Informational presentation on human interaction and communication with focus on patient safety in the healthcare environment. The concepts are appropriate for other industries which operate in a multi-disciplinary environment

1. Human Resource Factors
TEAM STEPPS
Margaret O’Donnell BSN MBA CEN CMTE EMT-P September 2014

2. TEAM STEPPS IS
• An evidence-based framework to optimize team performance across the health care
delivery system
• Scientifically rooted in more than 20 years of research and lessons from the application of
teamwork principles.
• Developed by Department of Defense's Patient Safety Program in collaboration with the
Agency for Healthcare Research and Quality.

3. TEAM STEPPS SEEKS TO
• Produce highly effective medical teams that optimize the use of information, people, and
resources to achieve the best clinical outcomes for patients.
• Increasing team awareness and clarifying team roles and responsibilities.
• Resolving conflicts and improving information sharing.
• Eliminating barriers to quality and safety.

4. Based on Team structure & four teachable – learnable skills
Communication
Leadership
Situation Monitoring
Mutual Support

5. TEAM STRUCTURE
Patient
Core Team
Coordinating
Team
Ancillary &
Support Services
Administration
Contingency Teams
Multi – Team System For Patient Care

6. COMMUNICATION
• SBAR (Q)
• Call Out
• Check Back
• Hand Off

7. SBAR (Q)
• Situation: What is going on with the patient
• Background: What is the clinical background or context
• Assessment: What do I think the problem is
• Recommendation & Request: What would I do to correct it
• Questions: When handing off patient – What questions do you have for me

8. CALL OUT
• Strategy used to communicate important or critical information
• Informs all members of team simultaneously
• Helps team members anticipate next step
• Important to direct responsibility to a specific individual for carrying out
the task

9. CHECK BACK & HAND OFF
• Use of closed loop communication to ensure information conveyed by the
sender is understood by the receiver as intended
• Transfer of patient information along with authority and responsibility during
transitions in care across the continuum
• Includes opportunity to ask questions, clarify, and confirm (Q)

10. I Introduction Introduce yourself and your role/job (include
patient)
P Patient Name, identifiers, age, sex, location
A Assessment Present chief complaint, vital signs, symptoms, and
diagnoses
S Situation
Current status/circumstances, including code
status, level of (un)certainty, recent changes, and
response to treatment
S
Safety Concerns Critical lab values/reports, socioeconomic
factors, allergies, and alerts (falls, isolation,
etc.)
THE
B Background Comorbidities, previous episodes, current
medications, and family history
A Actions Explain what actions were taken or are required.
Provide rationale.
T Timing Level of urgency and explicit timing and
prioritization of actions
O Ownership Identify who is responsible (person/team), including
patient/family members
N Next What will happen next? Anticipated changes? What
is the plan?Are there contingency plans?
I PASS the BATON / Hand Off

11. LEADERSHIP
• Effective Leaders
• Organize the team
• Identify and articulate clear goals (i.e., the plan)
• Assign tasks and responsibilities
• Monitor and modify the plan; communicate changes
• Review the team’s performance; provide feedback when needed
• Manage and allocate resources
• Facilitate information sharing
• Encourage team members to assist one another
• Facilitate conflict resolution in a learning environment
• Model effective teamwork

12. TEAM EVENTS
• Brief
• Short – Prior to start – Share plan
• Huddle
• Ad hoc meeting to reestablish situational awareness
• Debrief
• Informal information exchange to improve team performance and effectiveness
through lessons learned

13. SITUATION MONITORING
• Continually scanning and assessing current situation
• Awareness: state of knowing what is going on around you
• Shared mental model: each team member maintains situational awareness to
insure all are ‘on the same page’

14. CROSS - MONITORING
• Monitor each others actions
• Provide safety net within the team
• Ensure mistakes or oversights are caught quickly and easily
• “Watching each others back”

15. MUTUAL SUPPORT
• Task Assistance
• Protect each other from overload situations
• Place all offers and requests for assistance in the context of patient safety
• Climate in which it is expected assistance will be actively sought and offered

16. FEEDBACK
• SHOULD BE
• Timely
• Respectful
• Specific
• Directed
• Considerate

17. ADVOCATE FOR THE PATIENT
• When team members have differing viewpoints than the decision maker
• Assert a corrective action in firm and respectful manner
• Make opening
• State concern
• State problem (real or perceived)
• Offer solution
• Reach agreement on next steps

18. TWO CHALLENGE RULE
• If initial assertive statement ignored
• Make statement at least two times to ensure you have been heard
• Team member being challenged must acknowledge you have been heard
• If safety issue not addressed
• Take stronger course of action
• Use chain of command

19. CUS WORDS
• I am oncerned
• I am ncomfortable
• This i a Safety issue
STOP!

20. DESC SCRIPT
= Describe specific situation, provide concrete data
= Express how your feel / what your concerns are
= Suggest alternatives, seek agreement
= Consequences stated in terms of impact, strive for consensus