Reducing Workplace Violence with TeamSTEPPS®
Contents
Slide 1: Reducing Workplace Violence with TeamSTEPPS®
Slide 2: Rules of Engagement
Slide 3: Upcoming TeamSTEPPS Events
Slide 4: Help Line (312) 422-2609
Slide 5: Today's Presenter(s)
Slide 6: No Slide Title
Slide 7: Objectives
Slide 8: Healthcare is complex
Slide 9: Real Goal
Slide 10: No Slide Title
Slide 11: TeamSTEPPS® and Reducing Workplace Violence
Slide 12: Communication and Teamwork
Slide 13: No Slide Title
Slide 14: Team Structure
Slide 15: Where May Violence Occur?
Slide 16: Leadership
Slide 17: Team Intervention
Slide 18: Team Intervention
Slide 19: Situational vs. Designated Leaders
Slide 20: Situation Monitoring
Slide 21: Precipitating Factors
Slide 22: Some Examples of Precipitating Factors
Slide 23: Non-verbal signs of impending violence or Kinesics
Slide 24: Nonverbal Behavior Communication
Slide 25: Para-verbal Communication
Slide 26: Communication
Slide 27: Verbal Intervention
Slide 28: Verbal Intervention
Slide 29: Mutual Support
Slide 30: Staff Fear and Anxiety
Slide 31: Staff Fear and Anxiety
Slide 32: Rational Detachment
Slide 33: Scenario #1
Slide 34: 10 Ways to Defuse Incidents
Slide 35: Scenario #2
Slide 36: Joy and Meaning of Work
Slide 37: Summary
Slide 38: No Slide Title
Slide 39: Thank You
Slide 40: Questions and Answers
Slide 1
Reducing Workplace Violence with TeamSTEPPS®
December 14, 2016
Slide 2
Rules of Engagement
- Audio for the webinar can be accessed in two ways:
- Through the phone (*Please mute your computer speakers)
- Through your computer
- A Q&A session will be held at the end of the presentation
- Written questions are encouraged throughout the presentation and will be answered during the Q&A session
- To submit a question, type it into the Chat Area and send it at any time during the presentation
Slide 3
Upcoming TeamSTEPPS Events
- Master Training Courses
- Registration for courses in January-March 2017 now open
- Advanced Courses
- Now accepting applications for February 17 (UW) and March 21 (Northwell Health) courses (Due December 23)
- National Conference
- June 14-16, 2017
- Downtown Hilton, Cleveland, OH
- Registration open
- Call for proposals (Due December 16)
Slide 4
Help Line (312) 422-2609
Or email: AHRQTeamSTEPPS@aha.org
Slide 5
Today's Presenter(s)
Presented By:
Mei Kong, RN, MSN, Chief Operating Officer, NYC Health + Hospitals/Coney Island
Joseph Sweeny, Senior Director Hospital Police & WVP Coordinator, NYC Health + Hospitals/Bellevue
Slide 6
No Slide Title
- Mei and Joe Show at WPVP (workplace violence prevention)
- This show is dedicated to reducing violence in the workplace through TeamSTEPPS®
Slide 7
Objectives
- Integrate TeamSTEPPS® and nonviolent interventions to improve communication and teamwork for safe management of disruptive and aggressive patients.
- Reduce workplace violence through the use of early intervention methods for de-escalation. Enhance staff and patient experience and satisfaction through building a culture of patient safety and staff safety.
- Enhance staff and patient experience and satisfaction through building a culture of patient safety and staff safety.
- Increase joy and meaning of work through knowledge, skills and attitude.
Slide 8
Healthcare is complex
Slide 9
Real Goal
Prevent the fire before it happens
Slide 10
No Slide Title
Graphs showing industries and individuals affected by workplace violence.
Reference: Occupational Safety and Health Administration (OSHA)
Slide 11
TeamSTEPPS® and Reducing Workplace Violence
- A shout out to our sponsors and creators – Agency for Healthcare Research and Quality (AHRQ), Department of Defense (DoD), Health Research & Educational Trust (HRET), and American Hospital Association (AHA).
- Team Strategies and Tools to Enhance Performance and 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".
- The goal is safety for the patient and the staff!
Slide 12
Communication and Teamwork
- Bad news – poor communication and teamwork can be a source of tension and stress. It affects patient and staff safety
- Good news – most problems can be solved or prevented with effective communication among members
- Team collaboration is the key!
Slide 13
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Communication
- SBAR
- Call-Out
- Check-Back
- Handoff
Mutual Support
- Task Assistance
- Feedback
- Two-Challenge Rule
- CUS
- Cross-Monitoring
- DESC Script
- Shared Mental Model
- Conflict Resolution
Leadership
- Effective Team Leaders
- Team Events
- Brief, Huddle, & Debrief
Situation Monitoring
Slide 14
Team Structure
PREVENT - provide education and awareness for all employees on early detection of WPV symptoms.
RESPOND - de-escalation techniques.
REPORT - how to notify, escalate, and properly document an incident.
Slide 15
Where May Violence Occur?
Violence may occur anywhere in the health care facility, but it is most frequent in the following areas:
- Psychiatric units.
- Emergency rooms.
- Waiting rooms.
- Geriatric units.
- Traumatic brain injury unit.
Slide 16
Leadership
- Organize the team
- Roles and responsibilities.
- Brief
- Sharing the plan.
- Huddle
- Monitoring and modifying the plan.
- Debrief
- Reviewing the team performance.
Slide 17
Team Intervention
- Crisis Response Team
- Do you have a team?
- Who is your crisis response team?
- How is your team summoned?
Slide 18
Team Intervention
Team vs. Solo Intervention
- Safety – there is safety in numbers.
- Professionalism – team members can lend mutual support to one another during a crisis situation.
- Litigation – having another person on the scene provides a witness to the intervention.
Slide 19
Situational vs. Designated Leaders
Team Leader Duties
- Assess the situation.
- Plan the intervention.
- Direct or cue the other team members.
- Communicate with the acting-out individual.
Auxiliary Team Duties
- Check:
- Physical, psychological status of individual.
- Safety of environment.
- Address:
- What needs to happen to de-escalate the situation? Safety concerns?
- Are Control Dynamics being utilized safely?
- Recognize:
- Need for additional assistance.
- Need to change intervention strategies.
- Engage in:
- Verbal de-escalation with acting-out individual.
- Support to other team members.
Slide 20
Situation Monitoring
Patient and Staff Safety is the Number One Priority
- People working in high risk environments are highly dependent on situation awareness.
- Situation Awareness-oriented design and training creates Safety:
- Reduce human errors and system failures.
- Minimize risk.
Slide 21
Precipitating Factors
Internal or external causes of an acting out behavior over which a staff member has little or no control
Understanding precipitating factors can help staff to:
- Prevent acting-out behavior by being proactive.
- Recognize that acting-out behavior is not a personal attack.
- Avoid becoming a Precipitating Factor ourselves.
Slide 22
Some Examples of Precipitating Factors
- Loss of personal power.
- Need to maintain self esteem.
- Fear.
- Failure.
- Attention seeking.
- Displaced anger.
- Psychological/physiological causes.
- Others.
Slide 23
Non-verbal signs of impending violence or Kinesics
- Rapid eye movements.
- Pacing.
- Rapid breathing.
- Facial expressions, gestures, postures, such as clenching of jaws and fists.
A staff member's kinesics behavior can serve to escalate or de-escalate a given situation
Slide 24
Nonverbal Behavior Communication
Proxemics – Personal Space
- Personal space varies. On average, an individual's personal space is 1.5 to 3 feet.
- Factors of personal space include gender, size, cultural background.
- Invasion of an individual's space will increase that person's anxiety.
Slide 25
Para-verbal Communication
The vocal part of speech, including the actual words one uses
| Components | Suggested Approaches |
|---|---|
| Tone | Try to avoid inflections of impatience, condescension, inattention, etc. |
| Volume | Keep the volume appropriate for the distance and the situation |
| Cadence | Deliver your message using an even rate and rhythm |
Slide 26
Communication
With Whom Do We Share?
- Doctors/Nurses/Clinicians.
- Social Workers.
- Activity Therapists.
- Hospital Police.
- Psych Response Teams.
- Administration.
- Risk Managers.
- EVERYONE who is part of the team.
Slide 27
Verbal Intervention
DO
- Remain calm.
- Isolate the situation.
- Enforce limits.
- Listen.
- Be aware of non-verbal.
- Be consistent.
- Use CUS.
- Use the two-challenge rule.
- Check back and close the loop.
DON'T
- Overreact.
- Get in a power struggle.
- Make false promises.
- Fake attention.
- Be threatening.
- Use jargon.
- Jump to conclusions.
Slide 28
Verbal Intervention
Setting limits
Offer choices and state the consequences of those choices, starting with the positive first
- Simple/Clear - SBAR
- Reasonable - Check-Back
- Enforceable - Closing the loop
Slide 29
Mutual Support
Slide 30
Staff Fear and Anxiety
Unproductive
- Freezing
- Overreacting
- Psychologically
- Physiologically
- Responding inappropriately
- Verbally
- Physically
Productive
- Increase in speed and strength.
- Increase in sensory acuity.
- Decrease in reaction time (quicker response).
Slide 31
Staff Fear and Anxiety
Ways to control fear and anxiety:
- Understand what makes us afraid.
- Learn techniques to protect both ourselves and acting-out individuals in a crisis.
- Use a team approach – don't respond alone.
- Use physical intervention techniques to manage acting-out individuals.
Slide 32
Rational Detachment
The ability to stay in control of one's own behavior and not take acting-out behaviors that result.
- Staff may not be able to control Precipitating Factors, but they can control their own responses to the acting-out behaviors that result.
- Maintain a professional attitude.
- Find positive outlets for the negative energy absorbed during a crisis.
Slide 33
Scenario #1
- A patient becomes agitated in the dining room with other patients in the area.
- The crisis team comes in and addresses the patient.
- One or more other patients become involved and state "You come after him, you're also coming after me."
- How do you manage situation without getting everyone riled up?
Slide 34
10 Ways to Defuse Incidents
- Respect all individuals' personal space (situation monitoring).
- Be aware of your own body position and language; Keep nonverbal cues nonthreatening (non-verbal communication).
- Be empathic to others' feelings (mutual support).
- Use DESC during conflicts and try to de-escalate challenging questions (Listen attentively).
- Set and enforce reasonable limits (check-back).
- Permit verbal venting when possible (situational monitoring and awareness).
- Identify real reason or trigger for the behavior (brief, huddle, and debrief).
- Stay composed, avoid overreacting.
- Provide task assistance as needed.
- Use physical techniques only as a last resort.
Slide 35
Scenario #2
- A patient is placed on an Constant Observation watch (like a 1:1) for assaultive behavior.
- The person assigned to watch him is understandably afraid of him and is embarrassed to ask for help.
- Similarly, a staff member (could be SW, PhD, MD, AT) is assigned to provide care to someone who scares them.
- They then see the patient only sporadically and in very brief intervals.
- How to keep staff safe and also make sure patients cared for?
Slide 36
Joy and Meaning of Work
"Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams."
Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Healthcare
Luciane Leape Institute, NPSF
Slide 37
Summary
- Better Communication and Teamwork can help keep our patients and staff safe!
- Implementation of TeamSTEPPS can reduce workplace violence and/or injuries through early recognition.
- Knowledge, Skills, and Attitude are key attributes to Enhance Performance, Improve Satisfaction, Joy and Meaning at Work!
Slide 38
No Slide Title
Cartoon showing a boat with two men in front bailing water and two men in back doing nothing. One of the men in back says, “Sure glad the hole isn’t on our end.”
Slide 39
No Slide Title
Thank You
Slide 40
Questions and Answers
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