Classroom Slides

TeamSTEPPS Essentials Course

TeamSTEPPS is a teamwork system developed jointly by the Department of Defense (DoD)and the Agency for Healthcare Research and Quality (AHRQ) to improve institutional collaboration and communication relating to patient safety.

Contents:

Slide 1: Pocket Guide
Slide 2: Team Competency Outcomes
Slide 3: Key Principles
Slide 4: Multi-Team System For Patient Care
Slide 5: Effective Team Leaders
Slide 6: Team Events
Slide 7: Brief Checklist
Slide 8: Debrief Checklist
Slide 9: Situation Monitoring Process
Slide 10: Cross Monitoring
Slide 11: STEP
Slide 12: STEP
Slide 13: I'M SAFE Checklist
Slide 14: Task Assistance
Slide 15: Feedback
Slide 16: Advocacy and Assertion
Slide 17: Two-Challenge Rule
Slide 18: CUS
Slide 19: DESC Script
Slide 20: Collaboration
Slide 21: SBAR
Slide 22: Call-Out
Slide 23: Check-Back
Slide 24: Handoff
Slide 25: Handoff
Slide 26: Team Performance Observation Tool
Slide 27: Barriers, Tools & Strategies, and Outcomes
Slide 28: Identifying Opportunities to Use TeamSTEPPS Tools and Strategies

Slide 1:

Pocket Guide

TeamSTEPPS: Strategies & Tools to Enhance Performance and Patient Safety

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Slide 2: Team Competency Outcomes

Knowledge

  • Shared Mental Model

Attitudes

  • Mutual Trust
  • Team Orientation

Performance

  • Adaptability
  • Accuracy
  • Productivity
  • Efficiency
  • Safety

TeamSTEPPS is comprised of four teachable-learnable skills: Leadership, Situation Monitoring, Mutual Support, and Communication; the core of the TeamSTEPPS framework. The red arrows depict a two-way dynamic interplay between the four skills and the team-related outcomes. Interaction between the outcomes and skills is the basis of a team striving to deliver safe, quality care. Encircling the four skills is the patient care team which not only represents the patient and direct caregivers, but those who play a supportive role within the healthcare delivery system.

...TeamSTEPPS is an evidence-based framework to optimize team performance across the healthcare delivery system.

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Slide 3: Key Principles

Team Structure

Delineates fundamentals such as team size, membership, leadership, composition, identification and distribution.

Leadership

Ability to coordinate the activities of team members by ensuring team actions are understood, changes in information are shared, and that team members have the necessary resources.

Situation Monitoring

Process of actively scanning and assessing situational elements to gain information, understanding, or maintain awareness to support functioning of the team.

Mutual Support

Ability to anticipate and support other team members' needs through accurate knowledge about their responsibilities and workload.

Communication

Process by which information is clearly and accurately exchanged among team members.

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Slide 4: Multi-Team System For Patient Care

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Slide 5: Effective Team Leaders

  • Organize the team.
  • Articulate clear goals.
  • Make decisions through collective input of members.
  • Empower members to speak up and challenge, when appropriate.
  • Actively promote and facilitate good teamwork.
  • Skillful at conflict resolution.

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Slide 6: Team Events

Planning

  • Brief — Short session prior to start to discuss team formation; assign essential roles; establish expectations and climate; anticipate outcomes and likely contingencies.

Problem Solving

  • Huddle — Ad hoc planning to reestablish situation awareness; reinforcing plans already in place; and assessing the need to adjust the plan.

Process Improvement

  • Debrief — Informal information exchange session designed to improve team performance and effectiveness; after action review.

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Slide 7: Brief Checklist

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 Brief (Flash video, 36 sec.; 3.8 MB)

During the brief, the team should address the following questions:

  • Who is on the team?
  • All members understand and agree upon goals?
  • Roles and responsibilities are understood?
  • What is our plan of care?
  • Staff and provider's availability throughout the shift?
  • Workload among team members?
  • Availability of resources?

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Slide 8: Debrief Checklist

The team should address the following questions during a debrief:

  Communication clear?

  Roles and responsibilities understood?

  Situation awareness maintained?

  Workload distribution equitable?

  Task assistance requested or offered?

  Were errors made or avoided? Availability of resources?

  What went well, what should change, what should improve?

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Slide 9: Situation Monitoring Process

Situation monitoring is the process of continually scanning and assessing what's going on around you to maintain situation awareness.

Situation awareness is "knowing what is going on around you."

With a shared mental model, all team members are "on the same page."

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Slide 10: Cross Monitoring

An error reduction strategy that involves:

  • Monitoring actions of other team members.
  • Providing a safety net within the team.
  • Ensuring mistakes or oversights are caught quickly and easily.
  • "Watching each other's back."

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Slide 11: STEP

A tool for monitoring situations in the delivery of health care

Components of Situation Monitoring:

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Slide 12: STEP

√ Assess Status of Patient
 Patient History
 Vital Signs
 Medications
 Physical Exam
 Plan of Care
 Psychosocial

√ Assess Level of Team Members'
 Fatigue
 Workload
 Task Performance
 Skill
 Stress

√ Assess Environment
 Facility Information
 Administrative Information
 Human Resources
 Triage Acuity
 Equipment

√ Assess Progress Towards Goal
 Status of Team's Patient(s)?
 Established Goals of Team?
 Tasks/Actions of Team?
 Plan Still Appropriate?

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Slide 13: I'M SAFE Checklist

√ I = Illness
√M = Medication
√S = Stress
√A = Alcohol and Drugs
√F = Fatigue
√E = Eating and Elimination
 

An individual team member's responsibility...

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Slide 14: Task Assistance

A form of mutual support:

  • 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.

In support of patient safety, it's expected!

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Slide 15: Feedback

Information provided for the purpose of improving team performance

√ Feedback should be:

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 towards improvement — provide directions for future improvement.

Considerate — consider a team member's feelings and deliver negative information with fairness and respect.

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Slide 16: Advocacy and Assertion

Advocate for the patient

  • Invoked when team members' viewpoints don't coincide with that of the decision maker.

Assert a corrective action in a firm and respectful manner

  • Make an opening
  • State the concern
  • Offer a solution
  • Obtain an agreement

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Slide 17: Two-Challenge Rule

When an initial assertion is ignored:

  • It is your responsibility to assertively voice concern at least two times to ensure it has been heard.
  • The team member being challenged must acknowledge.
  • If the outcome is still not acceptable:
    • Take a stronger course of action.
    • Utilize supervisor or chain of command.

Empowers all team members to "stop the line" if they sense or discover an essential safety breach.

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Slide 18: CUS

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Slide 19: DESC Script

A constructive approach for managing and resolving conflict

D — Describe the specific situation or behavior; provide concrete data.

E — Express how the situation makes you feel/what your concerns are.

S — Suggest other alternatives and seek agreement.

C — Consequences should be stated in terms of impact on established team goals; strive for consensus.

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Slide 20: Collaboration

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.

"True collaboration is a process, not an event"

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Slide 21: SBAR

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SBAR (Flash video, 1 min., 35 sec.; 9.8 MB) (Plugin Software Help.)

A technique for communicating critical information that requires immediate attention and action concerning a patient's condition

Situation — What is going on with the patient?

"I am calling about Mrs. Joseph in room 251. Chief complaint is shortness of breath of new onset."

Background — What is the clinical background or context?

"Patient is a 62 year old female post-op day one from abdominal surgery. No prior history of cardiac or lung disease."

Assessment — What do I think the problem is?

"Breath sounds are decreased on the right side with acknowledgement of pain. Would like to rule-out pneumothorax."

Recommendation and Request — What would I do to correct it?

"I feel strongly the patient should be assessed now. Are you available to come in?"

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Slide 22: Call-Out

Strategy used to communicate important or critical information

  • Informs all team members simultaneously during emergent situations.
  • Helps team members anticipate next steps.
  • Important to direct responsibility to a specific individual responsible for carrying out the task.

Example during an incoming trauma:

Leader:       "Airway status?"
Resident:    "Airway clear"
Leader:      "Breath sounds?"
Resident:  "Breath sounds decreased on right"
Leader:    "Blood pressure?"
Nurse:     "BP is 96/62"

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Slide 23: Check-Back

Process of employing closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended.

The steps include the following:

  1. Sender initiates the message
  2. Receiver accepts the message and provides feedback
  3. Sender double-checks to ensure that the message was received

Example:

Doctor:   "Give 25 mg Benadryl IV push"
Nurse:   "25 mg Benadryl IV push"
Doctor:   "That's correct"

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Slide 24: Handoff

The transfer of information (along with authority and responsibility) during transitions in care across the continuum; to include an opportunity to ask questions, clarify, and confirm.

Examples of transitions in care include shift changes, physicians transferring complete responsibility, and patient transfers.

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Slide 25: Handoff

Strategy designed to enhance information exchange during transitions in care

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Slide 26: Team Performance Observation Tool

Team Structure
Assembles team.
Establishes leader.
Identifies team goals and vision.
Assigns roles and responsibilities.
Holds team accountable.
Actively shares information.
Leadership
Utilizes resources to maximize performance.
Balances workload within the team.
Delegates tasks or assignments, as appropriate.
Conducts briefs, huddles, and debriefs.
Empowers team to speak freely and ask questions.
Situation Monitoring
Includes patient/family in communication.
Cross monitors team members.
Applies the STEP process.
Fosters communication to ensure a shared mental model.
Mutual Support
Provides task-related support.
Provides timely and constructive feedback.
Effectively advocates for the patient.
Uses the Two-Challenge rule, CUS, and DESC script to resolve conflict.
Collaborates with team.
Communication
Coaching feedback routinely provided to team members when appropriate.
Provides brief, clear, specific, and timely information.
Seeks information from all available sources.
Verifies information that is communicated.
Uses SBAR, call-outs, check-backs, and handoff techniques.

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Slide 27: Barriers, Tools & Strategies, and Outcomes

BarriersTools & StrategiesOutcomes
  • Inconsistency in Team Membership
  • Lack of time
  • Lack of Information Sharing
  • Hierarchy
  • Defensiveness
  • Conventional Thinking
  • Complacency
  • Varying Communication Styles
  • Conflict
  • Lack of Coordination and Follow-Up with
    Co-Workers
  • Distractions
  • Fatigue
  • Workload
  • Misinterpretation of Cues
  • Lack of Role Clarity
  • Brief
  • Huddle
  • Debrief
  • STEP
  • Cross Monitoring
  • Feedback
  • Advocacy and Assertion
  • Two-Challenge Rule
  • CUS
  • DESC Script
  • Collaboration
  • SBAR
  • Call-Out
  • Check-Back
  • Handoff
  • Shared Mental Model
  • Adaptability
  • Team Orientation
  • Mutual Trust
  • Team Performance
  • Patient Safety!!

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Slide 28: Identifying Opportunities to Use TeamSTEPPS Tools and Strategies

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Opportunity to apply TeamSTEPPS technique to improve outcome (Flash video, 2 min., 11 sec.; 12.9 MB)

Current as of November 2008
Internet Citation: Classroom Slides: TeamSTEPPS Essentials Course. November 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/essentials/slessentials.html