AMERICAN INSTITUTES FOR RESEARCH

National Implementation of TeamSTEPPS Webinar 8

TeamSTEPPS: MAKING IT STICK
(Post-TeamSTEPPS Training Activities)

Moderator: Alexander Alonso
March 25, 2009
11:00 am CT

Operator: Ladies and gentlemen thank you for standing by and welcome to the TeamSTEPPS National Implementation Program Webinar 8, TeamSTEPPS: Making it Stick.

During the presentation all participants will be in a listen only mode. Afterwards we will conduct a question and answers session. If at any time during the conference you need to reach an operator please press the star followed by the 0. As a reminder this conference is being recorded Wednesday, March 25, 2009.

I would now like to turn the conference over to Alex Alonso. Please go ahead sir.

Alex Alonso: Thank you. I want to go ahead and welcome everyone to the eighth Webinar in the series of National Implementation Program Webinars. Our topic for today will be TeamSTEPPS: Making it Stick. We have two honored, esteemed colleagues who will be providing information regarding this topic.

The first is David Baker of Carilion Clinic, American Institutes for Research, and the Virginia Tech School of Medicine. And the second is Melissa Morris of Pediatric Services at Carilion Clinic.

As a reminder we ask that you consider others while participating in this Webinar. Please remember to mute your phones to reduce background noise. Do not put your phone on hold if you have hold music or advertisements. And keep in mind that a conference call is never better than the worst connection on the call.

Cori, at this time I want to go ahead and turn it over to you so you can provide some parameters about the Live Meeting software.

Cori White: Hi. The Live Meeting software is pretty straight forward for those of you who are participating in the Webinar in a non-speaker function. Pretty much you just sit back and watch the slides. The most important thing though for you to know is that we will be handling our questions and answers today primarily through the Live Meeting Client.

What that means is that in order to ask a question you’ll have to go to the top tab in your screen that says Q and A. When you click on that it will give you somewhere to enter a question, and you enter it there. If we think it’s something that can be handled immediately and maybe is something that’s not a question for the larger group, we’ll take care of it in that questions and answers dock.

If it’s a question that we think the rest of the group would benefit from, we will wait until we have a pause for questions and then go through and answer all of them for you. You’re welcome to enter questions at any time, but they will only get answered on the questions slide usually.

The other thing that’s important to know is that the top right hand side of your screen there’s an icon that has three sheets of paper, that if you hover over it over it, it says handouts. And that’s where you can get PDF versions of the slides for today if you want to print them out. We’ve included them both in full slide format and a format that’s three slides on a page with space for notes.

The other thing that you’ll see at the top right hand side of your screen is a little square that says feedback next to it. That’s the place where you can tell us how we’re doing. It automatically defaults to green which means you’re okay, but if you need us to slow down or you need some help with something please let us know through there. However we do ask that you don’t use the purple question box because there’s nothing we can do about it when you do that so instead we ask that you use the Q and A tab at the top of your screen.

If you’re not connected through Live Meeting today, as I know there may be a few people, we will also have audio conferencing which will be available through the operator. And operator would you like to tell us how people can log questions with you?

Operator: Absolutely. Ladies and gentlemen if you’d like to register for a question over the phone please press the 1 followed by the 4 on your telephone. You’ll hear a three tone prompt to acknowledge your request. If your question has been answered and you’d like to withdraw your registration please press the 1 followed by the 3. And if you’re using a speaker phone lift your handset before entering your 1, 4 request. Thank you.

Cori White: All right. Thank you. The other one thing that I didn’t mention that I should have mentioned is that at the end of the Webinar we’re going to take about two minutes and ask you for your feedback about the Webinar. We just have two quick questions that we like to ask. Those of you who have been on Webinars with us before will recognize them. It’s just sort of so we get a little bit of idea of how we’re doing.

So, go ahead Alex.

Alex Alonso: All right, thank you Cori and Operator. Today’s agenda will follow suit. We’re going to go ahead and let you know a little bit about who we are, what the National Implementation of TeamSTEPPS Program is, provide you some insight about sustainment activities as Carilion Roanoke Memorial Hospital, and specifically with regard to their pediatric implementation.

Then we’ll go ahead and provide you with some tips for sustainment, some results. And then we have a special section called National Trends in Sustainment Activities and this is information gathered from you, the master trainer List Serve members who provided information regarding the sustainment activities at your specific organization or facilities, followed by an open period for questions and information on how to contact us.

The American Institutes for Research is the private contractor for the National Implementation of TeamSTEPPS Program. We are a not for profit, nonpartisan DC based research organization with 11 U.S. offices and 12 international offices working specifically on health services research, education and work force topic, including staff from health services research background, nursing and physicians clinical backgrounds and social sciences backgrounds. Our mission is to better society through our research.

The National Implementation Program is a project designed to create a national infrastructure to support the adoption of TeamSTEPPS through CMS’s Quality Improvement Organizations, the Patient Safety Improvement Corps from AHRQ and the VA as well as other research organizations or research groups include High Reliability Organizations, the Action Network Partners from AHRQ, the academic medical centers across the United States and other professional organizations.

The goal was to make training available to all early adopters of TeamSTEPPS, spread TeamSTEPPS nationally and create up to 1200 new master trainers.

This project - this team is comprised of team resource centers including University of Minnesota, Creighton University, Carilion Clinic out of Roanoke and Duke University. As you can see we were also supported by two quality improvement organizations under CMS contract, the Lumetra Organization and Delmarva Foundation. We also have two independent contractors who are providing support in terms of evaluation of the impact of National Implementation of TeamSTEPPS and those are Booz Allen Hamilton, and the Group for Organization Effectiveness out of Albany, New York.

Our title sponsors are the Department of Health and Human Services and specifically the Agency for Healthcare Research and Quality and the Department of Defense Tri-Care Management Activities, specifically the Health Care Team Coordination Program.

Our project team consists of the Project Director, David Baker who is here with us today, myself, Debbie Milne, who’s in charge of Outreach and User Support, Cori White who is here with us today and is responsible for administrative duties on Webinars and research and Rachel Greenberg who is responsible for Outreach and User Support. It’s important to note that we are an interchangeable team.

Please note that these are our points of contact. I’m going to leave that up there for one second. However you will note that we will provide this information later on toward the end of the Webinar today.

David Baker is a principal research scientist at the American Institutes for Research. He is the Project Director and overall principle investigator for all TeamSTEPPS initiatives going on here at the American Institutes for Research including a medical team training case study, the development of TeamSTEPPS for rapid response systems, the development of TeamSTEPPS measures and evaluations, and the National Implementation Program.

He also has a dual appointment with the Carilion Clinic where he leads the team resource center, supports internal TeamSTEPPS implementation, and research on the affect of TeamSTEPPS including an evaluation using socio-technical problematic risk assessment.

He is also an associate professor with the Virginia Tech Carilion School of Medicine where he is working to integrate TeamSTEPPS into the curriculum.

Melissa Morris is a registered nurse with the Pediatric Services Unit at Carilion Clinic. She is also a TeamSTEPPS master trainer, she’s been part of the initial internal implementation and she specializes in sustaining the SBAR Huddle, CUS, 2-challenge rule and focusing on other sustainment activities.

At this point I’m going to go ahead and turn it over to David.

David Baker: So, thank you Alex. And Melissa and I are very happy to be joining you all today to tell you a little bit about Carilion’s story. We’ve been working on this for some time now, about pretty consistent with when the national implementation program started. We’ve been very engaged and very happy with where we’ve gotten with TeamSTEPPS.

For those of you who have been to Roanoke for the training which I’m sure some of you on the line have, you’ll know that I am located at Carilion but I also continue to work for AIR and to me that’s been a real huge advantage. I started most of the TeamSTEPPS work here at AIR where I happened to be located today doing this Webinar and when I got to Carilion it was a great opportunity to work within the hospital system and put some of these concepts into practice and see how they really work within our system.

So one of the things that we’ve been working on in particular as you can see from this slide is a little bit about how does TeamSTEPPS work. For those of you who have been to the training you’ll see it looks a little bit different than that green slide that we’ve put up there on a regular basis moving into the implementation planning.

Still, it has the basics stages right, assessment, planning, training, implementation and sustainment. The difference is the graphing. One of the things that we’ve been working on in particular at Carilion is to stick within the quality integration and implementation project department. I work with the VP of Medical Affairs who’s starting to think about TeamSTEPPS, thinking about our quality program and how this all fits together.

So the graphic that we have on our slides when we talk about how it works is the DMAIC graphic from Six Sigma. The reason we do that is because DMAIC is our QI improvement methodology. There are any number of these PDSA, the TeamSTEPPS approach, DMAIC, they all are kind of the same approach. So we’re trying to again customize the curriculum and think about how it fits over - fits in to what we’re talking about in terms of quality. And we’re continuously - this has been a relatively new thing in the last 3-4 months, but we’re continuously now trying to look at that and how the pieces of our quality program and our quality initiative fit together.

So you can see there’s our Roanoke Memorial Hospital. It’s located in beautiful Roanoke, Virginia, the star city of the south. Carilion Clinic overall or the Carilion Medical System consists of seven hospitals. We have a couple critical access hospitals. We have a couple community hospitals on the lake.

RMH is our largest hospital. It’s an 825 bed unit, it’s a level one trauma center and it’s a nonprofit healthcare system. I think one of the things Melissa can comment on more than I can is that we just recently were awarded or re-awarded our magnet designation, recertified in 2008. And within the RMH we have about 5000 employees, 1200 of which are nurses in acute and ambulatory setting.

One of the things that I think anybody that works in the system can relate to, and this gets back to my earlier slide, is we have a bunch of quality programs going on and this is what I’m talking about when we begin to think about how these all fit together. So we have two service oriented programs within our facility. One for staff called SERVE U, this is a customer service kind of program. The other for physicians which is called PLeaSE, Physicians Leading Service Excellence.

And one of the things we’re starting to look at is how does TeamSTEPPS fit within these programs that predate the implementation of TeamSTEPPS. SERVE U is something that all our new staff have to go through, PLeaSE is something the physicians have to go to. Can we take the TeamSTEPPS tools and begin to launch them earlier and align that with the SERVE U principle?

The nice thing about that that we see some potential in is these SERVE U principles are actually something that are included on each employees’ performance evaluation. You get a SERVE U rating which is a full 360 degree rating and it accounts for 35% of your overall performance grade. So it would be nice again thinking about the alignment commitment in terms of showing that these things are important, how we begin to bring these things together.

The second thing that we’re doing which I’m sure many of you are doing is we’ve got Six Sigma. We’ve got some green belts, some black belts, whatever color belts running around our hospital and they’re really about doing process improvement.

One of the things that we’re working on currently is our ED flow and I’m sure everybody can relate to the concept of flow and getting patients more efficiently through the ED and we’ve had an ongoing Six Sigma project in there and we’ve gained some results with some of the redesign activities and how we’re triaging patients and the like with respect to our emergency department.

Again we may not launch it as a separate initiative to say you’ve done Six Sigma now do TeamSTEPPS. We might figure out how we can fit it in to the Team - the Six Sigma team project that we have ongoing.

The final thing that we’re looking at and we’ve done this at one of our facilities already. One of our facilities is New River Valley Facility which is about 120 beds for some reason that sticks out in my mind. It’s about 35 miles south, southwest from our Roanoke, has started Just Culture projects.

Now again I think all these things fit together when we think about just culture and what David Marx talks about in terms of error reporting, understanding errors, understanding events. But again we need to think about how these all fit together and we’re just beginning that and starting to talk about how we can use the AHRQ Hospital Survey On Patient Safety Culture to help us inform things like TeamSTEPPS, perhaps our Service Excellence program and our Just Culture initiatives to make sense about how to customize these and bringing it in to one common quality framework.

So this is our current quality framework. So we have a quality plan, a quality framework which guides the things that we do at Carilion that come out of QI. What I’ve done in my briefings now is tried to talk about in terms of our quality initiatives how does TeamSTEPPS fit within our quality goal. So within quality we’re interested in things with respect to license, compliance, accreditation and regulatory issues. Well many things.

We just went through our Joint Commission review last week by the way, but many things Joint Commission has done historically have reinforced through their patient safety goals these TeamSTEPPS kind of initiatives.

So safety and performance improvement: obviously TeamSTEPPS fits there, more effective use of resources and certainly we’re trying to improve the clinical teamwork and excellence of those folks, it’s there as well and also in terms of improving our overall culture of safety which we’re now measuring on an annual basis.

So we’re trying to show how this program fits within our core initiative in that it’s just not something new and just not something different and it fits within our quality framework and what we’re trying to do.

Now I’m going to turn this over. Let me introduce Melissa. Melissa, are you on the phone?

Melissa Morris: Yeah.

David Baker: So Melissa is going to walk you through a little bit of what we’ve done in Pediatrics. Now Pediatrics, just to give some context before we turn it over to Melissa, when we started training at Carilion or became a TRC under the national implementation it was very important that each of those programs had ongoing implementations.

And last January, not this past one, 2008 our master trainers that had been prepared by AIR actually wanted to get ready to launch the program and be prepared for our first training in February. We brought in our pediatric group and our pharmacy group as our first launches of TeamSTEPPS within the institution.

Melissa was at that training. She’s one of our best and most well established master trainers and has been working on this project now for the past 14-15 months. So with that introduction I will turn it over to Melissa.

Melissa Morris: Thanks David. I think the biggest thing is that TeamSTEPPS has been instrumental in a lot of processes for us that have been new. Just a little background. Our hospital is a 92 bed children’s hospital but it’s within another hospital. And we operate an 8 bed PICU and then we have a 22 bed pediatric unit. So we had been in a big transition and we actually were in two separate hospitals, another hospital down the street and we moved to this hospital September - almost two years ago.

In the old hospital we had two different units. The pediatric unit was on the tenth floor and the PICU was on the fifth floor. So this just naturally created some communication problems, you know staff didn’t know each other very well. So one of our main objectives when we came here was just to bridge that gap with communication issues to develop some cohesion between those two groups of staff members and we also had several new graduate nurses that were working on the floor in the pediatrics unit. We wanted to give them the tools to be able to communicate effectively with the doctors and other team members.

We had also had several root cause analysis situations that had happened and when we looked back at those things we definitely were able to pinpoint that they were communication - breaks in communication. So that’s how we started our process.

So in the beginning we just started with providing the staff with tools and strategies just to make them successful and feel comfortable to be able to handle the different tools that we were giving them. Our goals of course were to improve patient’s satisfaction and safety and I think with that you know it just goes without saying that it will decrease your length of stay with your patients.

So what we did in the beginning was we picked a team. Our change team - it was very important to us that our change team be multidisciplinary. We had doctors that were head of the PICU and of the pediatric ward. We had RNs some of which were just staff members, some of which were CTLs which is a Clinical Team Leader who is like a head nurse. We had respiratory therapists and then we had one our HR representative that was on that team and of course David and his team helped us along with developing that.

So the most important thing for us was we wanted to create a sense of importance - you know urgency to our staff but to also create excitement in the staff so that they’re asking questions and wanting to know more about what we’re doing.

It was a difficult time too for us to do this because we were in a huge transition. We had just moved to this hospital. We also were going to electronic medical charting. So in the beginning we did this in small increments instead of you know overwhelming the staff at one time.

We started with SBAR and the hospital had implemented some training with SBAR but it wasn’t what we wanted. So we did a lot of training with SBAR. We then went to Huddles and then CUS and the two-challenge rule we have just implemented recently.

So once we gave these tools to our staff it was important for us to keep the staff doing them. A little bit about our huddles which I think the SBAR’s been wonderful and you have to have buy-in from the doctors to do that also and allow the nurses to get into the practice of communicating in that way. The huddles have been really nice.

We huddle between our pediatric ward, the charge nurse there, and the charge nurse in the PICU. Every morning we do that after rounds. So we have a clear vision of you know what patients are moving in and out of the units. What patients are having procedures done that day. Any kind of needs that you may have for staffing. This gives everybody on the same page.

It’s also that we can have any nursing staff or any member of our multidisciplinary team call a huddle at any time if we’re getting lots of admissions or if a patient is critical or it can be any situation that people need clarity and want to get the whole team together so we can talk about what our plan is going to be.

We also have huddles in the evening usually around 10:00 at night. For those, the physician gets with the nurses that are working that night and they have a clear plan as to what’s going to happen for the night for those particular patients that are in the unit so that nobody’s left wondering and that has been huge in the success with our staff members and the physicians too.

So I think it just makes our team work a lot more efficiently. So does anybody have any questions about that?

Cori White: Right now we don’t have any questions through the Live Meeting Client. Again I’d like to remind everyone that we prefer to receive your questions online through the Q and A tab at the top of your screen. If you have a question please enter it there. You can enter it now, you can enter it whenever you think of the question. But as of right now we don’t have any there.

Do we have any on the phone?

Operator: We actually do have a question on the phone line.

Cori White: Okay.

Operator: It comes from a caller from the U.S. Army Health Clinic. Please go ahead sir.

Man: I’m sorry. I got that answered over the email. I needed the slide because I was on audio. Sorry I didn’t delete the question.

Alex Alonso: No problem.

Cori White: Thank you.

Operator: That’s all we have on the phone lines.

Cori White: Yes. In the future if you need slides in advance that’s something you can ask for with your registration. I’m happy to send them, but usually we try to send them out in one big batch. So if you’re unable to be on Live Meeting when you register please just let me know.

Alex Alonso: Cori, it appears that we have one question, or two questions now on the - three actually.

Cori White: Ah, they’re coming in. Okay, so the first question is “How do you log these huddles?” And that’s actually two parts. I don’t - Alex, I don’t know if I understand the second part, you might have to do that one.

Alex Alonso: Okay, also “is MD at 2200 a hospitalist?” So we had a question regarding whether or not there was a doctor at the 10:00 pm hour who is a hospitalist.

Melissa Morris: Yes.

Alex Alonso: And you were logging these huddles.

Melissa Morris: We have on our pediatric ward we have a hospitalist that is onto that ward and then in the PICU we have an intensivist that is assigned to that ward. Now it depends on the severity or complex needs of the patients that are actually in the units at that point in time.

Those huddles can occur in the unit with everybody here, or they can occur over the phone. If we don’t have critical - you know our PICU is also a step-down unit too. So sometimes you don’t have a critical patient in here. So at that point in time we would just touch base on the phone and go from there.

Cori White: Okay, thank you. The next question is, is there any reason to consider these huddles rather than briefs?

David Baker: Melissa, do you want to answer that or I can make a comment on that. I’m not...

Melissa Morris: Go ahead and make a comment on that David.

David Baker: Sure, I think that’s kind of a - we’ve had this discussion, I don’t know what I would consider it at kind of the technical expert level. It was really an interesting discussion at some point as to whether or not you know what’s the difference between a huddle and a brief?

We kind of went back and forth and it was an interesting discussion kind of brought up - it was brought up by John Webster I don’t know if he’s on the phone today, but he’s one of what I would consider the founding fathers of all this. John’s an orthopedic surgeon out in San Diego.

You know on one hand technically a brief is that planning activity that you do initially, they formulate that initial plan together and then you would huddle when the plan changes. Now that being said I think on the implementation side I’m most happy that the people are getting together, they’re meeting and discussing this whether that’s a brief or a huddle that, to me personally, is a label and maybe a little bit less important.

But I know within the curriculum we teach it that way. So the first meeting of the day might be considered a brief and then the follow-up meetings might be huddles. Or however you want to phrase it. But I think Melissa - it’s been working well for you guys right? In terms of calling them huddles and everybody knows what they are and helping with that planning.

Melissa Morris: Oh, most definitely. I mean it is the staff so comfortable with calling a huddle and saying “okay I need to talk about this” or “I need some clarity about what is our plan for the day?” It has worked very well for us.

Alex Alonso: Yeah. Cori, do you want to go ahead and tackle the next question?

Cori White: Yes. The next question is “For the huddles in the ICU, does the team get down to the micro level of each patient as to the plan for the evening?”

Melissa Morris: It depends on what the patient’s needs are. If the patient is critical and they are needing more orders written or a different plan of care that needs to be established, then you kind of get out of the huddle part. You know the huddle is more of a brief “this is what our plan is, this is what our goals are, this is what our issues or concerns are.” Then you have to go from there.

: So I wouldn’t say it needs to go to a micro level. I think at that point then you’re re-rounding on your patients and going from that aspect.

Cori White: Okay. This next question is maybe for David, also Melissa. It says what has been the cost of this implementation to your organization?

David Baker: Well if you mean the cost in terms of doing it we’ve never calculated a cost per se. But let me tell you what - and Melissa can fill some of this in, we almost had Sheila Lambert here today, who is the director of nursing there who’s part of the change too, has been leading a lot of this too with Melissa and the whole team.

They have meetings all the time they get their change team together. She invites me every time and I always have a conflict. It’s almost gotten to be funny at this point because I tell her I’m going to come to the next one and I always have a conflict.

We never really calculated the costs if you will, but the way we’d have to measure that is in people’s time per se and Melissa can shed some light on that. What we did do differentially let’s say than how we teach the Master Training program of TeamSTEPPS in the 2-1/2 days is, we did the first day or practicing for our instructors with those groups as I mentioned January 2008.

Then we didn’t do any of the rest of the curriculum and what we did was we had a series of meetings one we brought in our patient safety officer. She reviewed all the RCAs - it’s kind of that front end analysis part.

Then we had other meetings to talk about and strategize a plan which was similar to the implementation planning workshop that everybody does, right, in the master training session we just did those through a series of meetings and thought about which tools we wanted to start with, being SBAR and Sheila and her team, and I don’t know if Melissa can comment more on this in terms of how the SBAR training was launched because I again missed that actually, ruled out SBAR in a series of small or little workshops that could be worked in at that time as opposed to imposing a big burden on staff time. Melissa do you want to comment on the actual launching of that?

Melissa Morris: Well, what we did originally, and you’ll see in some of the next slides that we put out, is we put ticklers out before we launched anything and had the staff asking questions. They’re like what? What’s going on here? What’s this TeamSTEPPS thing again? Why do we have penguins everywhere? We wanted to just kind of get people thinking.

So once we did that then we initially brought it out in a staff meeting. During that staff meeting which we strongly encouraged everybody to attend, members of the core team did role playing in front of the whole group saying the way to communicate not using SBAR and then the right way to communicate using SBAR. Then we allowed people to ask questions.

We also had people try different scenarios during that staff meeting and we designated that staff meeting to just be rolling out TeamSTEPPS. Then after that for those people who were not able to attend that staff meeting we did one on one teaching with each staff member. Each person on the team was responsible for a certain number of people to talk to.

We also went back and touched base with even the ones who had been in that staff meeting to see what questions they had, you know were they comfortable, giving them pointers. We created a report sheet that allowed them to be able to kind of write their thoughts down before they called the physician.

So those are some of the initial things that we did.

Cori White: Okay. The next question that we have is from someone who has not attended training yet. And this person says “I understand the techniques you’re using such as huddle and SBAR. But what exactly does TeamSTEPPS have to do with that? We’re about to engage in the train the trainer sessions and I’m not sure how this training will enhance our other QI activities which are already underway.”

David Baker: So if I understand the question right you’re about to engage in the train the trainer session I don’t know if that means you’re coming to the National Implementation Program, I’m going to go under that assumption.

So the way I think that the way that we worked it on the National Implementation Program you get a lot of detailed instruction that I think probably is that we’re not conveying in the way of time and details and having to recount that.

So many of these things that we talked in the National Implementation that were critical here in terms of conversations and structuring those and things that Sheila and I and the team talked about when I did make those meetings. I think that what we teach the instructors about the National Implementation Program is very comprehensive in terms of its master training aspect.

We go through in a lot of detail, all the tools and the curriculum in the first day. So you have a very, very good understanding of what TeamSTEPPS has to offer. The second day can really be defined in terms of three major buckets. How do you make this work and stick in terms of culture change, what you need to do, what it takes to make training successful because we’re all familiar.

A friend of mine always wanted to write a book called Overcoming the Effects of Training, because as soon as you get on the job you run into an experienced employee and they tell you to “forget all that training stuff, wait let me show you how to really do it”.

Then we do a whole breakout on coaching and how to coach these tools that are in there. Finally you work on your own implementation plan so you leave with something in terms of next steps as to what you want to do when you get back to your curriculum.

The additional benefit I truly believe we also cover are some things that are not in the TeamSTEPPS manual. For example we do a whole thing on new measures and tools that are available. Some of those we are putting on as they come available. We put them on the Web site when they’re ready for primetime, that’s TeamSTEPPS.ahrq.gov.

In addition we try to bring in experts in Roanoke to tell you about what they’re doing and how it works. The final tremendous benefit I think that people have in coming to the training is working with a bunch of people who are at the same starting point and many times we often have common areas of departments that are coming in and it’s an opportunity to think about how to make these things work.

Think about how to make it align within the QI initiatives. As you’re going to see here again in a few slides as we show you some of our results we’re having some tangible results in terms of the outcomes that are critical to anybody’s scorecard measures.

So there’s lots of value here but it’s a big undertaking; I mean it really takes a lot of planning and effort and thinking and the tricky part which we’ve had some success with is not making that overly burdensome and costly to have you do that. We get a lot of good experienced employees in these sessions, a lot of knowledgeable people about QI and how to make these programs work and it’s really beginning now to leverage and integrate these additional tools that can value as well.

Cori White: Okay. The next question is “Do you have coaches and how are they related to the change team? Are the coaches on the change team?”

David Baker: Melissa?

Melissa Morris: Well I would consider the change team - all of them to be coaches. I mean I think that’s an ongoing thing, but you know you’re being supportive of your peers and if you see somebody struggling in one area then you know to coach them through that. Does that answer that?

David Baker: I think the thing we’ve talked about certainly and this varies by department, but some of the other departments are having a larger role for coaches. Having a more prominent role for coaches when you move into things like that are more assertiveness techniques. So in the absence of behavior it is harder to assess. All right with huddles, SBAR, some of these tools there’s very definable times at which the behavior is supposed to occur.

In other cases like CUS which we’re working with in the pediatric group, that’s a little bit more of a challenge. One of the things I’ve seen very nice with a respect to coaches is at University of North Carolina. Not only do they have coaches but they have badges that label them as coaches and they’ve made their own pocket guides. In the back of the pocket guide they’ve actually put in the names of the coaches and their phone number so you can contact them if you have a question.

I would also add to that that I can think of one specific implementation to add in the emergency department. The change team actually is about 15 folks and they have about 68 coaches for a 450 person staff. So I would tell you that I would not always anticipate your coaches to be part of the change team but I would anticipate that your coach core be larger than the change team.

Cori White: Okay. The next question we have is “Do most people implement by department or has anyone undertaken a system implementation?”

David Baker: Well I’m going to answer that and I think that’s really, really interesting. I’ve had one person tell me that they went hospital wide and I know our - at a larger hospital. Now our Franklin Hospital which is a 35 bed hospital went hospital wide. But it’s a 35 bed hospital.

The way they did that is they brought in all their unit directors and gave them training and established how they were going to launch the tools in a hospital like that and they basically did this - said look, we’re going to do hospital briefings, we’re going to start Monday morning, we’re going to meet at 7:00 in the mail room.

So it is a little bit different model. Now I haven’t had this conversation with Celeste Mayer at University of North Carolina. They have one of the larger implementations and you’ll see in our follow-on slides we have later. We have a fairly large implementation going on. Our people now that are interested in implementing and we’re going to begin to offer our own training within Carilion through our corporate university and we’ve begun to think about bringing in units together to train together that have a lot of interactions with each other to start to move with more of that cross unit training.

And anybody who administers the AHRQ Culture survey will be familiar with this kind of result where there’s a scale that targets teamwork within units which is generally pretty positive. And then there’s a scale that targets teamwork across units which is usually lower than within units. “We don’t have a teamwork problem. It’s working with those other people that’s the challenge”.

And we’re beginning to think about logically inviting units that interact with each other given our level of requests and interests in this thing to do their implementation planning both within their unit in terms of what makes sense and then in a cross unit level so we can gain traction. Right? Across the units with these tools.

So that’s one of the things we’re thinking about. I’m sure there are other people who are doing these sorts of things. There’s a lot of smart people out there doing innovative things. These are just the things that I know of right now.

Cori White: Okay. We had a few people in Live Meeting chime in to tell us that they’re implementing either in their entire hospital or system wide and because you have now spoken up and told us that, you may get to look forward to a separate conversation with us.

We have one other thing I want to mention about questions and answers and that is if you have a question you need to actually type it in because if you just do the little hand symbol then we don’t know what your question is and we can’t answer it.

Do we have any further questions on the phone?

Alex Alonso: Operator do we have any other further questions?

Operator: We don’t. I can give a reminder if you like.

Alex Alonso: Sure, please do.

Operator: Absolutely. Ladies and gentlemen as a reminder if you’d like to ask a question from the phone line please press 1, 4 on your telephone.

Alex Alonso: At this point I think we’ll go ahead and move forward. Melissa, if you want to go ahead.

Operator: Actually we have one question.

Alex Alonso: Oh you do have one question? Okay.

Operator: Actually a couple of questions now. Our first question comes from the United States Air Force. Go ahead.

Woman: Hi. I was wondering what measurements you utilize, post-implementation of TeamSTEPPS, to verify to leadership the value of TeamSTEPPS?

David Baker: We’re going to show some other data here in a minute that we kind of went back and looked at within our pediatric unit. I think our general plan for now within our organization is we’ve committed to using the HSOPS Culture Survey as a unit of measurement for looking at this. Now we may delve into other things and we’re kind of building this right now as part of our overall quality system like our HCAHPS measures and maybe some other patient satisfaction measures, our PRC instrument that you’ll see some data on as measures.

Now within Carilion this also fits - we have a mortality team that has a scorecard measure that this fits under that we’re looking at as well, though I think that’s going to be harder to draw a direct link though it’s guided us on what units we’re targeting this year.

So where we’re moving toward them we may do some tweaking or add some additional items for our own personal use related to this valuation on the culture measure which we plan to do annually I believe. We’re right in the process of thinking about that now. That will be the data that will drive both our needs assessment for units that we haven’t trained yet as well as our tests - an initial test that we do every year to track our success with it.

So that’s the measure we’re currently focusing on as well as a couple others we need to explore as well HCAHPS and our satisfaction data.

Woman: Okay, thank you.

Operator: We do have one more question.

Alex Alonso: Go ahead.

Operator: Caller from North Shore LIJ. Please go ahead.

Woman : Hi David. Can you hear us?

David Baker: Hi

Woman: So we have our team here, and again I sent the comment that we do system wide implementation. We have 14 hospitals, 2 nursing homes and other facilities which we are planning to implement this and we are in progress like as you know.

But we have a concern of something that was mentioned before regarding labels. For examples (unintelligible). One of the things that we have maintained is don’t change the label. Because it’s not a pure area you’re going it’s contaminated with multiple projects from a research perspective that we’ve had to capture, so we have already been using huddles.

Some people call it safety rounds. And so we are very much adhered to the fact that we know brief has to be brief, that’s the planning. And huddle has to be when the status changes.

So we just wanted to make that comment that that’s how we have maintained it.

David Baker: Again, my comment is my perspective about these things, because we’ve had other conversations about the utility of using SBAR versus maybe SOAP or something else. And I’m more - and again it’s going to vary a little bit by culture I think. And to everybody - it kind of depends. We’re just happy that there’s a planning phase that people get together and formulate a plan and they have a plan to get back together if the plan changes.

I mean that to me is what’s important to our institution right now. For other institutions some of those things are important, and we hope one of the things. Because we know there’s so much good work going on out there, that we hope that through these Webinars or other vehicles we can create a way, if people are willing to, is to share these lessons learned as we move through this project and everybody’s doing such good things.

So certainly we had a - I have to admit when we brought this up I bet we had a 45 minute discussion about that. So - and that seems to be of all the terms, those seem to be the two terms that people seem to use interchangeably I would say are the briefs and the huddles. Not any of the other terms. They’re barely distinct. But that’s the one where it gets kind of tricky though, and huddles kind of becomes a colloquialism for brief for some reason.

Woman: But there are other names too David. It does happen more often to patient safety...

David Baker: I can only imagine. I’m just happy that people are getting together and sharing in - you know in the words of Mary Salisbury: “know the plan, share the plan, review the risk.”

Woman: Yes, we have learned a lot of lessons and we do plan to present a poster. So we will be in touch with you regarding that.

Alex Alonso: Okay. At this point I think we’ll go ahead and move forward. Go ahead Melissa, take control.

Melissa Morris: Okay. The next slides are just going to show how because we’re a pediatric unit we could get a little bit silly with some of the things that we did. Originally, before we rolled it out, we had these little penguins with little quotes on them everywhere. And people were like what’s the deal with these penguins? It became our mascot; the mascot of TeamSTEPPS. But it became our mascot and so we just kind of went from there.

We had bookmarks we made and the staff members made those. We had TeamSTEPPS pamphlets, notepads. We had pens that we gave our staff members. On this next slide is the report sheet that we made where people could write down their thoughts about what they were going to say before they called a physician.

So we’ve done lots of little novelty-type things. Just to keep people interested and to keep it fun in the beginning. Then as we have kind of gotten out of the fun part, put a good taste in everybody’s mouth and everything, then we have gotten more serious about it and said okay, these are the next you know the next steps that we’re going to implement and so we have you know we’ve given the staff members little pins to put on their badges, things like that.

So of course we talk to people on a regular basis about updates and the staff meetings. We did a grand round lecture where we had a guest speaker come in from another facility who was doing TeamSTEPPS and that was - that lecture was physicians and nurses both in that lecture.

We recently implemented TeamSTEPPS where we do monthly pointers and now we are also doing weekly pointers. This is an example of one of the weekly pointers that we’re doing and we have taken information out of the TeamSTEPPS curriculum and we are giving this to our staff members every week. It was started from the PALS pointer of the week that the PALS curriculum does and one of the team members said “why don’t we do TeamSTEPPS pointers of the week?”

So this has been very popular with the staff. And of course with our nurses we always attach chocolate to it. So we tape a candy bar to it and they find it in their mailbox every week. They coincide with what we are doing at that particular time just to reinforce the terms and the teaching things that we’re doing at that time. Like the CUS and the 2-challenge rule at that point.

So everybody loves going to their mailboxes to get their chocolate and their tip of the week. David do you want to speak to this one?

David Baker: Sure. So I’ll speak to it and you can help me clarify maybe a little bit.

Melissa Morris: Okay.

David Baker: So if anybody’s been through the implementation planning, we always talk about doing the site assessment and the needs assessment. Now this was 18 months ago or 14 months ago. And so it was very early on in the process and we wanted to get something going. And given the depth of knowledge in the unit, looking at some of the RCAs, we just kind of launched.

Recently Sheila Lambert the Director of Nursing up there went back and looked at some of the data. Now she had a good sense of when we implemented different things in terms of our TeamSTEPPS implementation. This is not an empirical study. This is kind of a cursory look at some archival data to try to determine did we have any impact here.

So this is - take it for what it is but it tells I think an interesting story. Now the PRC results are - that’s the company I guess. Melissa will correct me if I’m wrong - and it shows our staff and our patient satisfaction survey. And so what you see in these bullets and it’s not the best slide in the world in terms of its presentation because it is something I need to work on a little bit I think as I’m looking at it now to make it better. But basically our overall excellence rating was 45% for the implementation corner.

Now this is a little dated at this point because we got these - Sheila looked at these results a little while ago. For the last quarter I think which was the last quarter of 2008 was 61% with December being the highest in two years at 74%.

So again it’s kind of back-fitting some data but that looks good. I mean that’s the kind of trends we’d like to see. Staff, courtesy and friendliness was 50% for the implementation quarter. In that quarter again it was 67% with November being the highest in two years at 91.7%.

Doctors involving patients and their families was 56% for the implementation quarter - last quarter went up to 68%. Again these could be better but they certainly are going in the right direction. Nurses understanding and caring was 53% and 75% or almost 76% for the implementation quarter. Do you want to comment on those Melissa?

Melissa Morris: Well, I don’t do the particular numbers for - the numbers that we just recently got, but all of those numbers are up again. So we have done a steady climb. So we are very proud of that. You know without having particular numbers but they are definitely continuing to go up on all of those.

David Baker: Okay. Then we’ll go to the next slide. Turnover. We’ve had no turnover since the PICU implementation now. I always temper this one in this economy. Certainly that’s going to affect things but I see that as positive. On more important - not more important but I think more things that are perhaps clearer again, medication errors down 50% since implementation. Then Melissa can maybe shed some additional light on this but from my understanding we’ve had no codes or rapid response on the pediatric floor since implementation.

So if we’ve had codes or problems they’ve happened in the ICU where we want those to happen. Prior to the implementation we had had some events on the pediatrics floor which we wouldn’t want to happen. Would you like to comment on that Melissa?

Melissa Morris: That’s true. And so of course with those communication techniques it empowers the nurses to be able to be more proactive when they feel that their patient needs more intense care. Then nurses have gotten really good about using those techniques and I think that has been instrumental in not having those codes and those rapid responses on the peds floor.

David Baker: That’s one of the things you know that you can do in a way which somebody asks a question about what are you going to tell your leadership, is as long as you’re moving forward you’ve got some standardized measures probably that you’re already doing that you can use for baseline. These are the things we discussed in the national implementation.

In addition if you keep track of when you do things or have a good idea of when you do things you can go back and kind of look at some of these kind of measures that are taken all the time and would not be reasonable, right, in terms of some of the satisfaction and kind of the things that the patients are perceiving on the floor and see if you’re making a difference.

So there’s some opportunity in my opinion if you know the types of measures that you’re already collecting that you would expect to see some movement of and certainly you know we’ve had scorecard measures related to patient satisfaction and the like. So these would be meaningful to leadership if you brought them back.

Alex Alonso: Sorry.

David Baker: So Melissa, Alex just flipped this slide for us but I think you’d want to talk about this slide. Not me.

Melissa Morris: Okay, so I mean in conclusion in our areas I think that the communication factor has been huge for us. Because we have this separation in staff that were on two separate floors in our old facility. We all moved over to this new hospital. We’re all on the same floor and this just came in at a real good time for us.

So we created teams that had people in both areas and got that buy-in with the physicians and respiratory staff and a real true multidisciplinary approach I think has really made this successful for us. We’re showing patient outcomes have improved. I really feel like the staff is a lot happier with being able to feel comfortable communicating when they need to in certain situations and they feel empowered to do that.

So, like I said the huddles have been good for us. It empowers the staff as we said. So I think that you know the biggest thing for us is some of our staff members but I think that you know as a team we truly think of ourselves as a team and that one person doesn’t set out from the mix and it just aids in that process.

So we’re very happy with how our people have done with it. It’s developed a culture and that culture also includes accountability and cohesiveness. So that’s our story.

David Baker: Okay, so what I was going to just highlight, one of the interesting things with TeamSTEPPS and knowing the LIJ folks are on the phone. They can probably relate to this as well as others. We’ve had a lot of good success. The other place that we started this with was the pharmacy which launched with CUS. We currently have a physician in trauma, where she’s doing a research study actually around this; we collected baseline for about a month and a half. We’re now training all the trauma staff. And that’s done in two kinds of frameworks.

This trauma physician is focusing on the residents and the attendings. Then we have a nursing crash course which is to train the ED nurses where we’ve integrated the TeamSTEPPS principles in and then in both cases they go to the simulation lab for training. And then I mentioned our Franklin Hospital launch.

One of the things that of course comes with success is you almost have to be careful of it, because we’ve had a tremendous amount of interest based on the good work that was done up on pediatrics. So since then we’ve brought a number of additional teams in to do preliminary training. We have programs now with our labor and delivery, our co-teams, our ACE unit which is Advanced Care for the Elderly, Doctors in College which is currently doing a re-do of their nursing curriculum.

And they’re actually part of and involved in the Virginia Tech Carilion Medical School where we’re going to have interdisciplinary courses where nursing students, physician assistants and medical students will take classes together, one of which is a service leaning element which will have all the teamwork imbedded into it.

We also trained all of our human resources consultants. Each unit and department has an HR person attached to it as well as our educational consultants which are the training folks that are through our corporate university. And then we’ve just trained our patient transport services and we’re in the process of this year training all of our ICUs, cardiac services, the ED, the lab, which is TTL, and perhaps the OR.

This is now because we’ve briefed the VP chairs in the case of cardiac services and the ED and the OR both have VPs - vice presidents above those units want those units trained. So we’re getting traction across the hospital and you can see because cardiac services and I think it’s seven different units and the ICUs and patient transport and perhaps the ED now how things might fit together more in terms of the tools that might want to be used and practiced across those units.

Because you can imagine one of the things we’ve talked about as a project for this looking at outcome is, can we improve our “home to balloon” time which involves patient transport, cardiac services, the ED and the like. So we’re starting to think about that as we gained incredible traction.

One of the things that this is required that isn’t much in the master training program is to start thinking about the infrastructure. Some of the things that we’re trying to do again is see how this fits and going to impact our key scorecard measures. How do we bring others that have valuable skills into our change team so in our institution now we require that you notify your HR and your education consultants and get them involved in the change team.

The education consultants can help out with measurements, thinking about needs and about how to structure the training. All those things that are training focused, right? Same with the HR person that could be done by those folks that don’t - we’re trying to mix the right skills together so we have a real diversified team to do this. This requires some knowledge of training.

This requires some knowledge in being able to go into your event data or whatever measure you’re going to use. It requires clinical knowledge, knowledge of the unit. How do we make a change team that brings the resources there so it just doesn’t fall on the clinical staff?

We have a corporate university, and they’re actually now, because of the demand we’ve had, we’re going to start to offer our own training. We’ve talked about using the HSOPS already. The other thing that we’re doing as you can see from Melissa’s discussion, we did not train everybody in TeamSTEPPS.

And in fact I bet if you went up to our pediatric units and I’m not 100% sure because we’ve done a lot of tips and tools, they know what the huddles, the SBAR is and the things that they do in their practice. They may not know as much about the whole TeamSTEPPS.

So we did not invent this idea. I’m sure others have done it. We had a joint meeting with the University of North Carolina and one of the ideas that they’re using is to create a one hour online TeamSTEPPS overview.

So while there are choices in the curriculum they’re also - their feeling is it’s important for everybody to have a broad overview of the tools and sometimes even though they may not be focusing on the tools somebody else will bring another tool or find a useful into a situation for them.

So we are basically imitation is the greatest form of flattery. We’re imitating them. We’re creating a one hour online overview that all staff will be required to go to through any implementation and we’re working to get this CME and CEU credits aligned for that one hour session that people can do through our learning center.

We’ll also have quarterly cross organizational change team meetings and at these meetings what we’re moving for, initially we’re just doing discussions but now we’re going to distribute that out over the year so each group presents what they’re doing and how that’s going for them. So we’re going to have those a little bit more formalized.

So next month our patient transport services who because they have pilots and things of that nature, they’re familiar with these techniques. They have a plan, they’re ready to go. We’re actually doing the culture survey right now as their needs assessment with them. They’re going to come present their plan to this diverse group that has representations from all the implementations or planning implementations for our unit - from our institution along with a couple of others. So we’ll have three sessions to discuss.

Also the quarterly meetings give an opportunity to say how are our units fitting together to help establish that coordination and collaboration. Finally I started this this December, I’m coming back annually to the vice presidents that are department chairs and saying this is how we’re going. This is what we’ve progressed. This is our story thus far. When I brief them the first time I told them that they should expect results.

So I’m on the hook now and we’re all on the hook at our institutions because when we started this, this did not come out of our leadership. This was a grass root effort.

We started in pediatrics and pharmacy. It really grew. The staff gravitated and at some point among my boss, the VP of Medical Affairs and the VP of Quality, we said we need to bring this to our leadership. Now we’ve brought it to the leadership we’ve told them they need to expect results from us because we think this can have value. I expect next year we’ll be coming back and telling our story like this. So across multiple units and hopefully combine with some broader survey data that we have on the HSOPS.

I’m going to turn it back to Cori and Alex in terms of any questions.

Cori White: Okay. The first question that we have today is “Who pays for the pens, notepads, candy tips, etcetera?”

David Baker: Melissa, would you like to answer that?

Melissa Morris: Well some of that, like the notepads and some of the pens that have come out of our budget from our director. The candy on the tips, we take turns - as the CTLs we take turns and we purchase those ourselves. So that’s what we’ve done so far.

David Baker: Yeah, and each of our units by the way have created their own little things. Pharmacy has TeamSTEPPS calculators that look like little pill counting trays and the little buttons for the numbers are pills. They have TeamSTEPPS badges. Each unit has done their own little thing. We have some creative staff within our institute that we can work with and a way to get some of these things done and then it comes and it’s a little bit of money that they have within their budget right now or had within their budget to do these sorts of things.

Cori White: Okay, thank you. The next question we have is does PRC report Press Ganey reports?

David Baker: Do you know Melissa? Is that Press Ganey or is that some - I think it is but I’m not 100% sure.

Melissa Morris: I’m not 100% sure.

David Baker: I know we use a standard tool like Press Ganey. I’m going to bet that’s what it is, but I’m not 100% sure. That’s something I can check on if that’s important to this individual.

Melissa Morris: Mm-hm.

Alex Alonso: Okay Cori. Go ahead.

Cori White: The next question is “How long ago was implementation and how long of a span of time are you seeing these changes over?”

David Baker: We did the initial training the last week of January 2008. Then in the spring and I’m not sure of the exact dates we started with SBAR. Is that correct?

Melissa Morris: Right. Right.

David Baker: And not huddles? Right?

Melissa Morris: Well no. we started with SBAR first. We decided only to do one thing first because our staff was going through all the training, going to our electronic medical charting. So we didn’t want to overwhelm. Then once that got started we did huddles second. So we only introduced one at a time in that first it was about six months. So we kind of got a slow start but we had to with all of the other changes that were going on.

David Baker: Then we stopped because of Epic in the summer.

Melissa Morris: Right.

David Baker: We launched our EMR I want to say it was July. Then we also had the Magnet recertification...

Melissa Morris: Yeah. We had Magnet. We had several other surveys and then Joint Commission and so there was a lot of transition there; a lot of things going on. So we did stop for a little while.

David Baker: Right. We tried to be very strategic about when we did these things. So I believe CUS got launched this fall after sometime the end of November after we did this second phase of the EMR which was our CPOE, Physician Order Entry aspect of this. Then the group launched that. So we’ve had a lot of things going on in 2008 at Carilion and we - I know the team has been trying to be very tactical in thinking about when is the best time to launch different tools with the other initiatives going on.

Melissa Morris: While we were doing that of course we were revisiting the original things that we put out. Just keeping those things fresh was the key.

Cori White: Okay, I’m going to jump to a question that I know I can answer quickly. The question is, could you please let us know again how to get a copy of this presentation. The slides are available for download at the top right hand side of your Live Meeting Client. There is an icon that looks like three little pieces of paper and if you click on it you should be able to download the PDF versions of the slides.

If you’re having trouble doing that as we know some people do sometimes you can send a request for slides to TeamSTEPPSWebinars@air.org and that again is TeamSTEPPSWebinars@air.org.

Alex Alonso: Cori, I also want to address the questions regarding whether or not there are additional training sessions available under the national implementation program. If you have questions regarding that we ask that you contact us at TeamSTEPPScontact@air.org. Again that’s TeamSTEPPScontact@air.org.

David Baker: I would like to clarify that there are trainings available and certainly anybody who’s interested in training through the National Implementation Program we are still offering trainings. There is a short application process that we like you to complete because we like people that think about what they’re doing and what their needs are before they get there. That certainly proves to be a more - I hate that I’m going to say it this way - a “more better” process from our experience thus far.

So we certainly welcome people being involved. We really like that. The only thing that we ask for is that you come back and tell us how it’s going at some point.

Alex Alonso: Okay Cori, go ahead to the final question.

Cori White: Okay, the last question we have is “Are there other things going on in your organization that are associated with the increase in the satisfaction questions or do you believe that TeamSTEPPS is the cause?”

David Baker: Well obviously we didn’t do a tightly controlled study so anything’s possible, right? That’s why I wanted to temper that data. Now we’re going to track this and see how it’s going. I think probably there are as anything you can imagine - there are a number of factors that can contribute to those sorts of things.

But it’s likely in my opinion based on my experience and research in how you do these things that if we were to do this or have the ability to do this more empirically that TeamSTEPPS is likely accounting for a significant percentage of the variance or the change of that.

That doesn’t mean it’s the only thing and we could probably piece together all the factors that may be contributing, but we wouldn’t be able to parcel out how much variance each part is accounting for. But my guess is that - my educated guess looking at the trends would be that that would be the case.

In addition, I mean, this is a very cohesive unit looking at - if we were to add other data to this mix, we have some other date from the HSOPS. This unit scored themselves highest on the Culture Survey in terms of patient satisfaction across all our units and we’re also doing some other things. But we’re kind of backdated.

And so certainly you could raise questions about it but it tells a good story. And the final thing I’d like to acknowledge is that we’ve mentioned Sheila Lambert a number of times in this effort. The reason she - we were hoping that she’d be able to participate as well but she’s flying back from the National Pediatric Critical Care Conference where much of this work was presented. And I’d like to point out or acknowledge the fact that this work was acknowledged by that group as winning best poster at the conference. So this was a very nice thing for our team as well.

Alex Alonso: Operator do we have any questions on the line at the moment?

Operator: We actually do. We have a follow-up question and it comes from caller from the United States Air Force.

Woman: Hi I just had a question. How did you - I saw on the slide and maybe we haven’t gotten there yet. How did you incentivize the train-the-trainer person?

Alex Alonso: We haven’t gotten there yet.

Woman: Okay, so we’ll talk about that here? Thanks.

Alex Alonso: Operator do we have any other questions?

Operator: That’s all I have from the phone line.

Alex Alonso: Okay. So I’m going to jump forward to some of the information that we received from you all, and by you all we mean the master trainers of TeamSTEPPS under the National Implementation Program. We sent out a request for information about the sustainment activities taking place at your facilities. When we reviewed the sustainment activities we identified five course themes across these activities.

One was additional training being offered to staff. Marketing efforts. Administrative support activities. Sustainment activities in practice. And activities that involve spreading the TeamSTEPPS word if you will.

When we look at additional training activities it’s surprising to see how many organizations of the 45 responses I received, I can tell you that approximately 95% of the organizations reported that they were doing newcomer orientation of some sort involving TeamSTEPPS.

So whether you were new to the organization, whether you were new to a unit, whether you were new to that city, you were receiving TeamSTEPPS training in some shape or form. A lot of our groups were also providing briefing based on SBAR and grading their briefings along an SBAR protocol. We also had monthly refresher training.

For example some of the Webinars were required for some staff as well as for the DOD stuff, some of the LAN meetings that you have. The Learning Action Network meetings that you have were required for staff as far as monthly refresher training.

We also had some sustainment activities that included the integration of TeamSTEPPS pooled in root cause analyses being performed at the end of the month or at the end of a given period. We did see quite a few folks who reported engaging in simulation practice exercises over time. We saw quite a bit of home study TeamSTEPPS homework for healthcare providers across the board.

One thing that I thought was unique also I included here was we did see a TeamSTEPPS one-on-one mentoring or buddy initiating program and so they think of what happens to individuals who come to their organization when they’re hired - they are given an orientation which is about a three hour orientation.

But then they’re also given a buddy who will walk them through the basic processes involved in working at their organization. This is something that was done at one unit in particular and it was a one-on-one buddy that was tasked to initiate these individual on TeamSTEPPS social norms.

As far as marketing was concerned, we did see some - quite a bit of variation. We did have examples like David’s and Melissa’s that included the penguins, the penguin pens, the stress-guins, the numerous penguins all over the place, the candy bars and what-not. We saw a lot of bulletin board information or bulletin board materials.

We saw TeamSTEPPS newsletters, seasonal marketing reminders including a desired leadership trait for Valentines which I thought was an interesting one where individuals received a Valentines card and it provided for them the desired leadership traits and how TeamSTEPPS tools might help them achieve those desired leadership traits.

We saw a travelling mascot kind of like a Where’s Ya-Ya? Which is an example of an opposite of a no-no. If you recall Our Iceberg is Melting. We also saw Penguins Abound, in other words penguins all over the place. We saw story solicitation including a feedback box, including a story wall.

We had information on one facility who was going through a renovation and provided a story wall where people could actually write their stories regarding TeamSTEPPS events or TeamSTEPPS related events on a daily basis until the wall was full.

We received information about folks printing up TeamSTEPPS posters or rotating billboards even that had TeamSTEPPS information on them. Another common one was pizza parties or parties related to TeamSTEPPS in general or the use of TeamSTEPPS as a reward.

In terms of key administrative support activities that we saw, we saw people taking TeamSTEPPS as a key initiative under the organizational strategic plan for the organization when going through any type of culture change or any initiative. Monthly TeamSTEPPS day was one example. We saw for example a March DESC script day with a gumdrop exercise that was provided as a tool for incentivizing folks and making sure that folks use their TeamSTEPPS DESC script when possible.

Formally hiring an intern to fill data management roles or observer roles. One of the things we’ve talked about here is it helps to evaluate or constantly conduct observations of TeamSTEPPS behaviors or teamwork behaviors on site. And one of the things that we saw as a common theme across the board was that you had a local college student that was hired and trained to be a data manager or someone who could fill the role of an observer. We also saw the hiring of quite a few external coaches to provide or to fill that same role.

In practice we saw SBAR badges and cards being printed up. We saw huddle incentive trackings for folks who were being incentivized to track their huddles and the quality of their huddles. We saw the use of a weekly mega-brief across all disciplines when possible. We saw a tool of the month reminder at patient safety meetings when conducting grand rounds or other types of activities. We saw the notion of a TeamSTEPPS guru or somebody who would be considered a TeamSTEPPS black belt.

We saw a trainee to trainer incentive program so folks who were - and this was the question that was asked had, folks at one facility were incentivized to become a trainer who received TeamSTEPPS training and actually become a master trainer. The way that they were incentivized was actually that they were provided with staffing from an administrative assistant that they would not normally have received had they not moved from the role of trainee to trainer or master trainer.

So consider for example that you’re a fellow or a consultant at a specific facility and you want to have some administrative support. The only way you are going to get it at this particular place which was starved for administrative staff was to go from a trainee to a trainer.

We also saw the concept of patient involvement in the evaluation of handoffs. So patients were trained on what a proper handoff was, were given a check list and told tell us how well the handoff goes from when you move from the ED to a step-down unit.

As far as spread activities we did see that quite a few organizations were pushing TeamSTEPPS beyond their own organization and actually offering training to other organizations or other regional organizations. We saw folks actually providing collaborative partnerships with regional associations or patient safety organizations and we saw with or and without TeamSTEPPS demonstrations or demonstration studies being shared with other organizations or professional societies abroad.

At this point I want to ask if there are any questions keeping in mind that we are starved for time here. We’re coming up on the deadline. So Cori, do we have any questions?

Cori White: It doesn’t look like we have any questions on the Live Meeting. Operator do we have any on the phone?

Operator: We do not.

Cori White: Okay, well I just had one pop in through Live Meeting and it says “How much is the patient involvement in evaluation of hand-offs work?”

Alex Alonso: Of course this was sent to us via a qualitative string of emails, so I can’t tell you that information off the top of my head. What I can tell you is that I can ask that individual to provide us more information about how well it worked. But I wish I had more information about that.

I have seen one other study designed for that particular - with that same model in mind and it’s for the hand-off from triage to the emergency department, clinical staff. I’ve noted that there are several other studies kind of going along with this, but I’ve never seen it in a case where the patient was the only source of data collection. I think that folks also are required to use caution when relying upon patients to give you information like that.

Let’s see here. As far as that’s concerned do we have any other questions Cori?

Cori White: Not that I see on my Live Meeting. Operator has any popped up for you?

Operator: They have not.

Cori White: Okay, thank you.

Alex Alonso: Okay, I want to thank everyone who provided information for this small listserv poll that we conducted. It was extremely helpful. And then what I want to do Cori is turn it over to you so we can conduct the webinar polls.

Cori White: Okay, we have two quick poll questions that we’d like to ask you today. I’ll put the first one up and make sure that I have it open for answering. We’d just like to know how useful you found the information that we provided today. This helps us tailor future Webinars appropriately. And I’m going to give you just a minute or two to answer.

If while you’re answering you think of a question please put it in Live Meeting and we can answer any that are left.

Okay, it looks like the results are stabilizing a little bit so I’m going to close this poll and I’ll let you see the results. It looks like pretty much you found it useful.

The next question that we have is if you would recommend our Webinars to other people. This is just so again a little measure of quality for ourselves.

Again if you have a question you can enter it through the Q and A tab at the top of your Live Meeting and we’ll try to get it answered.

We have a question that just came in that says “How long have the incentives been in place to maintain sustainment of TeamSTEPPS? Do you plan to plan to continue for sustainment?”

David Baker: Melissa? I mean I think we’re continuing with our tips and things of that nature. I don’t know if you want to add anything. Again this is kind of the incentives or the little things this group has embraced. Different groups have thought about different ways to incentivize this.

Melissa Morris: Yeah, most definitely we will continue doing what we have done and think of new ideas doing that. So yeah, I think that will be an ongoing process.

Cori White: Okay, I’ve closed the second poll and I’m showing the results. It looks like the vast majority of you would be willing to recommend our Webinars to other people. Alex if you’d like to go back in and share contact information then I think...

Alex Alonso: We have two other questions that popped up Cori, I think.

Cori White: Yes, I see one more that came in. “What’s the easiest way to register for upcoming Webinars and can others who are not master trainers attend the Webinars.”

I guess that’s me since I handle registration. The easiest way to register for upcoming Webinars is first go to the TeamSTEPPS Web site which is ahrq.gov/teamstepps. And there will be selection item on the left side of your screen that says Webinars. That will show you the schedule for all future Webinars and also a brief description how to register.

The best way to register is to send an email to TeamSTEPPSWebinars@air.org and I’ll make sure that I follow up with further instructions. So again TeamSTEPPSWebinars@air.org or through the TeamSTEPPS Web site.

And I think that’s all the questions we have through Live Meeting. Operator did you have any?

Operator: We actually - just got one a couple of moments ago. It’s from the line of a participant at the U.S. Army. Please go ahead sir.

Man: Yeah. Our clinic is a free standing clinic, no inpatient, no holding beds, no ER, no operating room. Is there anybody doing TeamSTEPPS in that kind of setting that we could talk to about it?

Alex Alonso: One of the things I would - there may well be. There are people out there and I cannot remember off the top of my head, plus I only see perhaps about a quarter of these from the National Implementation perspective. If you’re on the List Serve I know that what our patient transport folks just did is send out an email to List Serve because they were curious about if anybody was doing it in the patient transport domain. And then they asked them to respond specifically to them with the email or point of person to contact.

And certainly there is about currently on the List Serve over, between 1100-1200 people on there. And so that would be a good group to throw that question out sir and see what kind of response you’d get. Because it would not surprise me if there are people out there who have been moving forward with this.

Man: Okay, thank you.

Alex Alonso: Operator do we have any other questions?

Operator: We do not.

Alex Alonso: Cori, do we have any other questions.

Cori White: I don’t see anything here. No.

Alex Alonso: Okay. At this point then I’m going to move forward and thank you all for participating here today. Keep in mind that if you are looking for resources regarding TeamSTEPPS you can use the AHRQ.gov/teamstepps Web site. There’s also a TeamSTEPPS Guide to Action and the DOD Patient Safety Web site at dodpatientsafety.usuhs.mil.

As far as contact information I’m going to leave this up here and I’m going to ask you to look forward to our next Webinar which will be on the topic of professional organization such as the AAMC, AHA and nursing professional organizations or - and what the value of TeamSTEPPS is for them. That Webinar will be on April 22 and we will be joined by several individuals who will be facilitating this particular event including Gwen Sherwood of the University of North Carolina.

All right. We hope you have a great day.

Cori White: Thank you all.

Operator: Ladies and gentlemen that does conclude today’s conference call. We thank you for your participation and we ask that you please disconnect your lines.