TeamSTEPPS Fundamentals Course: Module 1. Introduction

TeamsTEPPS Fundamentals 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.

TeamSTEPPS® Fundamentals Course: Module 1

Introduction: Classroom Slides

Slides:

Slide 1: TeamSTEPPS

 

TeamSTEPPS

Strategies and Tools to Enhance Performance and Patient Safety.

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Slide 2: Ice Breaker

TeamSTEPPS—Introduction
Ice Breaker

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Slide 3: Sue Sheridan Video

Photo, Sue Sheridan, safety advocate.

'Roll 'Em!' Play Video (icon: penguin film director)
 Sue Sheridan video (Flash video, 9 min., 49 sec.; 60.8 MB) (Plugin Software Help.)

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Slide 4: Video Discussion

  • How are patients harmed as a result of medical errors?
  • How can we prevent medical errors?
  • What are the solutions?
...Improved teamwork and communications...
Ultimately, a culture of safety

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Slide 5: Objectives

  • Describe the TeamSTEPPS training initiative.
  • Explain your organization's patient safety program.
  • Describe the impact of errors and why they occur.
  • Describe the TeamSTEPPS framework.
  • State the outcomes of the TeamSTEPPS framework.

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Slide 6: Teamwork Is All Around Us

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Slide 7: Proven Results

Graph 1: Length of ICU stay after team training.

The chart shows a 50% reduction of average length of stay in the year of the study. There was no change from June to July (average length of stay 2.2 days), and a sharp drop to 1.5 days in August. Length of stay fell to 1.4 in September, followed by a gradual drop to less than 1.1 in May.

Source: Pronovost, 2003. Johns Hopkins Journal of Critical Care Medicine.

Graph 2: OR Teamwork Climate and Postoperative Sepsis Rates (per 1000 discharges)

AHRQ National Average Postoperative Sepsis Rates (per 1000 discharges): 10.5.
Group mean for teamwork: Postoperative Sepsis Rates (per 1000 discharges): 11.5
Low teamwork climate Postoperative Sepsis Rates (per 1000 discharges) 15.5
Mid teamwork climate Postoperative Sepsis Rates (per 1000 discharges): 12
High teamwork climate Postoperative Sepsis Rates (per 1000 discharges): 6
Teamwork climate based on safety attitudes questionnaire.

Source: Sexton, 2006, Johns Hopkins.

Graph 3: Adverse Outcomes

The graph shows a 50% reduction in adverse outcomes.

Source: Mann, 2006. Beth Israel Deaconess Medical Center Contemporary OB/GYN.

Graph 4: Indemnity Experience

Malpractice claims, suits and observations pre-teamwork training was at 20. Post-teamwork training saw a reduction  to 11, a 50% reduction in malpractice claims, suits and observations.

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Slide 8: Introduction

Evolution of TeamSTEPPS

Curriculum Contributors

  • Department of Defense.
  • Agency for Healthcare Research and Quality.
  • Research Organizations.
  • Universities.
  • Medical and Business Schools.
  • Hospitals—Military and Civilian, Teaching and Community-Based.
  • Healthcare Foundations.
  • Private Companies.
  • Subject Matter Experts in Teamwork, Human Factors, and Crew Resource Management (CRM).

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Slide 9: TeamSTEPPS

Team Strategies & Tools to Enhance Performance & Patient Safety

"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."

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Slide 10: Patient Safety Movement

Slide 10 shows a timeline for the patient safety movement. The timeline is as follows:

1995: DoD MedTeams® ED Study
1999: "To Err is Human" IOM Report
2001: Executive Memo from President
2003: JCAHO National Patient Safety Goals
2004: Institute for Healthcare Improvement 100K lives Campaign
2005: TeamSTEPPS
2005: Patient Safety and Quality Improvement Act of 2005.

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Slide 11: The Components of a Patient Safety Program

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Slide 12: Course Agenda

  • Module 1—Introduction.
  • Module 2—Team Structure.
  • Module 3—Leadership.
  • Module 4—Situation Monitoring.
  • Module 5—Mutual Support.
  • Module 6—Communication.
  • Module 7—Summary—Pulling It All Together.

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Slide 13: Introductions and Exercise: Magic Wand

If I had a "Magic Wand" and could make changes within my unit or facility in the areas of patient quality and safety.

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Slide 14: Why Do Errors Occur—Some Obstacles

  • Workload fluctuations.
  • Interruptions.
  • Fatigue.
  • Multi-tasking.
  • Failure to follow up.
  • Poor handoffs.
  • Ineffective communication.
  • Not following protocol.
  • Excessive professional courtesy.
  • Halo effect.
  • Passenger syndrome.
  • Hidden agenda.
  • Complacency.
  • High-risk phase.
  • Strength of an idea.
  • Task (target) fixation.

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Slide 15: Institute of Medicine Report

Impact of Error:

  • 44,000—98,000 annual deaths occur as a result of errors.
  • Medical errors are the leading cause, followed by surgical mistakes and complications.
  • More Americans die from medical errors than from breast cancer, AIDS, or car accidents.
  • 7% of hospital patients experience a serious medication error.

Federal Action:

By 5 years;

↓ medical errors by 50%,

↓ nosocomial by 90%; and

eliminate "never-events" (such as wrong-site surgery)

Cost associated with medical errors is $8—29 billion annually.

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Slide 16: Medical Errors Still Claiming Many Lives

By Elizabeth Weise, USA TODAY

As many as 98,000 Americans still die each year because of medical errors despite an unprecedented focus on patient safety over the last five years, according to a study released today. Significant improvements have been made in some hospitals since the Institute of Medicine released a landmark report in 2000 that revealed many thousands of Americans die each year because of medical mistakes.

But nationwide, the pace of change is painstakingly slow, and the death rate has not changed much, according to the study in The Journal of the American Medical Association.

The researchers blame the complexity of health care systems, a lack of leadership, the reluctance of doctors to admit errors and an insurance reimbursement system that rewards errors — hospitals can bill for additional services needed when patients are injured by mistakes — but often will not pay for practices that reduce those errors.

"The medical community now knows what it needs to do to deal with the problem. It just has to overcome the barriers to doing it," says study co-author Lucian Leape of Harvard's School of Public Health.

The institute, a public policy organization, pushed key health care organizations to focus on patient safety, the new report says. As a result, reductions as much as 93% have been made in certain kinds of error-related illnesses and deaths.

Computerized prescriptions, adding a pharmacist to medical teams and team training in the delivery of babies are among the improvements medical centers are making, the study finds.

But "we have to turn the heat up on the hospitals," Leape says.

For example, 5% to 8% of intensive-care patients on ventilators develop pneumonia, the study says. But by strictly following a simple protocol of bed elevation, drugs and periodic breathing breaks, those outbreaks can be reduced to almost zero. "A little hospital in DeSoto, Miss., called Baptist Memorial did it, so it doesn't take a big academic medical center," Leape says.

Hospitals that eliminate infections should receive bonuses, Leape says. "If insurance companies paid 20% more for patients in (intensive-care units) where there were no infections, they'd cut costs substantially."

"We really need to rethink how we pay for health care. What we do now is pay for services, but what we should do is pay for care and outcomes."

...little progress towards the goal
Leape and Berwick,
JAMA May 2005

Improvements

Hospitals have taken steps to reduce medical errors and injuries.

Examples:

  • Computerized prescriptions: 81% decrease in errors.
  • Including pharmacist in medical team: 78% decrease in preventable drug reactions.
  • Team training in delivery of babies: 50% decrease in harmful outcomes — such as brain damage — in premature deliveries.

Source: Journal of the American Medical Association

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Slide 17: JCAHO Sentinel Events

Bar Graph: Root causes of sentinel events (all categories: 1995-2005).
The graph shows the percentage of each root cause from 3548 events, and whether the percentage hit the target for teamwork.

Root causePercentageMet Target
Communication65%Yes
Orientation/training58%Yes
Patient assessment42%Yes
Staffing22%Yes
Availability of information20%Yes
Competency/credentialing20%No
Procedural compliance20%Yes
Environmental safety/security18%No
Leadership12%Yes
Continuum of care12%Yes
Care planning11%Yes
Organization culture10%Yes

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Slide 18: What Comprises Team Performance?

...team performance is a science consequences of errors are great...

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Slide 19: Outcomes of Team Competencies

[D] Select for Text Description

  • Knowledge
    • Shared Mental Model
  • Attitudes
    • Mutual Trust
    • Team Orientation
  • Performance
    • Adaptability
    • Accuracy
    • Productivity
    • Efficiency
    • Safety

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Slide 20: Teamwork Actions

  • Recognize opportunities to improve patient safety.
  • Assess your current organizational culture and existing Patient Safety Program components.
  • Identify teamwork improvement action plan by analyzing data and survey results.
  • Design and implement initiative to improve team-related competencies among your staff.
  • Integrate TeamSTEPPS into daily practice.
"High-performance teams create a safety net for your healthcare organization as you promote a culture of safety."

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Slide 21: Supplemental Instructor Slides

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Slide 22: Train-the-Trainer/Coach Session Agenda

  • Module 1—Introduction.
  • Module 2—Team Structure.
  • Module 3—Leadership.
  • Module 4—Situation Monitoring.
  • Module 5—Mutual Support.
  • Module 6—Communication.
  • Module 7—Summary—Pulling It All Together.
  • Change Management: How to Achieve a Culture of Safety.
  • Coaching Workshop.
  • Implementation
    • Course Management.
    • Developing a Teamwork Improvement Action Plan.
  • Practice Teaching Session

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Slide 23: Teamwork Encompasses CRM

DoD has led the way in team research and innovations

  • Non-Healthcare
    • Combat Information Centers.
    • Joint Forces Operations.
    • Emergency Management Communities.
    • Army Special Forces.
    • Tank, Submarine, and Air Crews.
  • Healthcare
    • ED, OR, L&D, ICU, Dental.
    • Whole Hospital.
    • Combat Casualty Care.
...striving to be a high reliability healthcare system...

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Slide 24: Background: US Army Aviation

  • Army aviation crew coordination failures in mid-80s contributed to 147 aviation fatalities and cost more than $290 million.
  • The vast majority involved highly experienced aviators.
  • Failures were attributed largely to crew communication, workload management, and task prioritization.

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Slide 25: US Navy Breakthroughs: Tactical Decisionmaking Under Stress (TADMUS)

  • Cross-Training.
  • Stress Exposure Training.
  • Team Coordination Training (CRM).
  • Scenario-Based Training and Simulation.
  • Team Leader Training.
  • Team Dimensional Training.
  • Team Assessment.

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Slide 26: US Air Force CRM History

  • Mid to Late 80s AF bombers and heavy aircraft started CRM training.
  • 1992 Air Combat Command developed Aircrew Attention Management /CRM Training.
  • By 1998, CRM deployed uniformly across the AF.
  • Steady decline in human factors based mishaps since CRM training deployed.
  • AF Medical Service adapted training, rolled out in 2000.

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Slide 27: Eight Steps of Change

Drawing (Eight Steps of Change). Penguins struggling to climb the steps of an iceberg. One penguin in a lab coat with a stethoscope is standing on final step of the iceberg (Create a new culture). Each step is labeled with a change. Illustration by John Kotter.

Eight Steps of Change:

  1. Create sense of urgency
  2. Build the guiding team
  3. Develop a change vision and strategy
  4. Understanding and buy-in
  5. Empower others
  6. Short-term wins
  7. Don’t let up—be relentless
  8. Create a new culture

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Slide 28: Roadmap to a Culture of Safety

Drawing (Roadmap to a Culture of Safety). Penguins are trying to find their way to safety. The penguins leave the water because of a barking seal (catalytic event drives need for change). Penguins cluster by a road sign. One sign says Status Quo. One sign, labeled Errorville, points back to the sea. Signs saying JCAHO and Future point forward. One penguin looks back and thinks, “I’m staying right here. Yeah, they’ll be back.” A second penguin looks forward thinking, “What are they doing? Why do we need change?”

Some penguins move forward (build team, strategy, buy-in, establish goals) through prepare the climate. Penguins continue to develop action plan and TeamSTEPPS change coaching (implement action plan, train, empower others). The next stages are test intervention (outcomes), and celebrate wins, staying the course, and sustaining. The final stage of the journey is monitor, integrate, and continuous process improvement.

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Proceed to Module 2

Current as of November 2008
Internet Citation: TeamSTEPPS Fundamentals Course: Module 1. Introduction: TeamsTEPPS Fundamentals Course. November 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/fundamentals/module1/slintro.html