TeamSTEPPS Fundamentals Course: Module 6. Mutual Support

Classroom Slides

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: Mutual Support
Slide 4: Mutual Support
Slide 5: Task Assistance
Slide 6: Task Assistance Example 
Slide 7: What Is Feedback?
Slide 8: Types of Feedback
Slide 9: Characteristics of Effective Feedback
Slide 10: Providing Effective Feedback Video
Slide 11: Feedback Exercise
Slide 12: Advocacy and Assertion
Slide 13: The Assertive Statement
Slide 14: Two-Challenge Rule
Slide 15: Two-Challenge Rule
Slide 16: Two-Challenge Rule, cont.
Slide 17: Please Use CUS Words but only when appropriate!
Slide 18: Advocacy and Assertion Scenario
Slide 19: Conflict in Teams
Slide 20: Conflict Resolution: DESC Script
Slide 21: DESC-It
Slide 22: A DESC Scenario
Slide 23: Tools & Strategies Summary
Slide 24: Applying TeamSTEPPS Exercise


Slide 1: Mutual Support

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

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Slide 2: Objectives

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  • Describe how mutual support affects team processes and outcomes. 
  • Discuss specific strategies to foster mutual support (e.g., task assistance, feedback).
  • Identify specific tools to facilitate mutual support. 
  • Describe conflict resolution strategies.

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Slide 3: Mutual Support

Text description is below the image. Image: The TeamSTEPPS Logo. Select [D] Text Description below the image for details.

[D] Select for Text Description

  • Dependent upon information gathered through situation monitoring. 
  • Moderated by the communication of information. 
  • Enhanced by leaders who encourage and role model mutual support behaviors.

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Slide 4: Mutual Support

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Mutual support involves members: 

  1. Assisting each other. 
  2. Providing and receiving feedback. 
  3. Exerting assertive and advocacy behaviors when patient safety is threatened.

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Slide 5: Task Assistance

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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.

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Slide 6: Task Assistance Example

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Two members of the GI Laboratory are assessing an elderly patient who has just had conscious sedation for a colonoscopy. The monitor shows SVT at a rate of 150 and a BP of 76/48. The nurse calls out the vital signs while the physician continues to monitor the rhythm. A nurse passing by the room hears the call-out.

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Slide 7: What Is Feedback?

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Feedback is information provided for the purpose of improving team performance.

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Slide 8: Types of Feedback

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  • Formal: 
    • Retrospective and typically scheduled in advance. 
    • Has an evaluative quality. 
    • Examples: Collaborative discussions, case conferences, individual performance reviews. 
  • Informal: 
    • Typically in real time. 
    • Provided on an ongoing basis. 
    • Focuses on knowledge and practical skills development. 
    • Examples: Huddles, debriefs.

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Slide 9: Characteristics of Effective Feedback

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Effective Feedback is—

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

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Slide 10: Providing Effective Feedback Video

Image: A physician talks with a member of medical support staff. Select the penguin director icon below to access the video.

Select the link below to access the video.


Feedback (Flash video, 29 sec.)

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Slide 11: Feedback Exercise

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An attending watches an intern start to place a chest tube in an obese patient in an incorrect location.

How would you provide effective feedback?

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Slide 12: Advocacy and Assertion

Text description is below the image. Images: Penguin doctor at patient's bedside. A small agitated penguin in scrubs with a larger penguin doctor.
  • Advocate for the patient:
    • Invoked when team members' viewpoints don't coincide with that of a decisionmaker.
  • Assert a corrective action in a firm and respectful manner.

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Slide 13: The Assertive Statement

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  • Respectful and supportive of authority.
  • Clearly asserts concerns and suggestions.
  • Is nonthreatening and ensures that critical information is addressed.
  • Five-Step Process:
    1. Open the discussion.
    2. State the concern.
    3. State the problem—real or perceived.
    4. Offer a solution.
    5. Obtain an agreement.

 

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Slide 14: Two-Challenge Rule

Images: 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 15: Two-Challenge Rule

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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 16: Two-Challenge Rule, continued

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  • 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 17: Please Use CUS Words but only when appropriate!

Image: 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.

Select the link below to access the video.


CUS (Flash video, 10 sec.)

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Slide 18: Advocacy and Assertion Scenario

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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.

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Slide 19: Conflict in Teams

Text description is below the image. Images: Two penguin doctors visualizing different shapes. Two penguins arguing.

 

Informational Conflict
(We have different information!) → Two-Challenge Rule or DESC Script 

Interpersonal Conflict
(Hostile and harassing behavior) → DESC Script

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Slide 20: Conflict Resolution: DESC Script

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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.

 

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Slide 21: DESC-It

Text description is below the image. Image: Two penguins, one in white coat, have a quiet discussion.

Let's "DESC-It!"

  • Have timely discussion.
  • Work on win-win.
  • Frame problem in terms of your own experience.
  • Choose a private location.
  • Use "I" statements; avoid blaming statements.
  • Critique is not criticism.
  • Focus on what is right, not who is right.

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Slide 22: A DESC Scenario

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A nurse feels that a patient has abdominal distension and 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 23: Tools & Strategies Summary

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Barriers Tools and Strategies Outcomes
  • Inconsistency in Team Membership 
  • Lack of Time 
  • Lack of Information Sharing 
  • Hierarchy 
  • Defensiveness 
  • Conventional Thinking 
  • Complacency 
  • Varying Communication Styles 
  • Conflict 
  • Lack of Coordination and Followup With Coworkers 
  • Distractions 
  • Fatigue 
  • Workload 
  • Misinterpretation of Cues 
  • Lack of Role Clarity

Communication:

  • SBAR 
  • Call-Out 
  • Check-Back 
  • Handoff 

Leading Teams: 

  • Brief 
  • Huddle 
  • Debrief 

Situation Monitoring:

  • STEP 
  • I'M SAFE 

Mutual Support: 

  • Task Assistance 
  • Feedback 
  • Assertive Statement 
  • Two-Challenge Rule 
  • CUS 
  • DESC Script
  • Shared Mental Model
  • Adaptability
  • Team Orientation
  • Mutual Trust
  • Team Performance
  • Patient Safety!

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Slide 24: Applying TeamSTEPPS Exercise

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  1. Is your teamwork issue related to mutual support? 
  2. If yes, what is the mutual support issue? 
  3. Which mutual support tools or strategies might you consider implementing to address the issue?

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Page last reviewed March 2014
Internet Citation: TeamSTEPPS Fundamentals Course: Module 6. Mutual Support: Classroom Slides. March 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/fundamentals/module6/slmutualsupp.html