TeamSTEPPS Fundamentals Course: Module 5. Mutual Support: Classroom 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.

Contents:

Slide 1: Mutual Support
Slide 2: Objectives
Slide 3: TeamSTEPPS
Slide 4: Mutual Support
Slide 5: Task Assistance
Slide 6: Task Assistance
Slide 7: Discussion: Task Assistance
Slide 8: What Is Feedback?
Slide 9: Types of Feedback
Slide 10: Characteristics of Effective Feedback
Slide 11: A Feedback Scenario
Slide 12: Providing Feedback Effectively
Slide 13: Advocacy, Assertion, and Conflict Resolution
Slide 14: An Advocacy and Assertion Scenario
Slide 15: Advocacy and Assertion
Slide 16: The Assertive Statement
Slide 17: Conflict Resolution Options
Slide 18: Two-Challenge Rule
Slide 19: Two-Challenge Rule
Slide 20: Two-Challenge Rule
Slide 21: Please Use CUS Words but only when appropriate!
Slide 22: Conflict Resolution DESC Script
Slide 23: DESC-It
Slide 24: DESC Script in Action
Slide 25: A DESC Scenario
Slide 26: Common Approaches to Conflict Resolution
Slide 27: Collaboration
Slide 28: Mutual Support
Slide 29: Teamwork Actions


Slide 1: Mutual Support

One penguin is standing on the shoulders of another to look over an obstacle.

"A chain is only as strong as its weakest link." –Author Unknown

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Slide 2: Objectives

  • Define mutual support
  • Discuss task assistance and the types of feedback
  • Describe advocacy, assertion, and the Two-Challenge rule
  • Discuss "CUS" and "DESC script" techniques
  • Discuss common approaches to conflict resolution
  • List barriers, tools, strategies, and outcomes of mutual support

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Slide 3: TeamSTEPPS

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Slide 4: Mutual support

Mutual support is the essence of teamwork

  • Protects team members from work overload situations that may reduce effectiveness and increase the risk of error

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Slide 5: Task Assistance

Team members foster a climate in which it is expected that assistance will be actively sought and offered as a method for reducing the occurrence of error.

"In support of patient safety, it's expected!"

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Slide 6: Task Assistance

One penguin is standing on the shoulders of another to look over an obstacle.

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Slide 7: Discussion: Task Assistance

  • In which situations can task assistance be used?
  • How can you make this a daily practice on your unit?
  • How can you build it into your system to achieve cultural change?

"Ask for help... Offer help"

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Slide 8: What Is Feedback?

"Feedback is the giving, seeking, and receiving of performance-related information among the members of a team."
(Dickinson and McIntyre 1997)

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Slide 9: Types of Feedback

  • Can be formal or informal
  • Constructive feedback
    • Is considerate, task-specific, and focuses attention on performance and away from the individual (Baron 1988)
    • Is provided by all team members
  • Evaluative feedback
    • Helps the individual by comparing behavior to standards or to the individual's own past performance (London, Larson, and Thisted 1999)
    • Most often used by an individual in a coaching or mentoring role

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Slide 10: Characteristics of Effective Feedback

Good Feedback is—

  • Timely
  • Respectful
  • Specific
  • Directed toward improvement
    • Helps prevent the same problem from occurring in the future
  • Considerate

"Feedback is where the learning occurs."

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Slide 11: A Feedback Scenario

An attending watches an intern start to place a chest tube in an obese patient. The attending corrects the placement of the planned incision by pulling the intern aside, showing the intern the landmarks to use, and demonstrating how the patient's position on the table is slightly distorting the anatomy.

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Slide 12: Providing Feedback Effectively

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)


Feedback (Flash video, 29 sec.; 3 MB) (Plugin Software Help.)

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Slide 13: Advocacy, Assertion, and Conflict Resolution

Penguin doctor at patient’s bedside.

A small agitated penguin in scrubs with a larger penguin doctor

Two penguins arguing over a rock on the ice.

 

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Slide 14: An Advocacy and Assertion Scenario

A medical floor nurse is assigned to a patient following a myocardial infarction. The attending physician provides the final treatment, reviews the clinical situation, and determines that the patient is well enough to be discharged.

Before the patient is discharged, the nurse checks the patient's vitals one last time. The nurse finds it unusual that the blood pressure and heart rate are substantially elevated. Despite these concerns, the nurse discharges the patient because the physician made it clear that the patient was well enough to go home. Besides, the physician is a well-respected authority at the hospital.

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Slide 15: Advocacy and Assertion

Penguin doctor at patient’s bedside.

  • Advocate for the patient
    • Invoked when team members' viewpoints don't coincide with that of a decision maker
  • Assert a corrective action in a firm and respectful manner

A small agitated penguin in scrubs with a larger penguin doctor

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Slide 16: The Assertive Statement

  • Respect and support authority
  • Clearly assert concerns and suggestions
  • Use an assertive statement (nonthreatening and ensures that critical information is addressed)
    • Make an opening
    • State the concern
    • State the problem
    • Offer a solution
    • Reach an agreement

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Slide 17: Conflict Resolution Options

Two penguin doctors visualizing different shapes.

Information Conflict
(We have different information!)

Two-Challenge rule


Two penguins arguing.

Personal Conflict
(Hostile and harassing behavior)

DESC script

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Slide 18: Two-Challenge Rule

Penguin in white coat speaking softly to penguin doctor who is ignoring the speaker; 2) Penguin speaks more forcefully and the doctor reacts.

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Slide 19: Two-Challenge Rule

Invoked when an initial assertion is ignored...

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

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Slide 20: Two-Challenge Rule

"Empower any member of the team to "stop the line" if he or she senses or discovers an essential safety breach."

This is an action never to be taken lightly, but it requires immediate cessation of the process and resolution of the safety issue.

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Slide 21: Please Use CUS Words but only when appropriate!

Three-frame graphic of CUS Words rule: C = I am Concerned; U = I am Uncomfortable; S = This is a Safety issue. Each frame features a penguin displaying the relevant emotion.

Select the penguin director icon below to access the video.

CUS (Flash video, 10 sec.; 1.1 MB) (


CUS (Flash video, 10 sec.; 1.1 MB) (Plugin Software Help.)

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Slide 22: Conflict Resolution: DESC Script

A constructive approach for managing and resolving conflict

D—Describe the specific situation

E—Express your concerns about the action

S—Suggest other alternatives

C—Consequences should be stated

Ultimately, consensus shall be reached.

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Slide 23: DESC-It

Two penguins, one in white coat, in quiet discussion.

Let's "DESC-It!"

  • Have timely discussion
  • Frame problem in terms of your own experience
  • Use "I" statements to minimize defensiveness
  • Avoid blaming statements
  • Critique is not criticism
  • Focus on what is right, not who is right

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Slide 24: DESC Script in Action

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
DESC Script (Flash video, 1 min., 49 sec.; 11.4 MB) (Plugin Software Help.)

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Slide 25:

A DESC Scenario

A nurse sees that a patient has abdominal distension and has pain secondary to a distended bladder and needs a foley catheter. The nurse receives the order from the resident on call. When the attending later realizes that the order was given without his consent, he raises his voice to the resident in front of staff and the patient.

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Slide 26: Common Approaches to Conflict Resolution

Often used to manage conflict; however, typically do not result in the best outcome—

  • Compromise—Both parties settle for less
  • Avoidance—Issues are ignored or sidestepped
  • Accommodation—Focus is on preserving relationships
  • Dominance—Conflicts are managed through directives for change

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Slide 27: Collaboration

  • Achieves a mutually satisfying solution resulting in the best outcome
    • All Win!: Patient Care Team (team members, the team, and the patient)
    • Includes commitment to a common mission
  • Meet goals without compromising relationships

"True collaboration is a process, not an event."

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Slide 28: Mutual Support


BarriersTools and StrategiesOutcomes
  • Hierarchical Culture
  • Lack of Resources or Information
  • Ineffective Communication
  • Conflict
  • Time
  • Distractions
  • Workload
  • Fatigue
  • Misinterpretation of Data
  • Failure to Share Information
  • Defensiveness
  • Conventional Thinking
  • Brief
  • Huddle
  • Debrief
  • STEP
  • Cross Monitoring
  • Feedback
  • Advocacy and Assertion
  • Two-Challenge Rule
  • CUS
  • DESC Script
  • Collaboration
  • Shared Mental Model
  • Adaptability
  • Team Orientation
  • Mutual Trust
  • Team Performance
  • Patient Safety!

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Slide 29: Teamwork Actions

  • Foster a climate supportive of task assistance
  • Provide timely and constructive feedback
  • Be assertive and advocate for the patient
  • Use the Two-Challenge rule, CUS, and DESC script to resolve conflict
  • Resolve conflict through collaboration—Create a "Win-Win-Win" situation

"Those whom we support hold us up in life."
—Marie von Ebner-Eschenbauch

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Return to Index
Proceed to Module 6

Page last reviewed November 2008
Internet Citation: TeamSTEPPS Fundamentals Course: Module 5. Mutual Support: Classroom 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/module5/slmutualsupp.html