TeamSTEPPS is a teamwork system developed jointly by the Department of Defense (DoD)and the Agency for Healthcare Research and Quality (AHRQ) to improve institutional collaboration and communication relating to patient safety. Show
Instructor Outline: Essentials CourseInstructor Note: This course is designed to teach TeamSTEPPS Fundamentals to staff who do not engage in the direct delivery of care, but rather contribute essential information to the ongoing delivery of safe care. As such, participants in this course are not intended to further train others. It is important to note that the TeamSTEPPS Essentials Course is not interchangeable with the Fundamentals Course, nor is the Essentials Course a substitute for the basic education and skill practice offered through the Fundamentals Course. The outline below provides instructors with information in planning the instruction of the Essentials Course.
Additional Resources: Below are sources of additional information and videos you may use to customize this course to your participants' needs.
ContentsObjectives ObjectivesSay: Following this course, you will be able to:
Return to Contents TeamSTEPPS FrameworkSay: TeamSTEPPS stands for: Team Strategies and Tools to Enhance Performance and Patient Safety. TeamSTEPPS focuses on specific skills supporting team performance principles, including training requirements, behavioral methods, human factors, and cultural change designed to improve quality and patient safety. Within this course, teamwork concepts are introduced, including specific tools and strategies for improving communication and teamwork, reducing chance of error, and providing safer patient care. More than 30 years of research and evidence have been accumulated on teams and team performance in diverse areas, such as aviation, the military, nuclear power, health care, business, and industry. TeamSTEPPS has evolved from research in these high-risk fields to the health care environment, a high-risk, high-stakes environment in which poor performance may lead to serious consequences or death. Based on research, we know what defines a team, what teamwork requires, how to train team members, and how to manage team performance. Researchers have linked team training programs to improved attitudes, increased knowledge, and improved behavioral skills. For example, a meta-analysis published in 2008 (Salas, et al., 2008) included a comprehensive search of team training literature from 1955 through 2007 and examined over 300 empirical articles. Although this meta-analysis was not specific to team training in health care, its results demonstrated evidence that team training had a moderate, positive effect on team outcomes. TeamSTEPPS is built upon an evidence-based framework composed of four teachable, learnable skills: communication, leadership, situation monitoring, and mutual support—the core of the TeamSTEPPS model. The red arrows depict a two-way dynamic interplay between the four core skills and the team- related outcomes of enhanced knowledge, positive attitudes, and exceptional performance. Encircling the four skills is the patient care team, which represents not only the patient and direct caregivers, but also those who play a supportive role within the health care delivery system. Return to Contents Key PrinciplesInstructor Note: The key principles presented on this slide align with the five core modules presented in the TeamSTEPPS Fundamentals Course. Say: There are five key principles presented in this course. These principles correspond with the TeamSTEPPS Fundamentals course modules, which provide more indepth instruction to direct care staff. In this course, we will highlight key concepts from each module.
Return to Contents Team StructureSay: Team structure refers to the composition of a team. In health care, multiple teams are involved in patient care. This model is known as a multi-team system or MTS. Each team within an MTS is responsible for various parts of patient care, but all must act in concert to ensure quality patient care. A key component of the MTS is the patient. Patients are part of the patient care team and should be embraced and valued as contributing partners to patient care. In addition to the patient, the multi-team system is composed of several different teams.
Say: Ancillary Services consist of individuals who:
Ancillary Services are primarily a service delivery team whose mission is to support the Core Team. In general, an Ancillary Services team functions independently. Support Services are primarily a service-focused team whose mission is to create efficient, safe, comfortable, and clean health care environments, which impact the patient care team, market perception, operational efficiency, and patient safety. Ask:
Say: Administration includes the executive leadership of a unit or facility and has 24-hour accountability for the overall function and management of the organization. Administration shapes the climate and culture for a teamwork system to flourish by:
Return to Contents SBARSay: Within and across components of a multi-team system, communication is critical to the effectiveness of a team and to ensuring patient safety. TeamSTEPPS provides several communication strategies that can be used to ensure effective communication. The first technique is SBAR. SBAR provides a standardized framework for members of the health care team to communicate about a patient's condition. You may also refer to this as the ISBAR where "I" stands for "Introductions." SBAR is an easy-to-remember tool that is useful for framing any conversation, often a critical one requiring a clinician's immediate attention and action. In phrasing a conversation with another member of the team, consider presenting the:
Let's look at a short video clip in which the SBAR technique is used. Do: Discussion:
Return to Contents Call-OutSay: Another communication tool is the call-out. A call-out is a tactic used to communicate critical information during an emergent event. Critical information called out in these situations helps the team anticipate and prepare for vital next steps in patient care. It also benefits a recorder when present during a code or emergent event. One important aspect of a call-out is directing the information to a specific individual. Return to Contents Check-BackSay: A check-back is a closed-loop communication strategy used to verify and validate information exchanged. The strategy involves the sender initiating a message, the receiver accepting the message and confirming what was communicated, and the sender verifying that the message was received. As shown in the example on the slide, the doctor communicates an instruction, the nurse repeats it back, and the doctor closes the loop by verifying that the nurse received the message accurately. Return to Contents HandoffSay: When a team member is temporarily or permanently relieved of duty, there is a risk that necessary information about the patient might not be communicated. The handoff strategy is designed to enhance information exchange at critical times such as transitions in care. More importantly, it maintains continuity of care despite changing caregivers. A proper handoff includes the following:
Additionally, handoffs include the transfer of knowledge and information about:
It is important to highlight that both authority and responsibility are transferred in a handoff. As identified in root cause analyses of sentinel events and poor outcomes, lack of clarity about who is responsible for care and decisionmaking has often been a major contributor to medical error. Return to Contents I Pass The BatonSay: Each facility should determine a standard protocol for delivering handoffs and make the protocol known to staff. "I Pass the Baton" provides one option for conducting structured handoffs. I = Introduction—Introduce yourself and your role/job (include
patient). THE B = Background—Comorbidities, previous episodes, current medications, family history. Return to Contents Effective Team LeadersSay: Another critical aspect of teamwork is effective team leadership. Team leaders are well-informed team members who make decisions and take actions. Team leaders establish the goals of the team and help maintain its focus. There are two types of leaders: designated and situational. For a team to function successfully, a leader must be designated. In most clinical situations, the physician in charge is the designated team leader. Situational leaders emerge at designated times, such as during anesthesia induction, and at spontaneous times, for instance, the first responder to a code. When leading teams, both designated and situational team leaders must possess a set of effective skills regardless of the type of team they are leading or the situation in which they are leading it. At its core, leading teams involves the following activities:
It is critical that when leading teams, designated and situational leaders also:
Return to Contents Team EventsSay: Leading teams involves team events that include the activities of planning, problem solving, and process improvement. Three strategies that team leaders can use to facilitate these activities and promote teamwork are:
As shown on the slide, briefs are conducted at the start of a shift or a case, for example, to share a plan with the team. We will review briefs in more detail shortly. Huddles are ad hoc sessions to review and modify the established plans. These may involve reviewing the plans to ensure all team members continue to be on the same page or adjusting the plan based on known or anticipated changes. Debriefs are conducted to review what has occurred, such as after a case. These sessions are intended to improve team performance by identifying and reinforcing what went well and what can be improved. We will review debriefs in more detail shortly. Return to Contents Brief ChecklistSay: Briefs are a strategy for sharing the plan when leading a team. During a brief, which is sometimes referred to as a team meeting, the following information should be discussed:
Defining clear goals and a plan to achieve those goals is an important part of the brief as well as establishing clear roles and expectations for each team member. Successful teams measure their effectiveness in terms of how well they are performing against the established plan. The designated team leader usually conducts the brief, and team members actively participate. Similar to a preflight checklist used in aviation, the team leader should cover the items on this (or a similar) checklist. Conducting a brief at the beginning of a shift or prior to a case provides an ideal forum for communicating with other team members about the goals for each patient and the plan of care to ensure patient safety. Ask:
Say: Let's look at a short video clip that demonstrates a team conducting a brief. Do: Play the video by clicking the director icon on the slide. Discussion:
Return to Contents Debrief ChecklistSay: Research has shown that teams who effectively debrief their own performance can improve their teamwork in real time. Debriefs include:
Debriefs are most effective when conducted in an environment where honest mistakes are viewed as learning opportunities. Debriefs can be a brief (about 3 minutes or less) team event, typically initiated and facilitated by the team leader. This checklist can be used by the team during a debriefing to ensure that all information is discussed. Here are two guidelines for conducting debriefs:
These leadership techniques also help in maintaining an awareness of what is happening in your unit and with your team members. Situation monitoring is a continuous process that all team members should participate in. Return to Contents Situation MonitoringSay: Situation monitoring is a continuous process because of the dynamic situations in which teams function. This process consists of three components:
Ask:
Return to Contents STEPSay: How do you acquire a trained eye as you "monitor the situation" on your unit? What are relevant components of the situation that provide clues about impending complications or contingencies? The STEP process is a mnemonic tool that can help you monitor the situation and the overall environment. The STEP process involves ongoing monitoring of the—
It is not only the responsibility of the direct care team to monitor these elements—anyone involved in the care of patients or the environment should be expected to monitor the situation. Examples:
Return to Contents STEP AssessmentSay: In a health care setting, the most obvious element of the situation requiring constant monitoring is your patient's status. Even minor changes in the patient's vital signs may require dramatic changes in the team's actions and the urgency of its response. When assessing patient status, consider:
You should also be aware of team members' status, including:
You should be aware of the environment, including:
And finally, you should assess your progress toward goals by asking key questions. These questions are:
Return to Contents Cross-MonitoringSay: Health care providers are just as prone to human error as the general population. Teams that recognize and maintain an awareness of their individual team members' functioning are more likely to provide constructive feedback, have a shared understanding of the situation, and lend support or assistance when needed. Observing the actions of fellow team members—or cross-monitoring—is a safety mechanism that can be used to mitigate error before the patient is harmed. Commonly referred to as "watching each other's back," monitoring other team members by keeping track of their behavior and providing feedback ensures that procedures are being followed appropriately. It allows team members to self-correct their actions if necessary. Staff members need to constantly be aware of the situation, anticipate next steps, "watch each other's back," and take appropriate corrective action to prevent errors from reaching the patient. Let's try an exercise to demonstrate cross-monitoring. Find a partner so you are each in a pair. With your partner, share an example of a situation in which cross-monitoring was successful and one in which cross-monitoring should have been used but was not. Do: Give the pairs a few minutes to share their examples with one another. Then, bring the participants back together. Ask:
Say: Another tool for monitoring fellow team members and your own effectiveness is the I'M SAFE tool. Return to Contents I'M SAFE ChecklistAwareness of your own condition to ensure that you are fit and ready to fulfill your duties is essential to delivering safe, quality care. Team members should assess and report if there is a personal situation affecting their ability to perform. "I'M SAFE" is a simple checklist that can be used to determine both your co-workers' and your own ability to perform safely. I'M SAFE stands for—
Teams should be encouraged to set goals concerning the items on this checklist. For example, setting a goal that everyone will be given the opportunity to take a break and have lunch today. Ask:
Say: For this to be successful, there must be a culture in place in which staff feel safe to be honest without fear of reprisal, retribution, or disdain. Return to Contents Task AssistanceSay: Mutual support, which is commonly referred to as "backup behavior," is critical to team performance. Mutual support is derived from situation monitoring through the ability to anticipate patient needs, as well as other team members' needs, with accurate knowledge of their responsibilities. One method of providing mutual support is through task assistance. This includes both asking for assistance when needed and offering assistance to team members when the opportunity arises. Task assistance may involve asking for assistance when overwhelmed or unsure, helping team members to perform their tasks, shifting workload by redistributing tasks to other team members, delaying or rerouting work so the overburdened member can recover, and/or filling in for overburdened team members when necessary. Task assistance is guided by situation monitoring, because situation awareness allows team members to effectively identify when they, or other team members, need assistance. To a certain degree, some of us have been conditioned to avoid asking for help because of the fear of suggesting lack of knowledge or confidence. Many people refuse to seek assistance when overwhelmed by tasks. In support of patient safety, however, task assistance is expected. Ask:
Say: Error vulnerability is increased when people are under stress, are in high-task situations, or are fatigued. One of the most important concepts to remember with regard to task assistance is that assistance should be actively given and offered whenever there is a concern for patient safety. Return to Contents FeedbackSay: Another strategy to foster mutual support is feedback. Feedback is information provided for the purpose of improving team performance. The ability to communicate self-improvement information in a useful way is an important skill in the team improvement process. Feedback can be given by any team member at any time. It is not limited to leadership roles or formal evaluation mechanisms. Effective feedback benefits the team in several ways, including:
Ask:
Return to Contents Advocacy and AssertionSay: A third strategy used to facilitate mutual support is advocacy and assertion. Advocacy and assertion interventions are invoked when a team member's viewpoint does not coincide with that of a decisionmaker. In advocating for the patient and asserting a corrective action, the team member has an opportunity to correct errors or the loss of situation awareness. Failure to use advocacy and assertion has been frequently identified as a primary contributor to the clinical errors found in malpractice cases and sentinel events. You should advocate for the patient even when your viewpoint is unpopular, is in opposition to another person's view, or questions authority. When advocating, assert your viewpoint in a firm and respectful manner. You should also be persistent and persuasive, providing evidence or data for your concerns. Return to Contents Two-Challenge RuleSay: One strategy to facilitate team members' speaking up is the Two-Challenge Rule. It is important to voice your concern by advocating and asserting your statement at least twice if the initial assertion is ignored (thus the name, "Two-Challenge Rule"). These two attempts may come from the same person or two different team members.
Remember this is about advocating for the patient. The Two- Challenge Rule ensures that an expressed concern has been heard, understood, and acknowledged. There may be times when an initial assertion is ignored. If after two attempts the concern is still disregarded, but the member believes patient or staff safety is or may be severely compromised, the Two-Challenge Rule mandates taking a stronger course of action or using a supervisor or chain of command. This overcomes our natural tendency to believe the team leader must always know what he or she is doing, even when the actions taken depart from established guidelines. When invoking this rule and moving up the chain, it is essential to communicate to the entire medical team that additional input has been solicited. If you personally are challenged by a team member, it is your responsibility to acknowledge the concerns instead of ignoring the person. Any team member should be empowered to "stop the line" if he or she senses or discovers an essential safety breach. This is an action that should never be taken lightly, but requires immediate cessation of the process to resolve the safety issue. Return to Contents CUSSay: Using the CUS technique provides another tool for conflict resolution, advocacy, and mutual support. Signal words, such as "danger," "warning," and "caution" are common in the medical arena. They catch the reader's attention. In verbal communication, "CUS" and other signal phrases have a similar effect . If all team members have a shared mental model and are on the same page, when these words are spoken all team members will clearly understand the issue and its magnitude. To use CUS:
A few other phrases in use are:
Return to Contents Conflict Resolution: DESC SCRIPTSay: Conflict can occur in teams and it is important to know how to handle such situations when they occur. The Two-Challenge Rule, which we have already discussed as a tool to advocate and assert for patient safety, can also be used as a conflict resolution strategy. When team members have different information, the Two-Challenge Rule can be used to bring up the different information so it can be addressed. The DESC script can be used to communicate effectively during all types of conflict, and is most effective in resolving personal conflict. The DESC script is used in the more conflicting scenarios in which behaviors aren't practiced, hostile or harassing behaviors are ongoing, and safe patient care is suffering. DESC is a mnemonic for: D = Describe the specific situation. Ultimately, consensus should be reached. There are some crucial things to consider when using the DESC script:
Return to Contents Team Performance Observation ToolSay: In review, several key concepts and tools or techniques can be used to work as an effective team and ensure patient safety. The Team Performance Observation Tool presents types of behaviors that you might observe in a team's performance.
Say:
The Team Performance Observation Tool is generic, meaning it is not designed to focus on any particular clinical unit. However, it can be customized as needed. Some ways the tool might be integrated into practices include:
Return to Contents Tools and Strategies SummarySay: Throughout this course, you have received information about barriers to team effectiveness; tools and strategies to overcome such barriers; and the outcomes of effective teamwork. You have learned communication tools, such as SBAR, handoffs, and call-outs. You have also learned about leadership strategies for managing resources, along with tools for facilitating team events, such as briefs, huddles, and debriefs. You have also learned the situation monitoring mnemonic STEP and mutual support tools, such as the Two-Challenge Rule, CUS, and DESC script. Remember that enhanced patient safety is the ultimate outcome of consistently using the TeamSTEPPS tools and strategies to overcome barriers to team effectiveness. Return to Contents Exercise: SummarySay: To review what we've learned across the modules, we will watch a video scenario of a team in action. As you watch the video, make note of the use of TeamSTEPPS tools and strategies that are used. Do: Play the video by clicking the director icon on the slide. Discussion:
Say: The most important thing to take away from this course is how you will apply the tools and strategies that you learned in your daily work. Discussion:
Return to Contents Which healthcare team member is responsible for establishing systems to monitor and verify the competency requirements related to delegation in an organization quizlet?The chief nursing officers (CNOs) are accountable and responsible for establishing systems to assess, monitor, verify, and communicate competency requirements related to delegation. The primary healthcare team may not establish the principles of delegation.
Which healthcare team member is responsible for analyzing the knowledge and work of?The registered nurse must analyze any individual's knowledge before delegating a task. The charge nurse mainly functions as a liaison between team leaders and other healthcare providers.
Which member of the health care team is responsible for analyzing the knowledge and skills of unlicensed assistive personnel before delegating a task?Who is mainly responsible for analyzing the knowledge and work of newly hired unlicensed assistive personnel (UAP) before delegating a task? The registered nurse must analyze any individual's knowledge before delegating a task.
Which healthcare team member is responsible for the coordination and assignments of client care?Nurse managers work with their staff to coordinate all aspects of daily patient care on the unit.
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