Teamwork and communication

Teamwork and Communication Paula S Kent, RN, MSN, MBA Patient Safety Coordinator The Johns Hopkins Hospital Baltimore, Maryland USA pkent2@jhmi.edu ACKNOWLEDGEMENT The slides and videos used in this presentation have been customized from the Department of Defense TeamSTEPPS program TeamSTEPPS[TM] is an evidence-based teamwork system to optimize patient outcomes by improving communication and teamwork skills among health care professionals Slides and videos are made available through the Agency for Healthcare Research and Quality.* General permission has been given to customize the slides to meet the needs of this program *TeamSTEPPS™: Strategies and Tools to Enhance Performance and Patient Safety Agency for Healthcare Research and Quality, Rockville, MD http://www.ahrq.gov/qual/teamstepps/ Teamwork is the ability to work as a group toward a common vision, even if that vision becomes blurry.” (Author Unknown) “Communication is the response you get from the message you sent regardless of its intent.” (Author Unknown) Objectives Describe the importance of teamwork and communication in the hospital setting Identify challenges to effective teamwork and communication Recognize the connection between communication and patient safety Define mutual support Communication is… • the process by which information is exchanged between individuals, departments, or organizations • the lifeline of the front line staff e.g., charge nurse, physician team leader and the direct care providers on the unit • most effective when it permeates every aspect of an organization and unit Why is Communication so Vital in Hospital Settings? • It affects the functioning of the team caring for patients • Numerous handoffs occur-between levels of care, shifts and providers • Many care providers are involved in the care process e.g., nurses, doctors, consult services, therapies and ancillary services • Clinical diagnosis, therapies, procedures and the patient’s outcomes depend on accurate information • Communication is essential for effective patient care in the 24X7 healthcare environment Joint Commission: The Importance of Communication Voluntary reporting of sentinel events to the Joint Commission reveals: Ineffective communication is a root cause for nearly 66 percent of all sentinel events reported* * (JC Root Causes and Percentages for Sentinel Events (All Categories) January 1995−December 2005) NUMBER ROOTCAUSE Challenges to Effective Teamwork and Communication • Healthcare environments challenge the communication process in hospital settings • Each challenge creates an opportunity for a potential medical error • Many factors can “fuel the fire” for ineffective communication SBAR… • provides a framework for team members to effectively communicate about a patient’s condition • communicates the following information: – Situation - What is going on with the patient? – Background - What is the clinical background or context of the situation? – Assessment - What I think the problem is? – Recommendation - What would I recommend? Call-Out… A Call-Out is a strategy used to communicate important or critical information during an emergent event Call-outs – inform all team members simultaneously during emergency situations – help team members anticipate next steps in patient care – benefits a scribe taking patient notes during event Check-Back • A Check-Back is a strategy to “close the communication loop” • The Check-Back process occurs when: • the sender initiates a message • the receiver accepts message and confirms what was heard • the sender verifies message received • If a call-out strategy requires a response in the form of an order; the order is then verified with a “check-back” • A check-back is similar to a “read-back” for verbal orders Handoff A Handoff is designed to enhance the exchange of information at critical times in the patient’s care A handoff includes: – transferring information (along with authority and responsibility) during transitions in care across the continuum (e.g., between shifts, ICU to inpatient transfer, OR to PACU) – providing an opportunity to ask and respond to questions – maintaining continuity in care even though the care giver changes What is Mutual Support? – Mutual support is the essence of teamwork, simply stated it is “backing up your fellow team members” – Mutual support protects team members from work overload situations that may reduce effectiveness and increase the risk of error When is Mutual Support Needed? Any time a unit is in the “work overload” mode This can occur with –any unexpected event on a unit –new patients being simultaneously admitted to the unit –other departments being backed-up and delayed –abrupt changes in a patient’s status Mutual Support: What does it look like? Back-up Behavior • Monitoring team members performance to anticipate if assistance is needed-constant situational awareness • Cautioning team members if there is a potential for an unsafe situation • Distributing and assigning work thoughtfully • Reassigning work if a team member gets overwhelmed-giving a team member time to regroup • Providing constructive feedback to others to improve performance Mutual Support: Task Assistance In a Culture of Safety it is expected that assistance will be actively sought and offered as a method for reducing the occurrence of error Mutual Support: Feedback • Feedback is the giving, seeking, and receiving of performance-related information • Feedback can be formal or informal • Anyone on the team can give feedback What to when there are Differing Points of View • Advocate for the patient or staff member even if your opinion is not popular • Assert your opinion in a firm and respectful manner • Always provide your evidence for your concerns Failure to speak up can lead to adverse events! Challenges to Providing Mutual Support “I’d like to provide mutual support but… ” • “I don’t have enough time to get my own work done” • Be adaptable: Ask someone else to provide assistance to your colleague “I’d like to provide mutual support but… ” • “My colleague is going to feel I am criticizing him/her” • State your intention-you are trying to lessen their workload or improve on their performance What can you to communicate effectively? • Communicate with team members in a brief, clear, and timely format • Seek information from all available sources (“Don’t play one man down”) • Verify and share information • Use communication exchange tools and strategies daily, i.e., SBAR, call-out, check-back and handoff What can we to provide Mutual Support? • Foster a climate of safety: be supportive of task assistance • Provide timely and constructive feedback • Be assertive and advocate for the patient or a staff member • Use the mutual support techniques: task assistance, feedback, advocacy and assertion • Resolve conflict through collaboration—Create a “Win-Win” situation In Summary • Effective teamwork and communication present opportunities to create a positive patient experience and prevent medical error • Challenges to effective teamwork and communication are varied - SBAR, Call-Out, Check-Back and Handoff • Communication and Patient Safety are closely linked • Mutual support is the essence of teamwork, and involves “backing up your fellow team members.” Questions? ... positive patient experience and prevent medical error • Challenges to effective teamwork and communication are varied - SBAR, Call-Out, Check-Back and Handoff • Communication and Patient Safety are... factors can “fuel the fire” for ineffective communication Factors that Challenge Effective Teamwork and Communication … • Language barriers and varying communication styles • Distractions • Misinterpretation... setting Identify challenges to effective teamwork and communication Recognize the connection between communication and patient safety Define mutual support Communication is… • the process by which