TeamSTEPPS Everywhere: Implementing at the System Level: Slide Presentation
TeamSTEPPS®: National Implementation
Slide 1
TeamSTEPPS Everywhere: Implementing at the System Level
Slide 2
TeamSTEPPS System Implementation Overview
Lily Thomas, Ph.D., RN
Sustainment Strategies: Collaborative Care Councils
Catherine Galla, MSN, RN CENP
Implementing TeamSTEPPS: EMS
Myrta Rabinowitz, Ph.D., RN
Implementing TeamSTEPPS: Ambulatory Services
Denise Mazzapica, MSN, RN-BC
Implementing TeamSTEPPS in Home Care
Jayne O'Leary, MSN, RN
Slide 3
North Shore—LIJ Health System
Images: A map of the New York City/New Jersey/Long Island area shows the locations of North Shore—LIJ Health System medical facilities. An insert of a map of Ohio shows the location of the Cleveland Clinic.
Slide 4
Our Journey
Image: A timeline shows the following events:
- July 2007: Introduction to TeamSTEPPS.
- Sept. 2007—2008: Pilot Hospital Implementation.
- 2009-2013: 15 Hospitals, 2 LTCs Ambulatory Care, EMS *33,000 Trained*.
An arrow pointing from left to right is captioned TeamSTEPPS.
Slide 5
Images: A purple circle is captioned NSLIJHS IFN [North Shore-LIJ Health System Institute for Nursing]. Four arrows point from the circle to photographs of a North Short LIJ ambulance, a poster for the Broadlawn Manor Nursing and Rehabilitation Center, a physical therapist working with a patient, and a medical team standing in a group in front of a building.
Slide 6
TeamSTEPPS Implementation
Image: The shift process has three phases. Phase 1: Assessment. Pre-Training Assessment includes Site Assessment, Culture Survey and Data/Measures. Are these ready? If No, pass through Climate Improvement and return to Pre-Training Assessment. If Yes proceed to Action Plan and then move on to Phase 2. Phase 2: Planning, Training and Implementation. Training leads to Intervention. The Intervention section is highlighted. Intervention includes testing and leads to Phase 3. Phase 3: Sustainment. This phase includes Culture Change: Coach and Integrate, Monitor the Plan, and Continuous Improvement. Continuous Improvement includes going back to Training to lead to more Culture Change. At the bottom of the image is an arrow with the following actions after it from Phase I to Phase III: Set the Stage, Decide What to Do, Make it Happen, and Make it Stick.
Slide 7
Phase 1: Preparation
Image: A flowchart consisting of three boxes. In the uppermost box is Meet with Executive Leadership. A line connects this box to two below it; in the first is Provide Overview of TeamSTEPPS, in the second is a list:
Identify:
- Organizational Goals.
- Data/Measures.
- Infrastructure for Implementation.
- Sequence of Implementation.
Slide 8
Determine Organizational Goals
Image: A tridirectional arrow points to three boxes. The top box is captioned: TeamSTEPPS Goals: Decide Change Type. The left box is captioned Transformational Change: Changing the Culture to a Culture of Safety; and the right box is captioned Incremental Change: Problem Solving Using TeamSTEPPS Core Skills.
Slide 9
Phase 1: Assessment
- Site Assessment.
- Administration of ‘Hospital Culture of Patient Safety Survey'.
- http://www.ahrq.gov/qual/hospculture/hospsanform.pdf.
- Data/Measures.
Image: The Hospital Survey on Patient Safety Culture logo.
Slide 10
Begin with the End in Mind!
Slide 11
Collaborative Care Model
Image: The Collaborative Care Model is shown. At the center are two concentric circles; the inner circle is captioned Patients Come First and the outer circle is captioned Health Care Team. Two double-headed arrows point to/from the circle to a row of purple boxes above them; the boxes are captioned, left to right: Excellence, Caring, Honoring the Human Spirit, Collaboration, Professionalism, Leadership, and Safety. Two double-headed arrows point to/from the circle to a pair of purple boxes, one on either side; the boxes are captioned Practice Environment (Structure) and Care Delivery Model (Process). Two double-headed arrows point to/from Practice Environment (Structure) and Care Delivery Model (Process) to a purple box captioned Outcomes, Patient Experience, Financial Performance, Quality. A single arrows points from Care Delivery Model (Process) to TeamSTEPPS.
Slide 12
Infrastructure for Implementation
Image: Six boxes in two columns are captioned (first column) Organizational Level—Executive Sponsor Team, Service Level—Director Sponsor Team, Department/Unit Level—Collaborative Care Council; (second column) System PICG, Hospital PICG, and Service PICG. Double-headed arrows point to/from each box to the boxes above or below it and to the corresponding box in the opposite column.
Slide 13
Action Planning & Implementation
Slide 14
Implementation Sequence
Image: A row of five arrowhead shaped boxes pointing from left to right are captioned 1. Medical Surgery, 2. Critical Care, 3. ED, 4. Peri-Op, 5. Peri-Natal.
Slide 15
Timeline
| Hospital | 2007 - 2008 | Jan 2009 | Feb 2009 | March 2009 | Apr 2009 | May 2009 | June 2009 | July 2009 | Aug 2009 | Sept 2009 | Oct 2009 | Nov 2009 | Dec 2009 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Plainview | X | ||||||||||||
| Schneider's | X | X | X | X | X | X | |||||||
| LIJ | X | X | X | X | X | X | X | X | X | X | |||
| NSUH | X | X | X | X | X | X | X | X | X | X | X | X | X |
| SI North | X | X | X | X | X | X | X | X | X | X | X | ||
| SI South | X | X | X | X | X | X | X | X | X | X | X | ||
| Syosset | X | X | X | X | X | X | X | X | X | ||||
| Southside | X | X | X | X | X | X | X | X | X | X | |||
| Franklin | X | X | X | X | X | X | X | X | X | ||||
| Glen Cove | X | X | X | X | X | X | X | X | |||||
| Huntington | X | X | X | X | X | X | |||||||
| Zucker | X | X | X | X | X | ||||||||
| Forest Hills | X | X | X | X | X | X | |||||||
| Sterns | X | X | X | X | X | ||||||||
| Orzc | X | X | X | X | X |
TS = Image of the TeamSTEPPS logo.
Slide 16
Rapid... Systematic... Structured Rollout...
Image: A arrow pointing right captioned Training and an arrow pointing left captioned Implementation (Adoption in practice) collide with each other. At the point of collusion is an hourglass.
Slide 17
Organizational Timeline
Image: An organizational timeline shows the following schedule:
- Preparation—Weeks 1-4.
- Assessment—Week 3 through Month 2.
- Planning/Training: Months 2-4.
- Implementation: Months 5-7.
- Sustainment: Months 7-12 and Ongoing.
- Implementation: Months 11-12 and Ongoing.
Slide 18
Image: A timeline shows a rapid, systematic, structured rollout schedule for Department/Unit-level implementation:
- Brief Huddle Debrief—1-3.
- Situation Monitoring/Task Assessment—3-5.
- IPassTheBaton: 5-7.
- SBAR/Callout/Checkback: 7-10.
- Two-Challenge Rule/CUS, DESC Script: 9-12.
Slide 19
Lessons Learned
- Ongoing executive leadership support is essential.
- Standardize implementation: Rapid Systematic and Structured process.
- Cohort units to rollout according to planned sequence.
- Training: Use Multidisciplinary approach. Use Stories Redose.
- Transfer responsibility & accountability to the facility.
- Physician involvement is crucial.
Slide 20
Begin with the end in mind!
- Connect to organizational vision and mission.
- Customize sustainment plans.
Communicate!
- TS goals and benefits.
- Implementation Plan.
- Success stories.
Drive & Monitor:
- Processes.
- Rounding with onsite coaching.
- Outcomes.
Executive Leadership Support:
- Drive & monitor the TS implementation & sustainment.
- Enable accountability.
- Participate in Collaborative Care Council (CCC).
- Create job descriptions to include participation in CCCs.
- Monitor outcomes & design interventions.
Educate!
- Orientation, Annual Education.
Hardwire:
- Use TS processes to optimize improvements.
- Integrate TS competencies in policies and procedures.
Celebrate Success
Share Best Practice:
- Annual Dissemination.
Slide 21
Transformational Goal Results: Pilot Hospital
Images: A red arrow pointing down is captioned 2007: 9 Domains; a green arrow pointing up is captioned 2011: 11 Domains. A blue arrow captioned TeamSTEPPS points from the red arrow to the green arrow. Total = 12 Domains.
Slide 22
Transformational Goal Results: Health System
Images: A red arrow pointing down is captioned 2009: 9 Domains; a green arrow pointing up is captioned 2011: 7 Domains. A blue arrow captioned TeamSTEPPS points from the red arrow to the green arrow. Total = 12 Domains.
Slide 23
Transitions in Care
Images: An oval captioned TS [TeamSTEPPS] Integration is within a ring of smaller circles captioned EMS, Acute Care, Home Care, and PAANS. Around this figure are photographs of the North Shore LIJ emergency team and ambulance, medical staff performing operations and attending or working with patients, and the Outpatient entrance of a medical center.
Slide 24
Team Training & Implementation
Image: A red arrow bounds up a series of steps. The steps are captioned (bottom to top): Executive Overview, Understanding the Culture, Standard/Customized Curriculum and Training, Toolkit, and Permanent Change Team: Collaborative Care Councils.
Slide 25
Transitions in Care
Images: An oval captioned TS [TeamSTEPPS] Integration is within a ring of circles captioned EMS, Acute Care, Home Care, and PAANS. The Acute Care circle is enlarged. Beside this figure are photographs of medical staff performing an operation and attending a patient in a hospital bed.
Slide 26
Acute Care Toolkit
- Standard TS Training.
- Standard Scenarios.
- Multi-Team System (MTS).
- Briefing Template.
- Handoff.
- Collaborative Care Council.
Images: Photographs of medical staff performing an operation and attending a patient in a hospital bed.
Slide 27
Acute Care MTS
Image: A pyramid is divided into 4 levels. At the peak is MTS. The top level is Patient. On the second level is Core Team (RN, PCA, MD, SW, CM). The third level is in two sections; on the left is Coordinating Team (NM, UR, Hospitalist); on the right is Ancillary & Support Services (RT, PT, OT, Food & Nutrition, Environmental). At the base of the pyramid is Administration (Directors, Dept. Heads, Chairmen, CEO, CNO, CFO). Beside the pyramid is a trapezoidal box captioned Contingency Teams (RN, MD, RT, NM). A double headed arrow points to/from this box to the pyramid.
Slide 28
Transitions in Care
Images: An oval captioned TS [TeamSTEPPS] Integration is within a ring of circles captioned EMS, Acute Care, Home Care, and PAANS. The EMS circle is enlarged. Beside this figure are photographs of the North Shore LIJ emergency team and ambulance.
Slide 29
Image: A photograph of the North Shore LIJ emergency team and ambulance.
Slide 30
Image: A photograph of the North Shore LIJ Operations Center.
Slide 31
CEMS Toolkit
- Customized TS Training.
- Customized Scenarios.
- Multi-Team System (MTS).
- Briefing template.
- Handoff between EMS-ED.
- Collaborative Care Council.
Image: A photograph of the North Shore LIJ emergency team and ambulance.
Slide 32
EMS Scenario
A civilian calls EMS to report a house fire. People are still in the house and the fire is still in progress. EMS dispatch elicits information from the caller (situational monitoring), and summons additional resources as required (police, fire, supervision.) Upon arrival EMS is directed to stage at a determined location and are briefed about the situation (shared mental model). Multiple patients are identified and triaged. Treatments and transports proceed as appropriate.
Skills needed: Situation Monitoring, Shared Mental Model, Leadership-briefs, huddles, debriefs.
Created by CEMS.
Slide 33
Multi-Team System (MTS) for Patient Care in CEMS
10-84 House Fire (on the scene)
Image: A pyramid is divided into 4 levels. At the peak is MTS. The top level is Patient. On the second level is Core Team (EMTs & Paramedics). The third level is in two sections; on the left is Coordinating Team (Police, FDNY, IT, Dispatchers); on the right is Ancillary & Support Services (Support, Mechanic, Pharmacy). At the base of the pyramid is Administration (Human Resources, Corporate Compliance, CEMS Administration, FDNY Administration). Beside the pyramid is a trapezoidal box captioned Contingency Teams (EMTs & Paramedics, Supervisors). A double headed arrow points to/from this box to the pyramid.
Slide 34
Multi-Team System (MTS) for Patient Care in CEMS
10-82 House Fire (scene to hospital)
Image: A pyramid is divided into 4 levels. At the peak is MTS. The top level is Patient. On the second level is Core Team (EMTs & Paramedics). The third level is in two sections; on the left is Coordinating Team (IT, Dispatchers); on the right is Ancillary & Support Services (Support, Mechanic, Pharmacy). At the base of the pyramid is Administration (Human Resources, Corporate Compliance, CEMS Administration). Beside the pyramid is a trapezoidal box captioned Contingency Teams (EMTs & Paramedics, Supervisors). A double headed arrow points to/from this box to the pyramid.
Slide 35
Multi-Team System (MTS) for Patient Care in CEMS
10-81 House Fire (arrival at the ED)
Image: A pyramid is divided into 4 levels. At the peak is MTS. The top level is Patient. On the second level is Core Team (EMTs, Paramedics, Triage RN, PCA, MD). The third level is in two sections; on the left is Coordinating Team (IT, EVS, Security); on the right is Ancillary & Support Services (Support, Mechanic, Pharmacy). At the base of the pyramid is Administration (Human Resources, Corporate Compliance, CEMS Administration, Receiving Hospital Administration). Beside the pyramid is a trapezoidal box captioned Contingency Teams (Respiratory). A double headed arrow points to/from this box to the pyramid.
Slide 36
CEMS Brief Template
| Topic | When Reviewed ☑ | Document Discussion (if necessary) |
|---|---|---|
| 1. Staff Assignments-EMT's and Paramedics / Staffing Concerns | □ | |
| 2. Communication / Assignments received from Dispatch and Call center to the teams? | □ | |
3. Types of transport required:
|
□ | |
| 5. Any equipment issues? Ambulance's adequately stocked? | □ | |
| 6. How is internal communication with our hospital sites? | □ | |
| 7. Huddles as needed among ambulances and across teams | □ |
Slide 37
Communication—I PASS the BATON
Image: The figure, consisting of a series of red/pink arrows pointing right, elucidates the phrase I PASS the BATON:
I → Introduction → Introduce yourself and your role/job.
P → Patient → Name, Identifiers, age, sex location.
A → Assessment → Chief complaint, VS, symptoms & Dx.
S → Situation → Current status, recent changes & responses.
S → Safety → Critical values, allergies, alerts.
B → Background → Meds, Famlily History, Previous History, Co-morbidities.
A → Actions → Actions taken or required with rationale.
T → Timing → Urgency & prioritization of actions.
O → Ownership → Who is responsible?
N → Next → Anticipated changes? Plan? Contingency plan?
Slide 38
CEMS Collaborative Care Council
Image: A photograph of the CEMS Collaborative Care Council seated on the rear bumper of their ambulance. Inset above the photograph is an agenda:
| Agenda | Discussion | Action Plan or Follow-up |
|---|---|---|
| 1:1's | Reviewed the purpose of the 1:1's and the importance of bringing back the council minutes to the team | Ask Elizabeth and Sean to assist |
| Handoff Communication |
|
Discuss further: F/u with Elizabeth. Rob and Sean have attended. Invite team to the 9/6 ED collaborative:420 Lakeville Road-Suite 21 @ 10:00 am |
Slide 39
Transitions in Care
Images: An oval captioned TS [TeamSTEPPS] Integration is within a ring of smaller circles captioned EMS, Acute Care, Home Care, and PAANS. The Home Care circle is enlarged. Below this figure are photographs of home care staff working with patients.
Slide 40
Home Health Care
Images: A map of the New York City/New Jersey/Long Island area shows the North Shore—LIJ Home Health Care service areas: Richmond, Kings, Queens, New York, the Bronx, Nassau, and Suffolk. Photographs show home care staff working with patients.
Slide 41
Home Care Toolkit
- Customized Scenarios.
- MTS.
- Briefing Template.
- SBAR Tool.
- Handoff: Clinical Information Form I PASS.
- Collaborative Care Councils.
Image: Photograph of a home care staff member working with a patient.
Slide 42
Home Care Scenario
The physical therapist is in the home with a new patient, post–op Total Hip Replacement (THR) day 2.
While checking the orders, he notices there are no hip precautions ordered. He calls the MD's office to clarify and after 5 minutes the doctor answers the call. The physician starts to yell, "Stop calling my office with stupid questions! If you don't know what THR precautions are, then go back to PT school".
Skills needed: Mutual Support—CUS, DESC.
Created by NSLIJHS Home Care Network.
Slide 43
Multi-Team System (MTS) for Patient Care in Home Health
Image: A pyramid is divided into 4 levels. At the peak is MTS. The top level is Patient. On the second level is Core Team (Visiting RN, PT, OT, MD, ST, MSW, Infusion Case Manager, Intake, Telehealth, HHS/PCA, Family). The third level is in two sections; on the left is Coordinating Team (DPS, Telehealth, Managers, Receptionist, Billing Dept., Insurance Verification); on the right is Ancillary & Support Services (Team Secretary, DME and Supplies, Infusion Team, Pharmacy Liaisons & Techs, Service Reps, Coordinator of Reimbursement). At the base of the pyramid is Administration (VPs, DPS, Directors, Managers, MD). Beside the pyramid is a trapezoidal box captioned Contingency Teams (Weekend Staff, Covering Staff, Telehealth, Infusion Services). A double headed arrow points to/from this box to the pyramid.
Slide 44
Briefing Template for Home Care
| Topic | When Reviewed ☑ | Document Discussion (if necessary) |
|---|---|---|
| 1. Staff call in schedule or send via voice mail/email and/or in person | □ | |
| 2. Staff Assignments/Staffing Concerns/"Call-in's" | □ | |
| 3. Weekend/Holiday Issues/Coverage | □ | |
| 4. Intake Concerns-admission's/discharges and recert's. Case's not open and reason | □ | |
| 5. Safety Issues-prioritize-lives alone/no caregiver/falls risk/pressure ulcer risk/ frequent re-admissions | □ | |
| 6. What teams need assistance? Who can assist/float/admit patients | □ | |
| 7. Announcements/Updates | □ |
Slide 45
SBAR: A technique for communicating critical information that requires immediate attention and action concerning a patient's condition
Home Care Example:
- Mr.M is a 74 yr old male that you are admitting today.
- The patient had CHF and COPD, and is on Lasix 20 mg 1xday, Coreg 12.5 mg 2xday, Digoxin 0.25mg 1xday and MDI.
- The patient has minimal edema to both feet and decreased breath sounds at the bases.
Situation: "I am calling about Mr.M who is complaining of increased dyspnea."
Background: "Patient is a 74 yr old male discharged from the hospital with acute exacerbation of CHF."
Assessment: "Breath sounds are decreased at the bases and the patient has bilateral edema of the feet."
Recommendation: "Would you like to increase the daily Lasix dose?"
Slide 46
Handoff: (I PASS for Home Care)
Image: Screenshot of the North Shore-LIJ Home Care Network Transfer of Clinical Information form.
Slide 47
Collaborative Care Council Invitation
Script for Conversation with Council Members
"We are establishing a Collaborative Care Council for the North Shore Westbury branch and we want you to be part of it. This is a great opportunity to use your knowledge to make North Shore Home Care better. You will be meeting with your workgroup every month for an hour and it is a mandatory meeting. Eventually everyone will take part in the council, but I have selected you for this first one.
This will be ongoing for a term of 6-9 months and you will be expected to participate in discussions, different tasks and the development of a pilot project.
Betty Popp, our Service Excellence Coordinator, will be reaching out to you shortly with more information so make sure to check your email and respond."
Slide 48
Home Care Collaborative Care Council
Image: A photograph of the Home Care Collaborative Care Council seated at a table for a discussion. Inset above the photograph is an agenda:
| Agenda | Link to Other Initiative | Presenter | Discussion | Action—F/U |
|---|---|---|---|---|
| 1:1 Report | Betty | Check the lists developed for each team and distribute to staff | Managers to f/u | |
| Clinical Quality Items: TeamSTEPPS | Betty | >60% of all teams have been trained and are using briefing, huddles, SBAR |
Slide 49
Transitions in Care
Images: An oval captioned TS [TeamSTEPPS] Integration is within a ring of smaller circles captioned EMS, Acute Care, Home Care, and PAANS. The PAANS circle is enlarged. Beside this figure are photographs of two members of staff seating at a computer workstation and the Outpatient entrance of a medical center.
Slide 50
PAANS=Physicians and Ambulatory Network Service
Image: An circle captioned NSLIJ is within a ring of ovals captioned Ambulatory Services, Physician Enterprise, NSLIJ Medical Group, and Business Development.
Slide 51
PAANS Toolkit
- Customized Scenarios.
- MTS for Ambulatory Services.
- Briefing Template.
- SBAR.
Images: Photographs of two members of staff seating at a computer workstation and the Ambulatory Surgery Center entrance.
Slide 52
Front Office Scenario
Jack, an elderly man who just had cataract surgery, cannot drive. Jack was taken to the clinic by his son for a follow-up 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 (situation monitoring) 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.
Skills needed: Situation Monitoring, Situation Awareness, Leadership—Huddle.
TeamSTEPPS Primary Care Version
Slide 53
Primary Care Scenario
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 towards 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.
Skills needed: Situation Monitoring-STEP, Leadership.
TeamSTEPPS Primary Care Version
Slide 54
Multi-Team System (MTS) for Patient Care
Image: A pyramid is divided into 4 levels. At the peak is MTS. The top level is Patient. On the second level is Core Team (Physician, Fellow, Resident, NP, RN, PA, RT). The third level is in two sections; on the left is Coordinating Team (Sr. Directors, Administrators, Supervisors, Managers, MOAs); on the right is Ancillary & Support Services (Front Desk, Secretary, File Clerk, Biller, Coder, IT). At the base of the pyramid is Administration (Executive Leadership, Medical Directors, Sr. Leadership). Beside the pyramid is a trapezoidal box captioned Contingency Team (Quality, Social Work, Nutritionist, PT and Service Excellence). A double headed arrow points to/from this box to the pyramid.
Slide 55
Briefing Template
| Topic | When Reviewed ☑ | Document Discussion (if necessary) |
|---|---|---|
| 1.Welcome/Encourage all team to attend | □ | |
2. Staff Assignments/Staffing Concerns
|
□ | |
| 3. Patient Alerts/Safety Concerns:
Patients identified at "high risk" or need to be triaged / changes in scheduling: cancellations / "no shows" / testing / all staff informed of changes?
|
□ | |
4. Status of the team:
|
□ | |
| 5. Have all members of the team been included in the brief? If not, identify the designated staff who will "brief" or "debrief" staff as needed |
□ | |
| 6. Announcements/Updates | □ | |
7. Did you Huddle today?
|
□ |
Slide 56
SBAR: A technique for communicating critical information that requires immediate attention and action concerning a patient's condition
- The electronic health records system was not functioning.
- Alice had an appointment for follow-up 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 requested the necessary information using the SBAR technique.
- The provider was then able to see Alice on time and discuss her lab and x-ray results.
Situation: Electronic health records system is not functioning.
Background: Patient has an appointment for follow-up of lab and x-rays.
Assessment: There is no way to access the diagnostic data.
Recommendation: Request the necessary information from the lab and radiology by phone.
Slide 57
PAANS Collaborative Care Council
Image: A photograph of the Collaborative Care Council seated in a close-grouped circle of chairs for a discussion. Inset above the photograph is an agenda:
| Agenda | Discussion | Action Plan or Follow-up |
|---|---|---|
| 1:1's | Reviewed the purpose of the 1:1's and the importance of bringing back the council minutes to the team | Jerry will assist |
| SBAR to communicate with depts. and MDs |
|
Managers will follow up with staff to review Jayne and Lynn will create scenarios for next staff meeting |
Slide 58
Begin with the end in mind!
S Covey, The 7 Habits of Highly Effective People (Habit 2)
—Secret of Sustainment—
Connect TeamSTEPPS to Organizational Vision & Mission.
Slide 59
Collaborative Care Model
Image: The Collaborative Care Model is shown. At the center are two concentric circles; the inner circle is captioned Patients Come First and the outer circle is captioned Health Care Team. Two double-headed arrows point to/from the circle to a row of purple boxes above them; the boxes are captioned, left to right: Excellence, Caring, Honoring the Human Spirit, Collaboration, Professionalism, Leadership, and Safety. Two double-headed arrows point to/from the circle to a pair of purple boxes, one on either side; the boxes are captioned Practice Environment (Structure) and Care Delivery Model (Process). Beneath each box is a list of examples. Under Practice Environment: Resources: Human, Equipment, Supplies, Financial, CCCs. Under Care Delivery Model: Human Caring Model, Patient Safety Model, TeamSTEPPS, Evidence-based Practice, Microsystems, Six Sigma, Lean, Capstone, FTD. Two double-headed arrows point to/from Practice Environment (Structure) and Care Delivery Model (Process) to a purple box captioned Outcomes, Patient Experience, Financial Performance, Quality. Under this box is also a list of examples: Patient Satisfaction, Staff Engagement, Patient Safety, Quality Outcomes, Productivity & Efficiency, Predictability, Documentation.
Note: The logo for the Institute for Nursing appears in the upper left corner from this slide to Slide 65.
Slide 60
Making It Real: Collaborative Care Councils
- Collaborative Care Councils provide a networking infrastructure for interdisciplinary colleagues at all levels.
- Address practice issues related to quality.
- Improving care and service.
- Developing leaders.
- Tapping into individual gifts and collective capacity.
- Enhancing relationships.
- Having meaningful conversations.
- Achieving shared mission and vision.
Slide 61
Collaborative Care Council Model
Image: A group of four stick figures in a circle are captioned Work Team. A double-headed arrow points to/from the Work Team to a larger circle of 10 stick figures captioned Unit/Dept. Collaborative Care Council. An arrow points from the Unit/Dept. Collaborative Care Council to a row of four stick figures captioned One-On-One. A circle of 17 stick figures is captioned Central Hospital Collaborative Care Council; an arrow points from this circle to the Unit/Dept. Collaborative Care Council. A double-headed arrow also points to/from the Central Hospital Collaborative Care Council to a circle of 10 stick figures captioned System Collaboratives.
Slide 62
Council Impact Areas What Councils Work On
- Patient Safety.
- Clinical Quality Improvement.
- Recruitment and Retention.
- Patient / Staff Satisfaction.
- Use of Financial Resources.
- Staff Competency Improvements.
- Healthy Work Environment.
- Work of / with Other Councils.
- Connecting Health Care Settings.
- Process Improvement.
Slide 63
Key Council Success Strategies
Images: Slide shows a clipboard containing an Agenda and a pen with the words Standardized Agenda superimposed on it; a calendar for an unspecified month next to the words Advanced scheduling of meetings; and icons for the symbol @, a letter, and a telephone under the title Multi-modal Communication plan.
Slide 64
1:1 Critical to Sustainability and Growth
- Staff build relationships one person at a time.
- Enhances interpersonal relationships.
- Everyone feels connected and a part of decisions.
- Accountability increases—becomes "our decision."
Image: Six figures in white coats stand in a circle around a central, bare figure. Dotted lines at their feet connect all the surrounding figures to the central figure.
Slide 65
Evolution of Collaborative Care Councils
All Inpatient Units in:
- 16 Hospitals
- Outpatient Clinics.
- 2 LTC / Rehab.
CEMS
PAANS (Physician and Ambulatory Network Services)
Home Care Network
All sites have a Central Council
System wide -
Behavioral Health Collaborative
Emergency Services Collaborative
Allied Health, Ancillary & Support Service Councils
- Social Work.
- Food and Nutrition.
- Radiology.
- Laboratories.
- Rehab Services.
- In & Outpatient.
- Respiratory.
- Pharmacy.
- Environmental.
- Case Management.
- Central Sterile & Supply.
- HIM (Medical Records).
- Faculty Practice.
- Admitting.
- Security.
- Engineering.
- Telecommunications.
Slide 66
TeamSTEPPS Showcases
Image: A photograph shows a woman in a TeamSTEPPS display booth at a conference explaining how TeamSTEPPS works to an interested group of attendees.
Slide 67
Success Factors Unique to NSLIJ
Image: A six-pointed star is captioned "Implementation across a diverse care continuum."
Slide 68
Success Factors Unique to NSLIJ
- Hospitals:
- Tertiary.
- Community.
- Specialty
- Pediatrics.
- Behavioral Health.
- Ambulatory Care / Medical Offices.
- Long Term Care / Rehab.
- Ambulance Services / Home Health Care Network.
Slide 69
Unique to NSLIJ
On left side: "CCCs = Change Team is Permanent. In the middle: Videos, Leaders, Physicians & Staff. On the right side: Leadership, Support & Engagement.
Image: A double-headed arrow points in both directions beneath the text.
Slide 70
Unique to NSLIJ
- All Clinical Leaders / Dept Heads attend Master Training.
- All Clinical Leaders / Dept Heads become Trainers or Coaches.
- TeamSTEPPS Tools & Strategies anchored in daily practice...
- System Policy / Procedure:
- Human Resources.
- Orientation:
- Simulation scenarios.
Slide 71
Organizational Goals
Image: A three-headed arrow points to three boxes captioned: TeamSTEPPS Goals: Decide Change Type; Transformational Change: Changing the Culture to a Culture of Safety; and Incremental Change: Problem Solving Using TeamSTEPPS Core Skills.
Slide 72
Incremental Change Example 1—Inpatient Med Surg CCC
Reduce the risk of CLABS in Patients outside the ICU
Interventions:
- Handoff used to communicate patients with CLs.
- Cross Monitoring using daily check backs on patients with CLs to ensure dressing changes and line care.
- Briefs discussing the number of infection free days.
Results:
- Number of line days decreased by 50%.
- 43% reduction in the CLABS rate.
Slide 73
Incremental Change Example 2—Inpatient Med Surg CCC
Decreasing Bed Turn around Time:
- Discharge readiness packets.
- Multidisciplinary rounds.
- Afternoon discharge huddle.
- Discharge magnet.
- Communication with patient and family re discharge times.
Press Ganey Scores
| Pre | Post | |
|---|---|---|
| Discharge | 82.4% | 90.6% |
| Likelihood to recommend | 82.7% | 91.7% |
Percentile Ranking
| Pre | Post | |
|---|---|---|
| Discharge | 3rd | 99th |
| Likelihood to recommend | 2nd | 89th |
Slide 74
Incremental Change Example 3—Inpatient Med Surg CCC
Decreasing Catheter—Associate Infections
Interventions:
- Situation Monitoring by interdisciplinary staff.
- Collaboration: Daily Patient Care Rounds.
- Assessment Tool developed to track foley catheters.
- Implemented CAUTI Bundle.
Results:
CAUTI Rate: 1st Quarter: 10.6, 2nd Quarter:11.9, 3rd Quarter: 3.15.
Slide 75
TeamSTEPPS: The glue that binds it all together…
Images: Four interlocked puzzle pieces are captioned Acute Care, CEMS, Home Care, and Ambulatory; a bottle of glue labeled TeamSTEPPS is used to glue the puzzle pieces together. In the upper left corner of the slide is the logo for the Institute for Nursing.
Slide 76
The only way to discover the limits of the possible is to go beyond them into the impossible. ~ Arthur C. Clarke
Image: Photograph of a hiker standing on a mountain crest with arms upraised.
Slide 77
Image: A group of figures stand in a circle around a large red question mark.
