TeamSTEPPS for Office-Based Care: Introduction
Instructor's Guide
Contents
TeamSTEPPS for Office-Based Care: Introduction
TeamSTEPPS
TeamSTEPPS
TeamSTEPPS Skills
Does TeamSTEPPS Work?
Does TeamSTEPPS Work?
Office Environment
Office Environment
Team-Building Exercise: Paper Chains
Why Does Teamwork Matter in Office-Based Care?
References
TeamSTEPPS for Office-Based Care: Introduction
Say: Welcome to TeamSTEPPS for Office-Based Care. This presentation will cover the Introduction module for the TeamSTEPPS for Office-Based Care course.
Module Time: 30 minutes | |
Materials:
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TeamSTEPPS
Say: With over a decade of safety-driven collaboration, the Agency for Healthcare Research and Quality and the Department of Defense strive to optimize the lessons learned from multiple initiatives focused on reducing errors in medicine. One such evidence-based, collaborative work is TeamSTEPPS®. Based on TeamSTEPPS structure and process, health care teams plan, problem solve, communicate, collaborate, and coordinate to co-create and carry out care plans with their patients over time, despite uncertainties and any number of changing variables. The focused, purpose-driven ability of Crew Resource Management-based teaming behaviors to impact the good outcomes achieved by high-performing teams is well known.
A name, a concept and a methodology, TeamSTEPPS the acronym stands for Team Strategies and Tools to Enhance Performance and Patient Safety.
As a concept, TeamSTEPPS focuses on strengthening the specific knowledge, skills and attitudes of teamwork critical to highly reliable team performance and outcomes
As a methodology, TeamSTEPPS conveys to participants the knowledge, skills, tools and strategies found through decades of research critical to creating and maintaining high-performing teams. TeamSTEPPS curriculum provides the knowledge and critical success factors necessary to achieve excellence in behavioral training and performance simulation, human factors, and cultural change concepts specific to improvements in quality and patient safety.
Adaptable to all environments, TeamSTEPPS can be tailored to meet the needs of any team in any setting.
TeamSTEPPS for Office-Based Care tailors to the office-based setting the evidence base and many lessons learned from teaming in combat casualty care, inpatient and outpatient care, and ambulatory and clinic settings.
TeamSTEPPS
Say:
More than 40 years of research and evidence have been accumulated on teams and team performance in diverse areas (e.g., aviation, the military, nuclear power, health care, business and industry). TeamSTEPPS has evolved from research in these high-risk fields, where the consequences of error are great, to the health care field, a high-risk, high-stakes environment in which poor performance can lead to serious consequences or death. In effective teams, mistakes are caught, addressed, and resolved before they compromise patient safety. TeamSTEPPS provides specific tools and strategies for improving communication and teamwork, reducing chance of error, and enhancing patient safety.
Based on research, we know that teamwork is defined by a set of interrelated knowledge, skills, and attitudes (KSAs) that facilitate coordinated, adaptive performance in support of one’s teammates, objectives, and mission. Effective teamwork depends on each team member being able to:
- Anticipate the needs of others.
- Adjust to each other’s actions and to the changing environment.
- Have a shared understanding of how a procedure should happen in order to identify when errors occur and how to correct for these errors.
Team-related knowledge results in a shared mental model; attitudes result in mutual trust and team orientation. Outcomes of a high-performing team are adaptability, accuracy, productivity, efficiency, and safety.
Instructor Note: Before moving on to the next slide, ask if anyone has questions or comments. This is a good time to ask them to share comments they have about their own office-based teams and the challenges their teams face related to information exchange, communication, and teamwork.
TeamSTEPPS Skills
Say:
TeamSTEPPS is an evidence-based framework to optimize team performance across the health care delivery system. This framework is composed of four teachable-learnable skills:
- Leadership.
- Situation monitoring.
- Mutual support.
- Communication.
The red arrows on the graphic of the TeamSTEPPS framework depict a two-way dynamic interplay between the four skill areas and team-related outcomes. Interaction between the outcomes and skills is the basis of a team striving to deliver safe, quality care.
Encircling the four skills is the patient care team, which represents not only the patient, but also those who play a supportive role within the health care delivery system.
More than a logo, this graphic is designed and has become associated with the conceptual model of teaming in health care.
Does TeamSTEPPS Work?
Say:
Research has found that teamwork plays a critical role in providing quality health care, and that there are significant positive results when organizations implement teamwork initiatives. As TeamSTEPPS spreads across the many health care settings, the evidence base grows as well.
Some of the current clinical outcomes of team training include the following:
- 50 percent reduction in adverse outcomes, based on the average scores after they were weighted for severity (Mann, 2006).
- 50 percent decrease in the Severity Index, which measures the average severity of each delivery with an adverse event (Mann, Marcus, & Sachs, 2006).
- Reduced rate of adverse drug events.
- Improved medication reconciliation at patient admission (Haig, Sutton, Whittington, 2006).
Does TeamSTEPPS Work?
Say:
Research also cites outcomes of team training related to the way the team operates, such as the following:
- Significant improvement in communication and supportive behavior.
- Significant increases in perceptions of teamwork after training (Weaver et al., 2010).
- Reductions in turnover rate.
- Increases in employee satisfaction (Leonard, Graham, & Bonacum, 2004).
Later on we will look at some research that demonstrates the importance of teamwork in the primary health care setting.
Say:
This picture represents a moment in the life of the office-based team. What the patient sees and what you see are significantly different. The general public experiences the office from the perspective of one patient at a time, while office-based team members know the reality of juggling numerous patients over a long period of time. The work of an office-based team does not follow a linear process. It involves numerous parts working independently and interdependently.
How do you think this picture compares with the “front desk” picture that the average patient has of a medical office?
Instructor Note:
Provide participants with a chance to answer the question.
Followup questions:
- Do you think your patients have any idea how chaotic your office really is? How would they know? What would they hear? ...or see?
- If you could describe your office in one word, what would it be? If your patients could describe your office in one word, what would it be?
- If someone asked you to describe a typical day at your office, what would you say? If patients described a typical visit to your office, what would they say?
Prepare to discuss their answers and discuss this concept in greater detail on the next slide. If answers differ, ask "Why?"
Say:
On the surface, the office environment can and should appear orderly to patients, but to health care staff trying to attend to multiple tasks in a short time frame, it may seem chaotic. The analogy of a duck might help you understand what you see versus what the patient sees. The part of the duck that you can see—the part above the water—appears calm, but the part below the surface is chaotic with a lot of moving parts.
However, even though what the patient sees and what the team experiences are different, the actions of the primary health care team have a profound impact on patient care. Thus, when teams fail to work well together patients do know and experience firsthand the confusion, miscommunications and uncoordinated care that lead to mistakes and negative effects on patient outcomes such as safety, satisfaction or lack of engagement and activation.
It is important, therefore, that teams engage in teamwork, using proper teamwork strategies and skills. It is important to determine whether we are currently functioning as a real team. Next, we’re going to participate in an activity that will require us to work closely as a team.
Team-Building Exercise: Paper Chains
Say:
Before we get started, you're going to team up with the other people at your table and complete a team-building activity.
Do you remember making paper chains as a youngster or with your children? That is what we are going to do. This is a timed event with the goal to see which team can construct the longest chain. To make the chains, cut the construction paper into strips, make links by taping together the ends of a strip, then loop the next strip through it. Continue this process to make a chain.
Do: Play the video by selecting the director icon on the slide.
Do: Demonstrate how to make the chains as you explain the exercise.
You have 30 seconds to discuss with your team and 2 minutes to create the longest chain. Go!
Do: After 1/2 minute, prompt the teams to begin building. Stop them after the 2 min construction time. Have each group display the length of its chain. Have the groups set the first chains aside.
Now, discard all strips or unused links.
You're going to make a new chain; however, this time without the use of your dominant hand; place your dominant hand behind your back. You have 2 minutes. Go!
Do: After 2 minutes, have participants display the length of their second chains. Have the groups set the chains aside.
Now, you have one more chance to make the longest chain. However, this time, in addition to your dominant hand behind your back, you must not speak. You have 2 minutes. Go!.
Do: After the 2 minutes are up, display the final chains, and debrief the exercise. Ask questions such as:
- How did you work together?
- What worked well?
- What was the most challenging?
- What did your learn about yourself?
- What did you learn about your team?
Instructor Note: You may use a different team-building exercise here, if you prefer.
Ice Breaker Time: 10 minutes | |
Materials:
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Why Does Teamwork Matter in Office-Based Care?
Say:
There is a growing body of research that supports the value of teamwork in office-based health care. This research indicates that teamwork results in better continuity of patient care, better access to care, and greater patient satisfaction (Stevenson, et al., 2001).
Where there is teamwork among health care providers, patients perceive that they are receiving higher quality health care (Campbell et al., 2001).
A 2003 study (Bower, et al.) found that teamwork resulted in superior care for diabetes patients.
References
- Bower P, Campbell S, Bojke C, et al. Team structure, team climate, and the quality of care in primary care: An observational study. QSHC 2003;12:273-9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743743/.
- 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. http://www.bmj.com/content/323/7316/784.
- Haig K, Sutton S, Whittington J. SBAR: a shared mental model for improving communication between clinicians. Jt Comm J Qual Patient Saf 2006;32(3):167-75.
- 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. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765783/.
- Mann S, Marcus R, Sachs B. Lessons from the cockpit: how team training can reduce errors on L&D. (Grand Rounds) Contemp OB/GYN 2006 Jan;51:34-45. http://www.npic.org/Projects/Lessons_From_The_Cockpit.pdf.
- 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. http://www.ncbi.nlm.nih.gov/pubmed/11145623.
- Weaver SJ, Rosen MA, DiazGranados D, et al. Does teamwork improve performance in the operating room? A multi-level evaluation. Jt Comm J Qual Patient Saf. 2010;36(3):133-42. https://psnet.ahrq.gov/resources/resource/17607.