Treatment Delays3
Root Causes of Treatment Delays (1995-2004)
Communication 86%
Patient Assessment 77%
Continuum of Care 52%
Orientation and Training 41%
Availability of Information 39%
Competency and Credentialing 35%
Staffing 25%
Care Planning 20%
Leadership 19%
Environmental Safety and Security 19%
Organizational Culture 18%
Procedural Compliance 17%
Root Causes of Treatment Delays (1995-2004)
The root causes of treatment delays are as follows:
Communication 86%
Patient Assessment 77%
Continuum of Care 52%
Orientation and Training 41%
Availability of Information 39%
Competency and Credentialing 35%
Staffing 25%
Care Planning 20%
Leadership 19%
Environmental Safety and Security 19%
Organizational Culture 18%
Procedural Compliance 17%
Slide 7
Communication Breakdowns Cause
Infection-Associated Events3
Root causes of infection-associated events (2005)
Communication 75%
Environmental Safety/Security 50%
Continuum of Care 39%
Competency or Credentialing 38%
Procedural Compliance 38%
Patient Assessment 25%
Leadership 25%
Staffing 13%
Availability of Information 13%
Orientation and Training 12%
Organizational Culture 12%
Root causes of infection-associated events (2005)
The root causes of infection-associated events are as follows:
Communication 75%
Environmental Safety/Security 50%
Continuum of Care 39%
Competency or Credentialing 38%
Procedural Compliance 38%
Patient Assessment 25%
Leadership 25%
Staffing 13%
Availability of Information 13%
Orientation and Training 12%
Organizational Culture 12%
Slide 8
Exercise
Think of a defect that has occurred in your unit due to a communication breakdown. Using the standards of effective communication, list three to four ways in which communication could be improved to reduce the risk of similar defects occurring.Exercise icon
Slide 9
Barriers to Team Effectiveness1
Working Conditions:
  • Lack of coordination or followup
  • Distractions
  • Misinterpretation of cues
  • Hierarchy
  • Physical proximity
  • Shift changes
Resources
  • Lack of time
  • Workload
  • Processes
  • Technology
Team Composition
  • Inconsistency in team membership
  • Lack of role clarity
  • Defensiveness
  • Conventional thinking
  • Conflict
  • Fatigue
  • Complacency
  • Varying communication styles
  • Personality

Three rectangles, one for Working Conditions, one for Resources, and one for Team Composition: 

TeamSTEPPS logo and penguin

Slide 10
Positive Outcomes of Effective Teamwork
on Health Care4
  • Reduced length of stay
  • Higher quality of care
  • Better patient outcomes
  • Greater ability to meet family member needs
  • Improved patient experience with care scores
  • Lower nurse turnover
A nurse and physician conferring with their patient and the patient’s family member.
Slide 11
Shadowing
  • Helps:
    • Team members gain perspective of other roles
    • Identify issues affecting teamwork and communication that may affect patient care, patient care delivery, and outcomes
  • Who should shadow?
    • Unit teams using CUSP
    • Staff of patient care units where culture scores indicate a poor score in teamwork and safety
    • Units with little collaboration between disciplines
Two CUSP team members walking.
Slide 12
Daily Goals Checklist
  • This tool is used by team members to improve communication among the patient’s care team and family members regarding the patient’s plan of care
  •  The checklist provides a care plan that prompts health care staff to focus on tasks to accomplish that day to safely progress the patient closer to discharge
  • People and organizations that create explicit objectives, and provide feedback toward goals, achieve more results than groups that do not communicate defects
  • Discussion during rounds is divergent (brainstorming) rather than convergent (following an explicit plan)
 
Slide 13
Daily Goals
(vignette still)
Click to play
Video icon
Slide 14
How to Use the Daily Goals Checklist
  • Be explicit
  • Ask important questions:
    • What needs to be completed for discharge?
    • What do we hope to accomplish?
    • What are patients’ greatest safety risks?
Team members walking.
Slide 15
Using the Daily Goals Checklist
(vignette still)
Click to play
Video icon
Slide 16
Selected TeamSTEPPS Tools1
Four Components of Effective Teams Leadership:
  • Brief
  • Huddle
  • Debrief
Situation Monitoring:
  • STEP
  • I’M Safe
Mutual Support:
  • Task Assistance
  • Feedback
  • Advocacy and Assertion
  • Two-Challenge Rule
  • DESC Script
  • CUS
  • Collaboration
Communication:
  • SBAR
  • Call-Out
  • Check-Back
  • Handoff (I-PASS the BATON)
A table showing four components of effective teams
In the first column, Leadership tools include brief, huddle, debrief
In the second column, Situation Monitoring tools include STEP and I'M Safe
In the third column, Mutual Support tools include Task Assistance, Feedback, Advocacy and Assertion, Two-Challenge Rule, DESC Script, CUS, and Collaboration
In the fourth column, Communication Tools include SBAR, Call-Out, Check-Back, and Handoff (I-PASS the BATON) TeamSTEPPS logo and penguin
Slide 17
Briefing1
A briefing is a discussion between two or more people, often a team, using succinct information pertinent to an event.
A briefing immediately:
  • Maps out the care plan
  • Identifies each team member’s role and responsibilities
  • Heightens awareness of the situation
  • Permits the team to plan for the unexpected
  • Allows team members’ needs and expectations to be met
  • Sets the tone for the day
  • Encourages team members’ participation
Team members standing in discussion TeamSTEPPS logo and penguin
Slide 18
Briefing in Action
(vignette still)
Click to play
Video icon
Slide 19
Huddle1
  • Employs ad hoc planning to re-establish situational awareness, reinforce plans that are already in place, and assess any need to adjust the plan
  • Gathers team members to review patient data and decide on a course of action
  • Can be requested by any team member at any time
  • Uses the SBAR tool frequently
Team members engaged in a huddle. TeamSTEPPS logo and penguin
Slide 20
Debriefing1
Informal information exchange session designed to improve team performance and effectiveness after each review. Debriefings answer:
  • What went well?
  • What should change?
  • What do we need to adjust?
Debriefing Checklist:
  • Is communication clear?
  • Are roles and responsibilities understood?
  • Is situational awareness maintained?
  • Is the workload distributed equally?
  • Is task assistance requested or offered?
  • Were errors made or avoided?
  • Are resources available?
TeamSTEPPS logo and penguin
Slide 21
STEP1
Status of the patient
Team members
Environment
Progress toward goal
TeamSTEPPS logo and penguin
Slide 22
I’M Safe1
I = Illness
M = Medication
S = Stress
A = Alcohol and Drugs
F = Fatigue
E = Eating and Elimination
TeamSTEPPS logo and penguin
Slide 23
Task Assistance1
  • Team members protect each other from work overload situations
  • Effective teams place all offers and requests for assistance in the context of patient safety
  • Team members foster a climate where it is expected that assistance will be actively sought and offered
TeamSTEPPS logo and penguin
Slide 24
Feedback1
  • Timely—given soon after the target behavior has occurred
  • Respectful—focus on behaviors, not personal attributes
  • Specific—be specific about what behaviors need correcting
  • Directed toward improvement—provide directions for future improvement
  • Considerate—consider a team member’s feelings and deliver negative information with fairness and respect
TeamSTEPPS logo and penguin
Slide 25
Advocacy and Assertion1
  • Advocacy and assertion are used to support the patient when a team member’s viewpoints do not coincide with those of the decision maker
  • When advocating for the patient, team members should assert their opinion in a firm and respectful manner, providing evidence or data to support their concerns
  • An assertive statement should:
            - Open the discussion
- State the concern
- State the problem—real or perceived
- Offer a solution
- Obtain an agreement
TeamSTEPPS logo and penguin
Slide 26
Two-Challenge Rule1
  • Used when there is an information conflict and an initial assertion is ignored
  • Rule requires team members to state their observation at least twice to ensure that their interests and observations are being addressed
  • The Two-challenge Rule empowers any team member to stop the action if he or she senses, or discovers, an essential safety breach that hinders patient well-being
TeamSTEPPS logo and penguin
Slide 27
DESC Script1
A constructive approach for handling and managing personal conflict, the DESC script helps unit teams resolve these disputes.
  • Describe the specific situation
  • Express your concerns about the action
  • Suggest other alternatives
  • Consensus should be stated
TeamSTEPPS logo and penguin
Slide 28
CUS1
I am CONCERNED!
I am UNCOMFORTABLE!
This is a SAFETY ISSUE!
TeamSTEPPS logo and penguin
Slide 29
Collaboration1
Achieves a mutually satisfying solution resulting in the best outcome
  • Win-Win-Win for patient care team(includes the patient, team members, and team)
  • Commitment to a common mission
  Meet goals without compromising relationships
TeamSTEPPS logo and penguin
Slide 30
SBAR1
Provides a framework for effective communication between team members for the following information:
  • Situation―What is happening with the patient?
  • Background―What is the clinical background or context?
  • Assessment―What do I think the problem is?
  • Recommendation―What would I recommend?
TeamSTEPPS logo and penguin
Slide 31
Call-Out1
A strategy used to communicate critical information to all team members to prepare them for the upcoming procedures.
  • Informs all team members simultaneously
  • Helps team members anticipate next steps
  • Directs responsibility to a specific individual accountable for carrying out the task
TeamSTEPPS logo and penguin
Slide 32
Check-Back1
A strategy that ensures messages are received.
  • Sender initiates message
  • Receive accepts message, provides feedback confirmation
  • Sender verifies message was received
These three steps are sections of a closed loop communication
Diagram depicting how check-back works:
The sender initiates a message to the receiver, who loops back his or her understanding and feedback to the sender. The sender then verifies the message was received. TeamSTEPPS logo and penguin
Slide 33
Handoff1
  • Transfer of information, along with authority and responsibility, during transitions in care across the continuum, and includes an opportunity to ask questions, clarify, and confirm
  • Tool used: I PASS the BATON
Two team members conversing. TeamSTEPPS logo and penguin
Slide 34
I PASS the BATON1
  • Introduction
  • Patient
  • Assessment
  • Situation
  • Safety Concern
(the)
  • Background
  • Actions
  • Timing
  • Ownership
  • Next
TeamSTEPPS logo and penguin
Slide 35
Situational Awareness1
When team members use situational awareness, they:
  • Know the game plan through briefings and team management (e.g., workload and workflow management, task coordination, policies, and procedures)
  • Have an understanding of what’s going on and what is likely to happen next
  • Check-back and verify information
  • Provide ongoing updates—briefings, call-outs, and check-backs
  • Implement team huddles
TeamSTEPPS logo and penguin
Slide 36
Implement Teamwork and Communication: What the Team Needs to Do
  • Identify opportunities to improve teamwork and communication by reviewing barriers the team identified while learning from a safety defect
  • Discuss with frontline providers how and where they want to improve communication
  • Select a tool that best addresses providers’ concerns
  • Use teamwork and communication tools and incorporate them into team meetings and other relevant project processes
 
Slide 37
Summary
  • Effective communication plays an integral role in the delivery of high-quality, patient-centered care
  • Barriers to efficient teamwork and communication influence the outcomes of the unit team
  • Research supports the connection between communication errors and patient care delivery
  • CUSP and TeamSTEPPS employ successful tools and strategies that unit teams can implement to improve the effectiveness of teamwork and communication on their units
 
Slide 38
Additional CUSP Tools
  • Morning Briefing
  • Observing Patient Rounds
  • Team Check-up Tool
Tools icon
Slide 39
References
  1. Agency for Healthcare Research and Quality, Department of Defense. TeamSTEPPS. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/index.html
  2. (Adapted from) Dayton, E, Henriksen, K. Joint Commission Journal of Quality and Patient Safety. 2007 Jan;33(1):34–47.
  3. J Point Commission on Accreditation of Healthcare Organizations. Sentinel Events Statistics. Root Causes of Sentinel Events, 2005. http://www.jointcommission.org/sentinel_event.aspx
  4. Shortell SM, Marstellar JA, Lin M et al. The role of perceived team effectiveness in improving chronic illness care. Med Care 2004 Nov; 42:1040–1048.
 
Page last reviewed April 2013
Internet Citation: Implement Teamwork and Communication Alternative Text. April 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/modules/implement/implementalttext.html