Introduction: Classroom Slides

TeamSTEPPS Long-Term Care Version: Module 1

The Long-Term Care version of TeamSTEPPS adapts the core concepts of the TeamSTEPPS program to reflect the environment of nursing homes and other other long-term care settings such as assisted living and continuing care retirement communities. The examples, discussions, and exercises below are tailored to the long-term care environment.

Contents


Slide 1: TeamSTEPPS

Text Description is the title above the image.

TeamSTEPPS

Strategies and Tools to Enhance Performance and Patient Safety.

Return to Contents


Slide 2: Ice Breaker

Ice Breaker

Return to Contents


Slide 3: Sue Sheridan Video

Sue Sheridan Video

 

Select the penguin director icon below to access the video.

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

Sue Sheridan video on Patient Safety (Flash video, 9 min., 49 sec.) (Plugin Software Help)

Return to Contents


Slide 4: Video Discussion

Text Description is below the image.

  • How are residents 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.

Return to Contents


Slide 5: Objectives

Text Description is below the image.

  • Describe the TeamSTEPPS training initiative.
  • Explain resident safety in your nursing home.
  • Describe the impact of errors and why they occur.
  • Describe the TeamSTEPPS framework.
  • State the outcomes of the TeamSTEPPS framework.

Return to Contents


Slide 6: Teamwork Is All Around Us

Text Description is below the image.

Images: A collage of photographs shows people working as teams in a variety of situations: soldiers in combat, a crew on a ship, medical and surgical teams, a baseball team, and a soccer team.

Return to Contents


Slide 7: Evolution of TeamSTEPPS

Text Description is below the image.

Curriculum Contributors

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

Return to Contents


Slide 8: TeamSTEPPS

Text Description is below the image.

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."

Return to Contents


Slide 9: Patient Safety Movement

Text Description is below the image.

Image: A timeline shows the following events:

  • 1995: Department of Defence (DoD) MedTeam® ED Study.
  • 1999: "To Err is Human" Institute of Medicine (IOM) Report.
  • 2001: Executive Memo from President.
  • 2003: Joint Commission on Accreditation of Healthcare Organizations (JCAHO) National Patient Safety Goals.
  • 2004: Institute for Healthcare Improvement 100K lives Campaign.
  • 2005: TeamSTEPPS.
  • 2005: Patient Safety and Quality Improvement Act of 2005.

An arrow pointing from left to right beneath the timeline is captioned "Medical Team Training."

Return to Contents


Slide 10: The Components of Resident Safety

Text Description is below the image.

Image: Eight arrows point in toward a circle at the center. The inner portion of the circle is captioned "Resident/Person Centered Care" and the outer rim is captioned "Culture of Safety." The arrows are captioned:

  • Team Training.
  • Regulatory Compliance.
  • Process Improvement.
  • Organizations Sharing/Collaborating.
  • Education.
  • Research & Development.
  • Reporting/Data Collection.
  • Innovations/Lessons Learned.

Return to Contents


Slide 11: Course Agenda

Text Description is below the image.

  • 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.

Return to Contents


Slide 12: Introductions and Exercise: Magic Wand

Text Description is below the image.

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

Image: A penguin is dressed like a fairy godmother with magic wand, gauzy fairy wings, a pointed hat, and cats-eye eyeglasses.

Return to Contents


Slide 13: Why Do Errors Occur—Some Obstacles

Text Description is below the image.

  • Workload fluctuations.
  • Interruptions.
  • Fatigue.
  • Multitasking.
  • 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.

Return to Contents


Slide 14: Institute of Medicine Report

Text Description is below the image.

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.

Return to Contents


Slide 15: Medical Errors Still Claiming Many Lives

Text Description is below the image.

By Elizabeth Weise, USA Today

Image: USA Today logo.

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

Return to Contents


Slide 16: Root Causes of Sentinel Events

Text Description is below the image.

Image: A bar graph titled "Root causes of sentinel events (all categories: 1995-2005)" 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

Sentinel event information provided by Joint Commission.

Return to Contents


Slide 17: What Comprises Team Performance?

Text Description is below the image.

Image: The TeamSTEPPS logo is shown (Select for a Text Description). Arrows point from three text boxes to the pertinent sections of the logo:

Knowledge
Cognitions
"Think"

Attitudes
Affect
"Feel"

Skills
Behaviors
"Do"

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

Return to Contents


Slide 18: Outcomes of Team Competencies

Text Description is below the image.

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

Image: The TeamSTEPPS logo is shown (Select for a Text Description).

 

Return to Contents


Slide 19: Teamwork Actions

Text Description is below the image.

  • Recognize opportunities to improve resident safety.
  • Assess your current organizational culture and supporting components of resident safety.
  • Identify a teamwork improvement action plan by analyzing data and survey results.
  • Design and implement an 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."

Return to Contents


Slide 20: Supplemental Instructor Slides

Supplemental Instructor Slides

Return to Contents


Slide 21: Train-the-Trainer/Coach Session Agenda

Text Description is below the image.

  • 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.

Return to Contents


Slide 22: Teamwork Encompasses CRM

Text Description is below the image.

DoD has led the way in team research and innovations.

Non-Health Care:

  • Combat Information Centers.
  • Joint Forces Operations.
  • Emergency Management Communities.
  • Army Special Forces.
  • Tank, Submarine, and Air Crews.

Health Care:

  • ED, OR, L&D, ICU, Dental, Nursing Home.
  • Whole Hospital.
  • Combat Casualty Care.
...striving to be a high-reliability health care system...

Image: The cover of Team Training CRM: "Learning and Safety Culture" is shown.

Return to Contents


Slide 23: Background: U.S. Army Aviation

Text Description is below the image.

  • 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.

Images: Photographs of military helicopters and an airplane are shown.

Return to Contents


Slide 24: U.S. Navy Breakthroughs: Tactical Decisionmaking Under Stress (TADMUS)

Text Description is below the image.

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

Image: The cover of Making Decisions Under Stress is shown.

Return to Contents


Slide 25: U.S. Air Force CRM History

Text Description is below the image.

  • Mid to late 80s, AF bombers and heavy aircraft started CRM training.
  • In 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.

Image: A photograph shows an Air Force pilot in in the cockpit of his plane and another Air Force plane flying in the distance over the countryside.

Return to Contents


Slide 26: Eight Steps of Change

Text Description is below the image.

Image: Penguins are shown climbing up an iceberg. Each level is labeled as one Step of Change (from the bottom up):

  • Create sense of urgency.
  • Build the guiding team.
  • Develop a change vision and strategy.
  • Understanding and buy-in.
  • Empower others.
  • Short-term wins.
  • Don't let up—Be relentless.
  • Create a new culture.

Return to Contents


Slide 27: Roadmap to a Culture of Safety

Text Description is below the image.

Image: 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." Another sign, labeled "Errorville," points back to the sea. Signs saying "CMS" [Centers for Medicare & Medicaid Services] 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 an icy valley and mountain range labeled "Prepare the Climate." As they cross the ice field beyond the mountains and avoid a pool of killer whales, the penguins continue to "Develop Action Plan" and progress along the steps of "TeamSTEPPS Change Coaching" (implement action plan, train, empower others). The next stage of their journey is "Test intervention (outcomes)", until they arrive at "Celebrate wins! Staying the Course, and Sustaining." The final stage of the journey sees the penguins safely in their new home, where they can "Monitor, Integrate, and Continuous Process Improvement."

Return to Contents

Page last reviewed November 2012
Internet Citation: Introduction: Classroom Slides: TeamSTEPPS Long-Term Care Version: Module 1. November 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/longtermcare/module1/slltcintro.html