TeamSTEPPS Fundamentals Course: Module 4. Situation Monitoring: Instructor's Slides

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.

 
 

Attention to detail is one of the most important details...

— Author Unknown


Contents


Objectives

Objectives: Define situation monitoring; Define cross monitoring; Discuss the components of the STEP process; Define situation awareness (SA), and identify conditions that undermine SA; Discuss the importance of a shared mental mode; Discuss when to share information; and Recognize the barriers, tools, strategies, and outcomes of situation monitoring

Icon of a clock.Module Time: 45 Minutes

Say:

In this module, we'll-

  • Introduce the concepts of situation monitoring, cross monitoring, situation awareness, and shared mental models
  • Discuss the components of the STEP process to support situation monitoring
  • Identify some strategies to help cultivate shared mental models among teams
  • Discuss the importance of when to share information
  • Recognize potential barriers to success and identify tools and strategies to overcome them

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Scenario

A patient in the ICU has coded, and CPR is in progress. The Resuscitation Team is busy ensuring that intravenous access is available, and the ET tube is inserted correctly. Dr. Matthews, the Team Leader, is calling out orders for drugs, X-rays, and labs. Judy, a nurse at the bedside, is inserting an IV. Nancy, another nurse, is drawing up meds. Judy can tell by Nancy's expression that she didn't get the last order called out by Dr. Matthews. Judy calls out while continuing to place the IV, 'Nancy, he wants

Icon of sheets of paper.Customizable Content

Say:

Review the following scenario while keeping in mind how well members of this team worked together.

  • A patient in the ICU has coded, and CPR is in progress. The Resuscitation Team is busy ensuring that intravenous access is available and the ET tube is inserted correctly. Dr. Matthews, the Team Leader, is calling out orders for drugs, X-rays, and labs. Judy, a nurse at the bedside, is inserting an IV. Nancy, another nurse, is drawing up meds. Judy can tell by Nancy's expression that she didn't get the last order called out by Dr. Matthews. Judy calls out while continuing to place the IV, "Nancy, he wants the high-dose epinephrine from the vial in the top drawer."

Icon of a talk balloon. Discussion:

  • What examples of teamwork skills were demonstrated in this scenario?

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TeamSTEPPS Framework

TeamSTEPPS logo. For details, go to [D] Text Description.

[D] Select for Text Description

Say:

Situation monitoring is a key component of the teamwork process and is intimately linked to the other three essential elements of teamwork:

  • Because situation monitoring concerns the willingness and ability to continually monitor situations and share this awareness with fellow team members, it is enhanced by team leadership, given that team leaders encourage and role model supportive behaviors.
  • Situation monitoring allows mutual support through the ability to anticipate other team members' needs with accurate knowledge of their responsibilities.
  • Situation monitoring is also moderated by communication, which allows for the sharing of new and emerging information with other team members to retain a shared mental model.

Continual monitoring of the situation enables the team to anticipate and predict the needs of patients and fellow team members, allowing the team to be more adaptive and flexible. That allows the team to recognize early and respond to deviations in the plan of care, potential problems, or dangerous circumstances. Because of this vigilance, teams are better able to self-correct, compensate for fellow team members, and reallocate functions if necessary. Effective teams possess a shared understanding of the way a procedure or plan should be carried out and established goals met, which allows teams to mitigate and correct errors before they occur or cause harm to the patient.

The most important team outcome of knowledge is a shared mental model. The basic premise underlying the relationship between shared mental models and teamwork is that team effectiveness will improve if team members have a shared understanding of the situation.

We'll talk more about situation monitoring and shared mental models in this module.

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A Continuous Process

A circular process moves from Situation Monitoring (Individual Skill) to Situation Awareness (Individual Outcome), to Shared Mental Model (Team Outcome), and back to Situation Monitoring (Individual Skill).

Say:

Here we have a continuum that begins with the individual skill of situation monitoring. The processing of monitored information results in the individual outcome of situation awareness. Sharing your situation awareness with fellow team members results in the team outcome of a shared mental model.

  • Situation monitoring is the process of actively scanning and assessing elements of the situation to gain information or maintain an accurate understanding of the situation in which the team functions. Situation monitoring is a skill, which implies that it can be trained and developed as discussed earlier.
  • Situation awareness is the state of knowing the conditions that affect one's work. It is a detailed picture of the situation. Note: Situation awareness (SA) is not a static "thing" or concept. Because the situation and context in which the situation exists are dynamic and ever-changing, team members must continually assess relevant components of the situation and update their individual SA.
  • Shared mental models are the result of each team member maintaining his or her situation awareness and sharing relevant facts with the entire team. Doing so helps ensure that everyone on the team is "on the same page."
  • A continuous process is necessary because of the dynamic situations in which teams function. It allows individual team members to maintain their situation awareness and share new and emerging information with other team members to retain a shared mental model.

Ask:

When have you used situation monitoring in your work? How did the information that you obtained from the environment affect how you approached or responded to the situation?

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Situation Monitoring (Individual Skill)

Situation Monitoring (Individual Skill) - Process of actively scanning behaviors and actions to assess elements of the situation or environment: Fosters mutual respect and team accountability;

Icon showing an exclamation point in a box.Key Point:
  • Situation monitoring is a skill that essentially over time becomes second nature for the seasoned clinical professional.

Say:

Situation monitoring is the process of actively scanning behaviors and actions to assess elements of the situation or environment.

Situation monitoring is a skill team members can acquire, practice, and improve on. It enables team members to identify potential issues or minor deviations early enough so that they can correct and handle them before they become a problem or pose harm to the patient. Mutual respect and team accountability are cultivated because situation monitoring provides a safety net for both the patient and team members.

Ask:

What are some of the ways you monitor the situation on your unit or in your department?

Examples:

Assessing the patient's condition, noting malfunctioning equipment, and being aware of workload spikes and stress levels among team members

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Cross Monitoring Is

Cross Monitoring Is...  Process of monitoring the actions of other team members for the purpose of sharing the workload and reducing or avoiding errors: Mechanism to help maintain accurate situation awareness; Way of "watching each other's back"; and Ability of team members to monitor each other's task execution and give feedback during task execution. Mutual performance monitoring has been shown to be an important team competency. (McIntyre and Salas 1995)

Icon showing an exclamation point in a box.

Key Points:

  • Cross monitoring is a safety net feature for the patient.
  • It is the ability of team members to monitor each other's task execution and provide immediate feedback.
  • Mutual respect and team accountability are essential for the strategy of cross monitoring to be successful among team members.
  • This strategy is meant to help the team meet its collective goal: safe and effective patient care.
  • Mutual performance monitoring is an important team competency as described by McIntyre and Salas (1995).

Say:

Cross monitoring is used by fellow team members to help maintain situation awareness and prevent errors. Commonly referred to as "watching each other's back," it is the action of monitoring the behavior of other team members by providing feedback and keeping track of fellow team members' behaviors to ensure that procedures are being followed appropriately. It allows team members to self-correct their actions if necessary. Cross monitoring is not a way to "spy" on other team members, rather it is a way to provide a safety net or error-prevention mechanism for the team, ensuring that mistakes or oversights are caught early. When all members of the team trust the intentions of their fellow team members, a strong sense of team orientation and a high degree of psychological safety result.

Do:

Have participants form pairs, and have each pair share an example of a situation in which cross monitoring was successful and one in which cross monitoring should have been used but was not.

Have several pairs volunteer to share their examples with the larger group.

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Cross Monitoring Example

First of two images shows a penguin wearing scrub top as it reads a patient's vital signs out loud “SVT… 180 bpm… pressure… 98…50.” A second penguin in scrub top is thinking, “mmm… might need the crash cart?” The second image shows a female nurse and two male doctors in discussion. At bottom right is penguin director icon to denote a video link.

Icon showing an exclamation point in a box.

Key Points:

  • Vigilance leads to self-correction, which leads to error reduction.
  • Self-correction is the process by which team members reflect on previous performance to improve future performance.

Video TimeVideo Time: 0:18 seconds

Icon of a pencil tip.Materials: CrossMonitoring.InternTo Resident.LandD Video

Icon of sheets of paper.Customizable Content

Say:

In the cartoon, how might this team member's cross monitoring be beneficial to the patient and the team as a whole?

It would alert the team member to the need to-

  • Get the crash cart
  • Check on ICU availability
  • Have respiratory therapy start O2

Staff members need to constantly be aware of the situation, anticipate next steps, "watch each other's back" and take appropriate self-corrective action to prevent errors from reaching the patient.

In the next video, let's watch how Dr. Pham prevents a possible medication error using cross monitoring.

Icon of two stars in circles. Do: Play the video by selecting the director icon on the slide.

Icon of a talk balloon. Discussion:What actions by the intern Dr. Pham were a result of cross monitoring?

  • Direct and immediate feedback about the medication order
  • Active listening and participation in the care plan
  • Early detection and correction of team errors

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Step

STEP: Diagram of ice blocks showing stepped arrangment, labeled: Status of the patient; Team members; Environment; Progress toward goal.

Say:

How do you acquire a trained eye as you "monitor the situation" on your unit? What are relevant components of the situation that provide clues about impending complications or contingencies? The STEP process is a mnemonic tool that can help you monitor the situation and the overall environment.

The STEP process involves ongoing monitoring of the-

  • Status of the patient
  • Team members
  • Environment
  • Progress toward the goal

Examples:

  • The respiratory therapist notes that a ventilated patient is showing a marked increase in respiratory rate that might indicate an increased level of pain that cannot be communicated (STATUS).
  • The patient's nurse is busy helping another patient (TEAM MEMBERS).
  • It is a shift change, and everyone is busy, so you check the medication record and note that the patient is overdue for his morphine (ENVIRONMENT).
  • You notify the oncoming nurse of your concern (PROGRESS).

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Status of the Patient

STEP diagram using stacked ice blocks, emphasizing Status of the patient. Text box: patient history, vital signs, medications, physical exam, plan of care, psychosocial condition. Text box also contains penguin director icon to denote a video link.

Video TimeVideo Time: 0:37 seconds

Icon of a pencil tip.Materials: STEP.INPTMED video

Icon of sheets of paper.Customizable Content

Say:

In a healthcare setting, the most obvious element of the situation requiring constant monitoring is your patient's status. Even minor changes in the patient's vital signs may require dramatic changes in the team's actions and the urgency of its response. When assessing patient status, consider the following:

  • Patient History
  • Vital Signs
  • Medications
  • Physical Exam
  • Plan of Care
  • Psychosocial Condition (e.g., patient's stress level)

Icon of two stars in circles. Do: Play the video by selecting the director icon on the slide.

Icon of a talk balloon. Discussion:Even though the patient's vital signs were normal, why did Greg have reason for concern?

  • Patient was not lucid
  • Patient did not "seem" herself
  • Patient's stress level was elevated

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Team Members

STEP diagram using stacked ice blocks, emphasizing Team members. Text box: fatigue, workload, task performance, skill level, stress level.

Say:

You should also be aware of team members' status, to include the following:

  • Fatigue Level
  • Workload
  • Task Performance
  • Skill Level
  • Stress Level

Healthcare providers are just as prone to human error as the general population. Teams that recognize and maintain an awareness of their individual team members' functioning are more likely to lend support or assistance. Observing the actions of fellow team members is a safety mechanism that can be used to mitigate error before the patient is harmed.

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I'm Safe Checklist

I'M SAFE Checklist: I = Illness; M = Medication; S = Stress; A = Alcohol and Drugs; F = Fatigue; E = Eating and Elimination; and An individual team member's responsibility.

Say:

Awareness of your own condition to ensure that you are fit and ready to fulfill your duties is essential to delivering safe, quality care. Team members should assess and report if there is a personal situation affecting their ability to perform.

"I'M SAFE" is a simple checklist that should be used daily (or more frequently) to determine both your co-workers' and your own ability to perform safely. I'M SAFE stands for-

  • Illness. Am I feeling so bad that I cannot perform my duties?
  • Medication. Is the medication I am taking affecting my ability to maintain situation awareness and perform my duties?
  • Stress. Is there something (such as a life event or situation at work) that is detracting from my ability to focus and perform my duties?
  • Alcohol/Drugs. Is my use of alcohol or illicit drugs affecting me so that I cannot focus on the performance of my duties?
  • Fatigue. The effects of fatigue should not be ignored. Team members should alert the team regarding their state of fatigue (e.g., watch me a little closer today, I only had three hours of sleep last night).
  • Eating and Elimination. Has it been 6 hours since I have eaten or used the restroom? Many times we are so focused on ensuring our patient's basic needs that we forget to take care of our own. Not taking care of our elimination needs affects our ability to concentrate and stresses us physiologically.

Teams should be encouraged to set goals concerning the items on this checklist (e.g., everyone will be given the opportunity to take a break and have lunch today).

Ask:

  • In your current situation would you feel able to express that you're not safe?
  • What are the factors that inhibit you from doing so and/or that contribute to your inability to do so?
  • If you feel inhibited, what can you and your team do to change the culture?

For this to be successful, there must be a culture in place in which staff feel safe to be honest without fear of reprisal, retribution, or disdain.

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Environment

STEP diagram using stacked ice blocks, emphasizing Environment. Text box: Facility information, administrative information, human resources, triage acuity, equipment.

Say:

The environment directly affects the quality of care delivered. Is the needed equipment present? Is there enough staff to tend to all the patients? The environment can change quickly and dramatically, and teams must be able to adapt to the dynamic nature of the situation. When assessing the environment, consider the following:

  • Facility Information
  • Administrative Information
  • Human Resources
  • Triage Acuity
  • Equipment Status

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Progress Toward Goal

STEP diagram using stacked ice blocks, emphasizing Progress toward goal. Text box: Status of team’s patient(s)? Goal of team? Tasks/actions that are completed or that need to be done? Plan still appropriate?

Icon showing an exclamation point in a box.Key Point:
  • In reviewing progress toward the goal, have you noticed a change that would provide a reason to modify the goal?

Say:

By monitoring progress toward the team's established and agreed-on goals, team members will be able to alert the team when strategies or the plan of care may need to be reconsidered or revised or when additional resources are needed. When assessing progress, team members need to consider the following:

  • Status of the team's patients
  • Goal of the team
  • Tasks/actions completed or that need to be done
  • Continued appropriateness of the plan

Goals were established and agreed on at the team meeting. What has changed, and how does our goal have to be modified?

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Exercise: Situation Monitoring

Situation Monitoring: Recollect examples of situation monitoring, in which you needed to: Be aware of what was going on; Prioritize and focus on different elements of the situation; and Share this information with others.  Select one or two that best represent the concept of situation monitoring; and Share

Icon of a clock.Time: 5-10 minutes

Icon of a pencil tip.Materials:
  • Flipchart or Whiteboard (Optional)
  • Markers (Optional)

Say:

Break into groups and recollect real-life examples of situation monitoring in which you needed to-

  • Be aware of what was going on
  • Prioritize and focus on different elements of the situation
  • Share that information with others

Do:

Once each group has completed the exercise, ask the groups to share their examples with the larger group.

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Situation Awareness Is

Situation Awareness Is... The state of knowing the current conditions affecting the team's work: Knowing the status of a particular event; Knowing the status of the team's patients; Understanding the operational issues affecting the team;Maintaining mindfulness.  Image at right shows a seal trying to catch a penguin using fish as bait. The seal is thinking about eating the penguin, and the penguin is thinking about eating the fish.

Say:

Situation awareness is the state of knowing the conditions that affect one's work. It is the extent to which team members are aware of the following:

  • Status of a particular event
  • Status of the team's patients
  • Operational issues affecting the team
  • Need to maintain mindfulness

The healthcare environment is dynamic, requiring team members to continually reassess situations to update their situation awareness. What results is a sense of "knowing what's going on around them."

A loss of situation awareness results in the following:

  • Ambiguity
  • Confusion
  • Decreased communication

High-Reliability Organizations (HROs)
The success of HROs in managing the unexpected is due to their determined efforts to act mindfully! Strive to maintain an underlying style of mental functioning that is distinguished by continuous updating and a deepening of increasingly plausible expectations of what the context is, what problems define it, and what remedies it contains.

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Conditions that Undermine Situation Awareness (SA)

Conditions that Undermine Situation Awareness (SA).  Failure to-: Share information with the team; Request information from others; Direct information to specific team members; Include patient or family in communication; Utilize resources fully (e.g., status board, automation); Document

Icon showing an exclamation point in a box.Key Point:
  • Create a culture in which there is an expectation that information will be shared among team members and that information will be actively sought from others.

Say:

Below are some of the numerous barriers to maintaining situation awareness. They are the result of team members' failure to-

  • Share information with the team
  • Request information from others
  • Direct information to specific team members
  • Include patient or family in communication
  • Utilize resources fully (e.g., status board, automation)
  • Maintain documentation that is adequate, complete, and timely

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A Shared Mental Model Is

A Shared Mental Model Is... The perception of, understanding of, or knowledge about a situation or process that is shared among team members through communication. "Teams that perform well hold shared mental models." (Rouse, Cannon-Bowers, and Salas 1992).  Image at right shows four penguins all thinking about food.

Icon showing an exclamation point in a box.Key Points:
  • Situation monitoring is a trained eye.
  • Cross monitoring is "watching each other's back."
  • Situation awareness is "knowing what is going on around you."
  • With a shared mental model all team members are "on the same page."

Say:

A mental model is a mental picture or sketch of the relevant facts and relationships defining an event, situation, or problem. When all members of a team share the same mental model, this is referred to as a "shared mental model." Sharing your situation awareness with fellow team members results in a shared mental model, or in "everyone being on the same page."

Similar to the way situation awareness is the result of an individual team member's situation monitoring, a shared mental model is the result of each team member maintaining his or her situation awareness and sharing relevant facts with the entire team. In isolation, it is possible for an individual team member to misinterpret cues or to place too much emphasis on one piece of information. Shared mental models are knowledge structures of the relevant facts and relationships about tasks or situations that the team is engaged in, and about the way the team members interact. Shared mental models enable the team to anticipate and predict each other's needs; identify changes in the team, task, or teammates; and adjust the course of action or strategies as needed.

Shared mental models are sustained by the following:

  • The process of planning
  • Team decision-making
  • Vocalizing

Research supports the notion that the ability to hold shared mental models is an important team competency.

Shared mental models provide team members with a common understanding of who is responsible for what task and what the information requirements are. In turn, this allows them to anticipate one another's needs so that they can work (i.e., provide patient care) in synchronicity (Stout et al. 1999).

Do:

Ask participants to share instances in which they have been on the "same page" with others on their team.

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Shared Mental Model?

Shared Mental Model? Four people in a group are wearing hazard suits and masks and searching the ground. A fifth person in shorts and polo shirt stands by apparently unconcerned.

Say:

On our continuum of situation monitoring, situation awareness, and shared mental model, where are these two groups? How can lack of a shared mental model affect safety?

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Practical Exercise Preparation—Optional Activity

Practical Exercise.  Tabular data follows this image.

Room #PatientOrdersVS
1JacksonEKG, O2, Cardiac EnzymesHR 115 R 24 B/P 174/98
2SimmonsCBC, U/A, HCG, IVHR 132 R 22 B/P 92/76
3BaileyCXR, neb Rx, CBC, UA, O2HR 120 R 32 B/P 132/86

ExerciseYou have the option of using the following exercise if you want.

Prepare two sets of information, and place separately on an index card or sheet of paper.

Information Set A should include a list of three to four patients by name, sex, and age.

Example of Information Set A:

  1. Patient Jackson is a 23-year-old male.
  2. Patient Simmons is a 19-year-old female.
  3. Patient Bailey is a 76-year-old male.

Information Set B should include some details of past medical history, or presenting symptoms, or scheduled procedure for each patient listed in Information set A.

Example of Information Set B:

  1. Patient Jackson is a known cocaine user with chest pain, and you are concerned about a possible MI.
  2. Patient Simmons is hypotensive and experiencing tachycardia, and you are concerned about a ruptured ectopic pregnancy.
  3. Patient Bailey has tachypnea, tachycardia, and fever, and you are concerned about pneumonia.

A Status Board slide should be prepared for display that includes the standard information used on a specific unit for patients listed in the information sets. An example Status Board is found in slides. You should modify as necessary for your audience based on the units they work on.

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Exercise: Optional Activity

Practical Exercise.  Tabular data follows this image.

Room #PatientOrdersVS
1JacksonEKG, O2, Cardiac EnzymesHR 115 R 24 B/P 174/98
2SimmonsCBC, U/A, HCG, IVHR 132 R 22 B/P 92/76
3BaileyCXR, neb Rx, CBC, UA, O2HR 120 R 32 B/P 132/86

Icon of a clock.Time: 10 minutes

Icon of a pencil tip.Materials:
  • Copies of Information Set A
  • Copies of Information Set B
  • Status Board Slide

Icon showing an exclamation point in a box.Key Points:
  • Sharing information is critical to the development of a shared mental model.

Do (Small Group Exercise):

Divide the class into an even number of teams.

  • Provide half the teams with Information Set A and the other half with Information Set B.
  • Display the Status Board slide.
  • Ask each team to independently discuss and prioritize the patients using only the information provided.
  • After 5 minutes, ask a representative from each team to report his or her team's conclusions.
  • Focus discussion on the relationship between the communication of information and the development of a shared mental model.

OR

Do (Whole Group Exercise):

  • Display the Status Board slide.
  • Ask the class to prioritize the patients using only the information provided on the slide.
  • After they discuss their conclusions, provide the class with Information Set A.
  • Discuss how the additional information alters the group's initial plan.
  • Provide Information Set B. Discuss how this additional information changes the group's revised plan.
  • Focus discussion on the relationship between the communication of information and the development of a shared mental model.

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How Shared Mental Models Help Teams

How Shared Mental Models Help Teams: Help ensure that teams know what to expect, so if necessary, can regroup to get on the "same page"; Foster communication to ensure care is synchronized; Ensure that everyone on the team has a picture of what it should look like; Enable team members to predict and anticipate better; Create commonality of effort and purpose. "Shared mental models help teams avoid errors that place patients at risk."

Icon showing an exclamation point in a box.Key Points:
  • Shared mental models help teams avoid errors that put patients at risk.
  • Shared mental models ensure that all team members are aware of the plan of care.

Say:

Can you think of ways that the team will work more efficiently and effectively if all members of the team are "on the same page?" If teams are better able to predict and anticipate, then the team will know what is supposed to happen. They will have a better understanding of how the case is progressing.

How do shared mental models help teams?

  • Lead to a mutual understanding of problems, goals, team strategies, patients' condition, and plan of care
  • Lead to more effective communication to ensure that team members have the necessary information for task performance
  • Enable team members to back up and fill in for one another
  • Help team members understand each other's roles and how they interplay
  • Improve ability of individual team members to predict and anticipate the needs of the team
  • Create commonality of effort and purpose

Most important, shared mental models help teams avoid errors that put patients at risk.

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What Do You See?

Three images of optical illusions with multiple interpretations: face in profile/rear view of seated man, old woman/young girl, and duck/rabbit.

Say:

Each team member has a unique perspective and information that benefits the team as a whole when shared. Different people may view the same situation differently, but without sharing and communicating, each team member may have a different understanding.

Ask the audience what they see in each picture. After responses are given, discuss how totally different figures are seen if the pictures are viewed from the left versus the right.

Icon of a talk balloon. Discussion:

  • When looking at these images, what do you see?
  • Do you see different images if you look right to left versus left to right?
  • How did sharing perspectives increase your ability to see the whole picture?

Answers:

  • Left image: Indian and Eskimo
  • Center image: Duck and rabbit
  • Right image: Old lady and young one

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When To Share?

When to Share?: Briefs; Huddles; Debriefs; and Transitions in Care. ...Share information as soon as possible when a change occurs in the patient's status.

Say:

There are both ad hoc and structured opportunities to share vital information with team members. Some examples of when information can be shared include team events such as briefs, huddles, and debriefs. It is important to establish the expectation that these team events will occur and that all team members are empowered to speak up. Teams should communicate often and at the right time to ensure that fellow team members have the information they need to be able to contribute.

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Situation Monitoring

Situation Monitoring. Tabular data follows this image.

BARRIERSTOOLS and STRATEGIESOUTCOMES
  • Hierarchical Culture
  • Lack of Resources or Information
  • Ineffective Communication
  • Conflict
  • Time
  • Distractions
  • Workload
  • Fatigue
  • Misinterpretation of Data
  • Failure to Share Information
  • Brief
  • Huddle
  • Debrief
  • STEP
  • Cross Monitoring
  • Situation Awareness
  • Shared Mental Model
  • Adaptability
  • Team Orientation
  • Mutual Trust

Say:

This module discussed barriers that hinder team members from accurately monitoring situations that affect the care of the patient and the effectiveness of the team.

The tools and strategies introduced in this module to overcome these barriers include the following:

  • STEP-a mnemonic template to help cue active monitoring of all the vital components of a situation
  • I'M SAFE checklist-a list to prompt a self-status check
  • Cross monitoring-"watching each other's back"
  • Shared mental models and their impact on patient safety are the most important outcomes of situation awareness. Other benefits include the following:
    Adaptability-having members who can back up and fill in for one another and easily adjust the plan of care as new information becomes available
    Team orientation-having members who understand each other's roles and how they fit together
    Mutual trust-having members who trust other team members' intentions
  • By conducting situation monitoring you are more likely to have a positive experience:
    — You'll enjoy working as a team.
    — You'll trust your teammates.
    — You'll be better able to adapt to changes and quickly recover
    — And finally, your team will be safer and more likely to identify and correct errors.

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Teamwork Actions

Teamwork Actions: Conduct team exercises to increase situation monitoring skills; Share information in a timely fashion; Include patient and/or family in communication; Use cross monitoring; Apply the STEP process when monitoring the situation; Foster communication to ensure that all members of the team have a shared mental model; Share information during briefs, team huddles, debriefs, and transitions in care. "Teams do not seek consensus; they seek the best answer." —Katzenbach and Smith

Say:

Teamwork actions can include the following:

  • Conduct team exercises to increase situation monitoring skills
  • Share information
  • Include patient and/or family in communication
  • Use cross monitoring
  • Apply the STEP process when monitoring the situation
  • Foster communication to ensure a shared mental model among all team members
  • Share information during team events (e.g., briefs, huddles, and debriefs) and transitions in care

Ask:

What actions will you take to improve your and your team's situation monitoring skills?

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References

Katzenbach, J. R., and D. K. Smith. The Wisdom of Teams: Creating the High-Performance Organization. New York: Collins, 2003.

Langan-Fox, J., J. Anglim, and J. R. Wilson. "Mental Models, Team Mental Models, and Performance: Process, Development, and Future Directions." Human Factors and Ergonomics in Manufacturing 14 (2004): 331.

Marks, M. A., J. E. Mathieu, and S. J. Zaccaro. A Temporally Based Framework and Taxonomy of Team Processes. Academy of Management Review 26 (2001): 356.

McIntyre, R. M., and E. Salas. "Measuring and Managing for Team Performance: Emerging Principles From Complex Environments." In Team Effectiveness and Decision Making in Organizations. Ed. R. A. Guzzo, E. Salas, and Associates. San Francisco: Jossey-Bass, 1995, 9.

Mohammed, S., and B. C. Dumville. "Team Mental Models in a Team Knowledge Framework: Expanding Theory and Measurement Across Disciplinary Boundaries." Journal of Organizational Behavior 22 (2001): 89-106.

Rouse, W. B., J. A. Cannon-Bowers, and E. Salas. "The Role of Mental Models in Team Performance in Complex Systems." IEEE Transactions on Systems, Man, and Cybernetics 22, no. 6 (1992): 1296-1308.

Salas, E., J. A. Cannon-Bowers, and E. L. Blickensderfer. "Team Performance and Training Research: Emerging Principles." Journal of the Washington Academy of Sciences 83 (1993): 81.

Sims, D. E., E. Salas, and C. S. Burke. "Is There a 'Big Five' in Teamwork?" 19th Annual Meeting of the Society for Industrial and Organizational Psychology, Chicago, IL. 2004.

Stout, R. J., J. A. Cannon-Bowers, E. Salas, and D. M. Milanovich. "Planning, Shared Mental Models, and Coordinated Performance: An Empirical Link Is Established." Human Factors 41 (1999): 61-71.

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Proceed to Module 5

Current as of November 2008
Internet Citation: TeamSTEPPS Fundamentals Course: Module 4. Situation Monitoring: Instructor's Slides: TeamsTEPPS Fundamentals Course. November 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/fundamentals/module4/igsitmonitor.html