Importance of Culture and Assembling the Team Presentation

CUSP BOOT CAMP
Importance of Culture:
Assembling The Team
April 16 th , 2013
Gail J. Rudder RN, CRNI, CIC

Assembling the Team
Objectives
• Recognize how culture impacts the Team
• Learn how to build an Effective Team using CUSP/
TeamSTEPPs approach
• Know the four principles of TeamSTEPPs
• Learn how to identify and engage team members and
define roles and responsibilities
• Enhance Team Communication

What is the Culture
• Assessment of the current culture –
o How do things work,
o How do we communicate,
o When bad things happen what’s next
• Teamwork – Do we work in silos
• Patient Involvement
• Systems – Are the systems flawed, conducive to error
• Openness and transparency
• Accountability

Why Teamwork and
Communication Matter
• Better patient outcomes, higher patient satisfaction,
and lower malpractice claims.
• Studies by the Institute of Medicine found that
quality and effectiveness of care vary greatly
depending on how well a healthcare team
functions, and
• that system failures rather than individual
performance account for more errors or adverse
events.

Did You Know
• From 1995 to 2005, ineffective communication identified as a
root cause for ~ 2/3 of all sentinel events reported to the Joint
Commission on Accreditation of Healthcare Organizations,
o a statistic supported by analyses of closed malpractice claims.
• 4 of the top 6 case areas that make up a majority of lawsuits are,
in some way, associated with a failure in teamwork.
• System errors, including failures in teamwork, contribute to
almost 1/3 of settled malpractice claims.
• The government and other third party payers have moved towards
not paying for a select set of medical errors – “Never Events” or
“serious reportable events”.
• www.pathwaysforpatientsafety.org

Benefits of Effective Teamwork &
Communication
• Consistent delivery of patient care
• Essential for managing the complexity of patient
care in setting that often exceeds the capabilities of
an individual clinician
• Allows staff to learn from mistakes rather than
place blame
• Provides a positive effect on patient safety

What is a Team
Definition: A team is a group of two or more individuals
with specific roles that relate to one another and who
share a common goal.
- Team members are highly interdependent in
accomplishing their goals.
- Their interactions have a strong effect on patient
care outcomes.
What does a good team look like – do you know it when
you see it

Unit Team Characteristics
CUSP
• Has diverse local
“opinion leaders” and
dissenters.
• Is willing to help to
spread the intervention.
TeamSTEPPS
• Develops a strong sense
of collaborative trust and
confidence.
• Manages and optimizes
performance outcomes
• Develops a strong sense
of collective trust, team
identity and confidence.

Team Member Characteristics
CUSP
• Maintain a positive outlook
• Emphasize dedication to
project goals.
• Focus on the broader view
• Practice attention to detail
• Understand roles and
responsibilities.
TeamSTEPPS
• Provide quality information
and feedback.
• Skillful conflict
management.
• Stress reduction for the
whole team through better
performance.
• Understand roles and
responsibilities.

Tools You Can Use
• The Team STEPPS program is available free of
charge at either the Agency for Healthcare
Research and Quality (AHRQ) website:
• http://www.ahrq.gov/teamstepps or the Department
of Defense Patient Safety Program website:
• http://dodpatientsafety.usubs.mil/teamstepps

Principles for Success
• Leadership – Buy-in and support is key
• Mutual performance monitoring
• Mutual support
• Situational awareness

Applying Teamwork Principles to
Patient Safety
Create a sense of URGENCY
It is important to “make the case” for effective teamwork
• Self-assessment – Where Do We Stand
• Safety events (HAIs)
• Accreditation/Regulatory Survey findings
• Stories about near misses
• Patient and employee surveys
• Staff concerns about quality and patient safety

Creating the Team
• Project Leader
• Executive Leader -
VPMA, VPNE, CNO
(imperative if program is
to be successful)
• Physician Champions
• Quality Manager
• Risk Manager
• Patient Safety specialist/
Officer
• Nurses and other front
line staff
• Environmental Services
• Pharmacist
• Infection Preventionist
• SMEs- Educators
Initially started as unit based in the ICU – concept of
CUSP has spread through “Buy In”

Barriers to Team Performance
• Inconsistency in team membership
• Lack of time – Biggest challenge
• Lack of information sharing
• Hierarchy
• Varying communication styles
• Presence of conflict
• Lack of coordination and follow-up
• Misinterpretation of cues
• Lack of role clarity

Team Performance
Engagement
• Engagement: “To involve oneself or become
occupied; to participate fully and deeply”
• Active support of the project
o
o
o
o
Engaged
Apathy
Aversion
Uninvolved

Engage Team Members Using the
4 E’s
• Engage (adaptive) – How does this make the world
a better place
• Educate (technical) – What do we need to know
• Executive (adaptive) – What do we need to do
What can we do with our resources/culture
• Evaluate (technical) - How do we know we
improved safety

Project Leader’s Role
• Encourages unit staff involvement
• Obtains staff feedback
• Manages documentation of CUSP activities
• Educates staff about CUSP
• Is a frontline provider, nurse educator, physician, or
other staff member

Physician Engagement
• Identify physician leaders
• Create an understanding of this role
• Listen to physician concerns
• Develop plans to address concerns
• Reward physician leaders
• Create a vehicle for communication
• Develop a plan for communications

Role of the Physician Champion
• Serves as the role model for CUSP activities
• Meets with CUSP team at least monthly
• Participates in monthly senior executive
partnership meetings
• Communicates with physician group as needed
• Assists with implementation of interventions
Recognized as someone who will carry the torch!

Engage Other CUSP Team
Members
• Executive partners
• Nurses
• Patient Safety Specialists/Officers
• Infection Preventionists

Senior Executive’s Role
• Helps the team prioritize improvement efforts
• Helps the team navigate organizational
bureaucracy – aka. RED TAPE
• Ensures the CUSP team has resources to fix
problems
• Makes rounds and meets monthly with members of
health care team on the unit

Nurse Manager’s Role
• Supports CUSP activities
• Ensures safety assessment results are shared with
staff
• Assigns project leaders to interventions
• Assists with scheduling executive partnership
• Manages local resources

Patient Safety Officer’s Role
• Serves as a senior executive partner in some
institutions
• Coordinates executive orientation with the initiative
• Verifies that surveys are analyzed and results are
reviewed in a timely manner
• Monitors progress of the intervention
• Disseminates results and shares stories
Success stories are just as important as event
stories

Assemble the Team: What the
Team Needs to Do
• Recruit a team lead, nurse manager, physician,
and executive partner along with any other team
members
• Meet with hospital departments (QI, IP&C, Risk)
• List team member names and contact information
• Use the 4 Es to ensure team engagement

Enhance Team Communication
“Good communication is at the heart of patient
safety.”
When critical information about a patient’s condition
or care does not get to the right person at the right
time, patients can suffer the consequences.

Team Communication
Why is it important
To facilitate optimal information exchange and
problem-solving, team members should:
• Use standardized terminology
• Use standardized patterns of communication
• Use concise communication
• Confirm and validate information

Team Communication Tools
You can use
SBAR – Situation, Background, Assessment,
Recommendation
Ø Helps team members accurately share information,
ensuring that both the sender and receiver of
information place the appropriate focus on what is
communicated.
Ø Focuses on essential information related to the
patient’s condition and the communicator’s
recommendation on needed action.
• AMA Foundation SBAR Handout (PDF)

SBAR
• Situation - What is going on or what happened to
the patient
• Background – What is the clinical background or
context Include pertinent information from H&P,
medical record
• Assessment – What do I think the problem is
• Recommendation – What would I do to correct it

Example of the SBAR Tool

Empowerment of Staff
• Staff feel empowered to speak up
• CUS – Concerned, Uncomfortable and Safety issue
• Safety Debriefs
• Daily/shift huddles
Even the briefest of meetings will help you and your
team work together to achieve and sustain a culture
of safety…….

Summary
• The CUSP team will include health care providers,
support and leadership staff
• The “4 E’s” is a highly effective tool for recruiting team
members
• Team members work together to identify barriers and
address them as a group
• For teams to be successful, the roles and responsibilities
need to be clearly defined.
• Effective communication builds awareness of potential
problems and concerns and allows the team to seek
solutions

Comments from Faculty
Comments from Participants

References
• 1. Agency for Healthcare Research and Quality,
Department of Defense. TeamStepps. Available at
www.ahrq.gov/teamsteppstools/instructor/index.html
• 2 Pronovost P J, Berenholtz SM, Goeschel CA, et al.
Creating high reliability in health care organizations
Health Serv Res 2006; 41 (4.pt 2):1599-1617
QUESTIONS