Primary Care Teams Classroom Slides

TeamSTEPPS Primary Care Version

The Primary Care version of TeamSTEPPS adapts the core concepts of the TeamSTEPPS program to reflect the environment of primary care office-based teams. The examples, discussions, and exercises below are tailored to the primary care environment.

Slides:

Slide 1: TeamSTEPPS® For Primary Care Teams
Slide 2: TeamSTEPPS®
Slide 3: TeamSTEPPS Skills
Slide 4: Does TeamSTEPPS Work?
Slide 5: Does TeamSTEPPS Work?
Slide 6: Primary Care Office Environment
Slide 7: Primary Care Office Environment
Slide 8: Team Building Exercise
Slide 9: Why does Teamwork Matter in Primary Care Offices?
Slide 10: Primary Care Team Structure
Slide 11: Let's Talk about Your Team
Slide 12: Teamwork & the Primary Care Team
Slide 13: Example of Poorly Functioning Medical Office Team
Slide 14: What breakdowns did you see?
Slide 15: Teamwork Strategies for Addressing Breakdowns
Slide 16: Leadership
Slide 17: Leadership Strategies
Slide 18: Briefs
Slide 19: Briefing Checklist
Slide 20: Huddle
Slide 21: Debrief
Slide 22: Debrief Checklist
Slide 23: Leadership in the Primary Care Medical Office
Slide 24: Exercise
Slide 25: Front Office Scenario
Slide 26: Leadership
Slide 27: Situation Monitoring
Slide 28: Cross Monitoring is...
Slide 29: STEP
Slide 30: Situation Monitoring in the Primary Care Medical Office
Slide 31: Situation Monitoring Exercise
Slide 32: Front Office Scenario
Slide 33: Situation Monitoring
Slide 34: Mutual Support
Slide 35: Task Assistance
Slide 36: What Is Feedback?
Slide 37: Types of Feedback
Slide 38: Characteristics of Effective Feedback
Slide 39: Advocacy and Assertion
Slide 40: The Assertive Statement
Slide 41: Conflict Resolution Options
Slide 42: Two-Challenge Rule
Slide 43: Two-Challenge Rule
Slide 44: Please Use CUS Words but only when appropriate!
Slide 45: Conflict Resolution DESC Script
Slide 46: DESC-It
Slide 47: Ineffective Approaches to Conflict Resolution
Slide 48: Collaboration
Slide 49: Mutual Support in the Primary Care Medical Office
Slide 50: Exercise
Slide 51: Front Office Scenario
Slide 52: Mutual Support
Slide 53: Communication
Slide 54: Communication is...
Slide 55: SBAR provides...
Slide 56: Handoff
Slide 57: Handoff
Slide 58: Hand-Off Exercise
Slide 59: Check-Back is...
Slide 60: Communication in the Primary Care Medical Office
Slide 61: Communication Exercise
Slide 62: Front Office Scenario
Slide 63: Patient and Family Centered Care
Slide 64: Equipping the Patient
Slide 65: Patient Centered Scenario
Slide 66: Barriers to Team Effectiveness
Slide 67: Example of High Functioning Medical Office Team
Slide 68: Pulling it All Together What were their successes?
 


Slide 1: TeamSTEPPS® For Primary Care Teams

TeamSTEPPS For Primary Care Teams

Return to Contents


Slide 2: 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 3: TeamSTEPPS Skills

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

D] Select for Text Description

Return to Contents


Slide 4: Does TeamSTEPPS Work?

Text Description is below the image.

Clinical Outcomes

  • 50% reduction in the Weighted Adverse Outcome Score (WAOS), which describes the adverse event score per delivery.
  • 50% decrease in the Severity Index, which measures the average severity of each delivery with an adverse event:
    • Mann S, Marcus R, Sachs B. Grand Rounds: Lessons from the cockpit: how team training can reduce errors on L&D. Contemp OB/Gyn 2006;51:34-45.
  • Reduced rate of adverse drug events.
  • Improved medication reconciliation at patient admission:
    • Haig K, Sutton S, Whittington J. SBAR: a shared mental model for improving communication between clinicians. Jt Comm J Qual Patient Saf 2006 Mar;32(3):167-75.

Return to Contents


Slide 5: Does TeamSTEPPS Work?

Text Description is below the image.

Teamwork Outcomes

  • Significant improvement in communication and supportive behavior.
  • Significant posttraining increases in perceptions of teamwork:
    • Weaver SJ, Rosen MA, DiazGranados D, et al. Does teamwork improve performance in the operating room? A multilevel evaluation. Jt Comm J Qual Patient Saf 2010 Mar;36(3):133-42.
  • Reductions in turnover rate.
  • Increases in employee satisfaction:
    • Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004;13 Suppl 1:85-90.

Return to Contents


Slide 6: Primary Care Office Environment

Text Description is below the image.

Image: A team of penguins are working in an office environment made out of snow and blocks of ice.

Return to Contents


Slide 7: Primary Care Office Environment

Text Description is below the image.

  • Ducklike Chaos—calm appearing above the water while chaos churns below.
  • Primary Care Medical Office:
    • Does not conform to a pattern of work.
    • Has many components working together on multiple tasks simultaneously.
    • Treats numerous patients simultaneously.

Return to Contents


Slide 8: Team-Building Exercise

Text Description is below the image.

Exercise

Image: A penguin rides an exercise bicycle.

Return to Contents


Slide 9: Why Does Teamwork Matter in Primary Care Offices?

Text Description is below the image.

  • Better continuity of care, access to care, and patient satisfaction:

    Stevenson K, Baker R, Farooqi A, et al. Features of primary health care teams associated with successful quality improvement of diabetes care. Fam Pract 2001;18:21-26.

  • Higher patient-perceived quality of care:

    Campbell SM, Hann M, Hacker J, et al. Identifying predictors of high-quality care in English general practice: observational study. BMJ 2001;323:1-6.

  • Superior care for diabetes patients:

    Bower P, Campbell S, Bojke C, et al. Team structure, team climate, and the quality of care in primary care: an observational study. Qual Saf Health Care 2003; 12:273-9.

Return to Contents


Slide 10: Primary Care Team Structure

Text Description is below the image.

Image: Pairs of green arrows pointing in opposite directions form a circle. At the top of the circle is a penguin in a white medical coat with the caption "Clinicians." On the right-hand side of the circle are two penguins, one in a pink shirt and the other carrying a clipboard, captioned "Clinical Support Staff." On the bottom of the circle are two penguins in white coats examining an x ray, captioned "Ancillary Support Staff." On the left-hand side of the circle is a penguin sitting at a desk and working at a computer, captioned "Administrative Staff." At the center of the circle, connected to each of these staff penguins by double green arrows, are a pair of penguins, one large and one small, captioned "Patients."

Return to Contents


Slide 11: Let's Talk About Your Team

Text Description is below the image.

  • What does it look like?
    • Who are the team members?
    • When do you interact?
    • How do you exchange critical patient information?
    • If you had a magic wand, how would you change your team (if at all)?

Image: A penguin rides an exercise bicycle.

Return to Contents


Slide 12: Teamwork & the Primary Care Team

Text Description is below the image.

  • The Primary Care Team has all these obstacles to effective care:
    • Conflict.
    • Lack of coordination.
    • Distractions.
    • Fatigue.
    • Workload.
    • Misinterpretation of cues.
    • Lack of role clarity.
    • Miscommunication.
    • Hierarchy.
    • Lack of information sharing.

Image: Three penguins in various colored shirts are climbing a mountain of ice; each level is labeled to represent an obstacle listed above. A penguin in a white medical coat stands at the top.

Return to Contents


Slide 13: Example of Poorly Functioning Medical Office Team

Text Description is below the image.

Let's watch four different primary care teams in action.

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
Poor Teamwork in the Primary Care Medical Office (Flash® video, 11 min., 57 sec.; 131 MB) (Plugin Software Help.)

Return to Contents


Slide 14: What breakdowns did you see?

Text Description is below the image.

Image: A wooden bucket labeled "Successes" contains one fish. A wooden bucket labeled "Failures" contains many fish.

Return to Contents


Slide 15: Teamwork Strategies for Addressing Breakdowns

Text Description is below the image.

Images: STEP diagram [Status of patient, Team members, Environment, Progress toward goal] using stacked ice blocks. A group of penguins wearing football uniforms huddle together. Two penguins in track uniforms are running a relay race; one penguins passes the baton to the other. Penguins illustrate the statements that make up the acronym CUS: C - I am Concerned! U - I am Uncomfortable! S - This is a Safety Issue!

Return to Contents


Slide 16: Leadership

Text Description is below the image.

  • Leadership is a process of motivating people to work together collaboratively to accomplish tasks.
  • Shared leadership.
  • Characteristics of effective leadership:.
    • Role modeling and shaping teamwork through open sharing of information.
    • Constructive and timely feedback.
    • Facilitation of briefs, huddles, debriefs, and conflict resolution.

Return to Contents


Slide 17: Leadership Strategies

Text Description is below the image.

  • Briefs—planning.
  • Huddles—problem solving.
  • Debriefs—process improvement.

Leaders are responsible to assemble the team and facilitate team events
But remember...
Anyone can request a brief, huddle, or debrief.

Return to Contents


Slide 18: Briefs

Text Description is below the image.

Planning

  • Form the team.
  • Designate team roles and responsibilities.
  • Establish climate and goals.
  • Engage team in short- and long-term planning.

Image: Penguins in various medical uniforms gather around a table for an informal meeting. One penguin is examining an x ray.

Return to Contents


Slide 19: Briefing Checklist

Text Description is below the image.

Topic
Who is on your team today?X
All members understand and agree upon goals?X
Roles and responsibilities understood?X
Staff availability?X
Workload?X
Available resources?X
Review of the day's patients?X

Return to Contents


Slide 20: Huddle

Text Description is below the image.

Problem Solving

  • Hold ad hoc, "touch-base" meetings to regain situation awareness.
  • Discuss critical issues and emerging events.
  • Anticipate outcomes and likely contingencies.
  • Assign resources.
  • Express concerns.

Image: A group of penguins wearing football uniforms huddle together.

Return to Contents


Slide 21: Debrief

Text Description is below the image.

Process Improvement

  • Brief, informal information exchange and feedback sessions.
  • Occur after an event or shift.
  • Designed to improve teamwork skills.
  • Designed to improve outcomes:
    • An accurate reconstruction of key events.
    • Analysis of what worked or did not work and why.
    • What should be done differently next time.
  • Recognize good team contributions or catches.

Return to Contents


Slide 22: Debrief Checklist

Text Description is below the image.

Topic
Communication clear?X
Situation awareness maintained?X
Workload distribution?X
Did we ask for or offer assistance?X
Were errors made or avoided?X
What went well, what should change, what can improve?X

Image: Three penguins wearing football uniforms are seated on a bench while a penguin dressed as a coach reviews their game plays.

Return to Contents


Slide 23: Leadership in the Primary Care Medical Office

Text Description is below the image.

Let's watch the first primary care team demonstrate proper team leadership.

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
Leadership in the Primary Care Medical Office (Good Teamwork) (Flash® video, 3 min., 49 sec.; 42 MB) (Plugin Software Help.)

Return to Contents


Slide 24: Exercise

Text Description is below the image.

  • Think about your office team.
  • Have you encountered a leadership problem?
  • What strategy would you use to overcome it?

Image: A penguin rides an exercise bicycle.

Return to Contents


Slide 25: Front Office Scenario

Text Description is below the image.

Jack, an elderly man who just had cataract surgery, cannot drive.� Jack was taken to the clinic by his son for a followup on his blood pressure and diabetes.� While Jack was in the examination room, his son was called away on an emergency.� When Jack finished his appointment and found that his son was not waiting for him, he was very upset. The front desk administrator realized that Jack had no way to get home and called a quick huddle with the nurse and the billing specialist.� Together they decided to arrange for a taxi to take Jack home. The front desk administrator then called Jack after he arrived home to make sure all was well.

Return to Contents


Slide 26: Leadership

Text Description is below the image.

Barriers

BarriersTools and StrategiesOutcomes
  • Hierarchical Culture.
  • Lack of Resources or Information.
  • Ineffective Communication.
  • Conflict.
  • Brief.
  • Huddle.
  • Debrief.
  • Shared Mental Model.
  • Adaptability.
  • Team Orientation.
  • Mutual Trust.

Return to Contents


Slide 27: Situation Monitoring

Text Description is below the image.

Process of actively scanning behaviors and actions to assess elements of the situation or environment.

  • Fosters mutual respect and team accountability.
  • Provides safety net for team and patient.
  • Includes cross-monitoring.
... Remember, engage the patient whenever possible.

Return to Contents

Slide 28: Cross-Monitoring is...

Text Description is below the image.


A process of monitoring unfolding actions against the established plan of care to avoid errors

  • Helps maintain accurate situation awareness.
  • Way of "watching each other's back".
  • Gives team members a way to monitor patient care and give constructive feedback.
Mutual performance monitoring has been shown to be an important team competency.
(McIntyre and Salas, 1995)

Return to Contents


Slide 29: STEP

Text Description is below the image.

Components of Situation Monitoring:

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

Image: The STEP diagram depicts the components listed above using stacked ice blocks.

Return to Contents


Slide 30: Situation Monitoring in the Primary Care Medical Office

Text Description is below the image.

Let's watch the second primary care office demonstrate proper team situation monitoring.

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
Situation Monitoring in the Primary Care Medical Office (Good Teamwork) (Flash® video, 2 min., 26 sec.; 27 MB) (Plugin Software Help.)

Return to Contents


Slide 31: Situation Monitoring Exercise

Text Description is below the image.

  • Think about your daily office routine.
  • Have you encountered barriers to situation monitoring?
  • What strategy would you use to overcome them?

Image: A penguin rides an exercise bicycle.

Return to Contents


Slide 32: Front Office Scenario

Text Description is below the image.

Susan was due for a mammogram and the provider ordered it.� Upon arrival at the mammography service, Susan was told that she would have to pay for the mammogram, since her insurance company did not cover it.� Confused, Susan returned to the primary care clinic and told the administrative assistant that she did not have the money to pay for this.� She was especially upset because her mother was a breast cancer survivor.� The administrative assistant assessed (1) the status of the situation, that a billing specialist (2) team member was needed, (3) the environment (the patient was upset), and (4) the progress toward the goal (patient was being denied access). The billing specialist then called the insurer and clarified that the insurer had the wrong dates and Susan's mammogram was due.� The insurer realized their error and covered the mammogram.

Return to Contents


Slide 33: Situation Monitoring

Text Description is below the 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.

Return to Contents


Slide 34: Mutual Support

Text Description is below the image.

Mutual support is the essence of teamwork:

  • It includes the ability to anticipate the needs of other team members through knowledge of their tasks and responsibilities.
  • It protects team members from work overload situations that may reduce effectiveness and increase the risk of error.

Return to Contents


Slide 35: Task Assistance

Text Description is below the image.

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!"

Return to Contents


Slide 36: What Is Feedback?

Text Description is below the image.

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

Return to Contents


Slide 37: Types of Feedback

Text Description is below the image.

  • Can be formal or informal.
  • Constructive feedback:
    • Is considerate and task specific and focuses attention on performance and away from the individual.
    • Baron RA. Negative effects of destructive criticism: impact on conflict, self-efficacy, and task performance. J Appl Psychol 1988 May;73(2):199-207.
  • 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 M, Larson H, Thisted L. Relationships between feedback and self-development. Group Org Manage 1999;24(1):5-27.
  • Most often used by an individual in a coaching or mentoring role.

Return to Contents


Slide 38: Characteristics of Effective Feedback

Text Description is below the image.

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."

Return to Contents


Slide 39: Advocacy and Assertion

Text Description is below the image.

  • 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.

Image: A penguin in a white medical coat listens to an enthusiastic small penguin who is jumping up and down.

Return to Contents


Slide 40: The Assertive Statement

Text Description is below the image.

  • 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 your concern.
    • Explain the problem.
    • Offer a solution.
    • Reach an agreement.

Return to Contents


Slide 41: Conflict Resolution Options

Text Description is below the image.

Information Conflict (We have different information!) → Two-Challenge Rule.

Image: Two penguins are talking together; one penguin "speaks" a red square and the other "speaks" a green circle.

Personal Conflict (Hostile and harrassing behavior) → DESC script.

Image: Two penguins are arguing.

Return to Contents


Slide 42: Two-Challenge Rule

Text Description is below the image.

Images: A penguin in a white coat is talking to a taller penguin wearing a stethoscope. In Image 1, the first penguin is speaking softly; in Image 2, he is shouting with his wings upraised.

Return to Contents


Slide 43: Two-Challenge Rule

Text Description is below the image.

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 chain of command.

Return to Contents


Slide 44: Please Use CUS Words but only when appropriate!

Text Description is below the image.

C—I am Concerned!

Image: A penguin in a green shirt looks concerned.

U—I am Uncomfortable!

Image: A penguin in a white shirt looks embarrassed.

S—This is a Safety Issue!

Image: A penguin in a blue shirt says "Stop!" and emphatically holds up crossed wings.

Return to Contents


Slide 45: Conflict Resolution DESC Script

Text Description is below the image.

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 will be reached.

Return to Contents


Slide 46: DESC-It

Text Description is below the image.

Let's "DESC-It!"

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

Image: A penguin in a white coat has a talk with a shame-faced smaller penguin.

Return to Contents


Slide 47: Ineffective Approaches to Conflict Resolution

Text Description is below the image.

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.

Image: Two penguins are arguing.

Return to Contents


Slide 48: Collaboration

Text Description is below the image.

  • 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.
  • Meets goals without compromising relationships.
"True collaboration is a process, not an event."

Return to Contents


Slide 49: Mutual Support in the Primary Care Medical Office

Text Description is below the image.

Let's watch the third primary care office demonstrate proper team mutual support.

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
Mutual Support in the Primary Care Medical Office (Good Teamwork) (Flash® video, 4 min., 10 sec.; 46 MB) (Plugin Software Help.)

Return to Contents


Slide 50: Exercise

Text Description is below the image.

  • Think about your office team.
  • Have you encountered a problem with mutual support?
  • What strategy would you use to overcome it?

Image: A penguin rides an exercise bicycle.

Return to Contents


Slide 51: Front Office Scenario

Text Description is below the image.

Your clinic has a rule that patients will still be seen if they arrive within a 30-minute window of their appointment. Greg arrives 5 minutes past the window and sincerely apologizes for being late. The administrative assistant tells Greg that he will simply have to reschedule the appointment for a later time. The patient advocate overhears this and pulls the administrative assistant aside. She agrees that Greg should be rescheduled according to the clinic's rules, but she explains to the administrative assistant that he lives very far away and relies on friends and family to transport him to doctor's visits and that all efforts should be made to see him today. The administrative assistant appreciates this information and the fact that the advocate pulled him aside to tell him. The administrative assistant ensures that Greg will be seen today.

Return to Contents


Slide 52: Mutual Support

Text Description is below the 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.
  • 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!

Return to Contents


Slide 53: Communication

Text Description is below the image.

  • "The process by which information is clearly and accurately exchanged between two or more team members in the prescribed manner and with proper terminology and the ability to clarify or acknowledge the receipt of information."
    Cannon-Bowers JA, Tannenbaum SI, Salas E, et al. . Defining competencies and establishing team training requirements. In Guzzo RA, Salas E, and associates, eds. Team effectiveness and decision-making in organizations. San Francisco: Jossey-Bass; 1995. p. 333.

Return to Contents


Slide 54: Communication is...

Text Description is below the image.

  • The process by which information is exchanged between individuals, departments, or organizations.
  • The lifeline between the patient and any member of the team.
  • Effective when it permeates every aspect of an organization.

Image: Two penguins are trying to communicate across a wall labeled assumptions, fatigue, distractions, and HIPAA. The source penguin is thinking about a message. The receiver penguin is holding a sign with the same message. The source sends a message to the receiver and the receiver sends feedback to the source.

Return to Contents


Slide 55: SBAR provides...

Text Description is below the image.

  • A framework for team members to effectively communicate information to one another:
    • Situation—What is going on with the patient?
    • Background—What is the clinical background or context?
    • Assessment—What do I think the problem is?
    • Recommendation/Request—What would I recommend? What do I need from you?
  • SBAR's adaptability is encouraged—make this work for your team!

Remember to introduce yourself...

Return to Contents


Slide 56: Handoff

Text Description is below the image.

The transfer of information (along with authority and responsibility) during transitions in care across the continuum; to include an opportunity to ask questions, clarify, and confirm.

Image: Two penguins in track uniforms are running a relay race; one penguins passes the baton to the other.

Return to Contents


Slide 57: Handoff

Text Description is below the image.

  • Optimized Information.
  • Responsibility—Accountability.
  • Uncertainty.
  • Verbal Structure.
  • Checklists.
  • Acknowledgment.
Great opportunity for quality and safety.

Return to Contents


Slide 58: Handoff Exercise

Text Description is below the image.

  • Develop a handoff checklist based upon needs of your particular office:
    • How is your team unique?
    • Keep in mind core components.

Image: A penguin rides an exercise bicycle.

Return to Contents


Slide 59: Check-Back is...

Text Description is below the image.

Image: Diagram of a Check-back loop. Check-back is a circular process with three parts: "Communication" goes through "Sender initiates message." This leads to "Closed," which goes through "Receiver accepts message and provides feedback confirmation." This leads to "Loop," which goes through "Sender verifies message was received." This leads back to "Communication," which continues the process.

Return to Contents


Slide 60: Communication in the Primary Care Medical Office

Text Description is below the image.

Let's watch the fourth primary care office demonstrate proper team communication.

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
Communication in the Primary Care Medical Office (Good Teamwork) (Flash® video, 3 min., 33 sec.; 39 MB) (Plugin Software Help.)

Return to Contents


Slide 61: Communication Exercise

Text Description is below the image.

  • Think about your office team.
  • What do you think are the opportunities to improve communication in your office?
  • If you had a magic wand, what strategies would you use to overcome communication breakdowns?

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 62: Front Office Scenario

Text Description is below the image.

For some unknown reason, the electronic health records system was not functioning and the staff had to transition to writing paper notes.� Alice had an appointment for followup of labs and x rays.� Since there was no way to access the diagnostic data, the provider asked the administrative assistant to call both the laboratory and the radiology service to get the results via telephone.� The administrative assistant called and explained the situation, the background, and the assessment, and requested the necessary information. This method of communication expedited the transfer of information from the radiology technician to the administrative assistant. The provider was then able to see Alice on time and discuss her lab and x ray results.

Return to Contents


Slide 63: Patient- and Family-Centered Care

Text Description is below the image.

Primary care teams should:

  • Hear the patient's stories, be open and honest with them, and take action with them.
  • Respect the patient and family as the central hub of the care team.
  • Make sure patients share fully in decisionmaking.
  • Speak to patients in a way they can understand and enable them to feel empowered to be in control of their care.

Return to Contents


Slide 64: Equipping the Patient

Text Description is below the image.

  • Improving health care quality is a team effort.
  • Patients can improve their care and the care of their loved ones by taking an active role in the process.
  • Encourage patients to ask questions, understand their condition, and evaluate their options.
  • The AHRQ Web site "Questions Are the Answer" is a great resource for patients and families on what questions to ask their providers:

    http://www.ahrq.gov/questionsaretheanswer/

    Questions Your Patients Should Ask

    What is the test for?
    When will I get the results?
    Why do I need this treatment?
    Are there any alternatives?
    What are the possible complications?
    Which hospital is the best for my needs?
    How do you spell the name of that drug?
    Are there any side effects?

    Return to Contents


    Slide 65: Patient-Centered Scenario

    Text Description is below the image.

    Janet brought her 6-year-old son to Dr. Lee's office with sore throat and a fever. After a quick strep test, Dr. Lee diagnosed him as having strep throat. Dr. Lee ordered amoxicillin 250 mg 3 times a day for 10 days. Janet said, "I really hate to give him medications; can we wait to see if it will go away by itself?" Dr. Lee said, "Janet, strep throat is serious and can lead to rheumatic fever, which can cause inflammation of his heart and permanent heart murmur—he needs to take this medicine." Janet looked very alarmed but said nothing else and simply thanked Dr. Lee as he walked out. Jill, the medical assistant who remained in the room with them, asked Janet if she had any questions. Janet said she couldn't think of any. Jill knew the importance of working with the patient and family to involve them in the plan of care. She encouraged Janet to discuss any concerns and always ask questions.

    How can Jill help Janet address her concerns?

    What are some questions Jill can help Janet think about?

    Return to Contents


    Slide 66: Barriers to Team Effectiveness

    Text Description is below the image.

    BarriersTools and StrategiesOutcomes
    • 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 Co-Workers.
    • Distractions.
    • Fatigue.
    • Workload.
    • Misinterpretation of Cues.
    • Lack of Role Clarity.
    • Brief.
    • Huddle.
    • Debrief.
    • STEP.
    • Cross-Monitoring.
    • Feedback.
    • Advocacy and Assertion.
    • Two-Challenge Rule.
    • CUS.
    • DESC Script.
    • Collaboration.
    • SBAR.
    • Check-Back.
    • Handoff.
    • Shared Mental Model.
    • Adaptability.
    • Team Orientation.
    • Mutual Trust.
    • Team Performance.
    • Patient Safety!!

    Return to Contents


    Slide 67: Example of High-Functioning Medical Office Team

    Text Description is below the image.

    Let's watch our four primary care office teams demonstrate all four of the core teamwork skills discussed during this training.

    Select the penguin director icon below to access the video.

    'Roll 'Em!' Play Video (icon: penguin film director)
    Good Teamwork in the Primary Care Medical Office (Flash® video, 14 min., 15 sec.; 157 MB) (Plugin Software Help.)

    Return to Contents


    Slide 68: Pulling It All Together: What were their successes?

    Text Description is below the image.

    Image: A wooden bucket labeled "Failures" contains no fish. A wooden bucket labeled "Successes" contains many fish.

    Return to Contents
    Return to Index


    Internet Citation:

    TeamSTEPPS® Primary Care Version: Primary Care Teams Classroom Slides. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/teamsteppstools/primarycare/slpcobt.htm


     

Page last reviewed August 2012
Internet Citation: Primary Care Teams Classroom Slides: TeamSTEPPS Primary Care Version. August 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/primarycare/slpcobt.html