TeamSTEPPS® Primary Care Module
AHRQ's 2012 Annual Conference Slide Presentation
Select to access the PowerPoint® presentation (2.8 MB).
Slide 1
TeamSTEPPS® Primary Care Module
Richard Ricciardi, PhD, NP
Agency for Healthcare Research and Quality
Center for Primary Care, Prevention and Clinical Partnerships
Slide 2
Acknowledgement
Deborah A. Milne, RN MPA
American Institutes for Research
Slide 3
First Step
- Convened Technical Expert Panel (TEP) December 2010
- Representatives from AHRQ and DoD.
- Experts in primary care and quality improvement.
- Interprofessional primary health care providers.
Slide 4
Laying the Groundwork
- Defined the "team."
- Identified the "system."
- Evaluated the challenges.
- Decided areas of focus.
Slide 5
Primary Care Office (PCO) Team
- Technical Expert Panel defined the scope of "team" for purpose of this project
- Focus of the project was intended to be on optimizing teamwork within the medical office.
- Caveat - it was noted that external care coordination is of extreme importance for future work.
Slide 6
Primary Care Team Structure
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."
Slide 7
Primary Care Office Environment
Image: A team of penguins are working in an office environment made out of snow and blocks of ice.
Slide 8
Some of the Inputs
- Patient phone calls/Emails.
- Scheduling.
- Medication refills.
- Interruption of patient flow.
- Walk-ins, lab results.
- Formulary questions.
- Missed appointments.
- Population data management.
- Information from insurers.
- Urgent appointments.
- Calls from consultants/external providers.
- Personnel transitions.
Slide 9
Challenges to Teamwork in Primary Care Offices
- Quality Measures (Process and Outcome).
- Standardization.
- Definitions.
- Role Ambiguity.
- Non-linear work flow.
- Assumptions/Habits/Change.
Slide 10
Curriculum Training Structure
- When training teams to implement TeamSTEPPS:
- Developed to be taught in conjunction with TeamSTEPPS Essentials.
OR
- When training Master Trainers:
- To be taught as an addition to TeamSTEPPS Fundamentals.
Slide 11
Next Steps
- Literature review.
- Curriculum design guide development.
- Developed draft curriculum slides and instructor guide.
- Begin preliminary scripts for video vignettes:
- We asked all TEP members to send us brief "stories" that represented actual scenarios they had experienced.
Slide 12
Field Testing
- Two sites.
- TeamSTEPPS essentials followed by Primary Care Office Module.
- Data collection.
Slide 13
Highlights of Field Testing Focus Groups
- "What parts of the module are most relevant to primary care?"
- Patient advocacy and communication.
- Conflict resolution.
- Situation monitoring.
- Debriefing.
Slide 14
Highlights of Field Testing Focus Groups
- "What improvements could be made to the module?" More emphasis on roles of non-clinical staff in the care team. More case-based scenarios, especially across team roles.
Non clinical staff felt that they often had important information to communicate but no process to do so
Quote: "Little bits that you don't automatically put into the records as a formal thing are so important."
- Resulting module change:
- Included 4 scenarios in module that emphasize non-clinical staff.
Slide 15
Highlights, cont...
- "What parts of the module do not make sense?"
- Definitions of "Huddles" and "Briefs" conflicts with NCQA Primary Care Medical Home (PCMH) language.
Quote: "PCMH designates the TeamSTEPPS Brief as a Huddle. We all need to know what we mean in terms of what we're doing."
- Resulting module change:
- More emphasis on flexibility/customizability throughout the curriculum, as long as each team member shares the same mental model.
Slide 16
Video Production
- Scenario video production—4 paired scenarios (right way and wrong way)
- Script changes influenced by field testing results.
- Each based on an actual event.
- Leadership, Communication, Mutual Support, Situation Monitoring.
Slide 17
Leadership in the Primary Care Medical Office
Let's watch the primary care team demonstrate proper team leadership.
Image: A woman is working at a computer at a reception desk; a man is working at another desk in the background.
Slide 18
Questions?
