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Operator: Ladies and gentlemen thank you for standing by, welcome to TeamSTEPPS
National Implementation Webinar 9: TeamSTEPPS and Academic Healthcare Associations.
During the presentation all participants will be in a listen only mode. Afterwards
we will conduct a question and answer session. At that time if you have a question
please press star then the number 1 on your telephone. If you would like to withdraw
your question press the pound key.
Your speakers for today are Alex Alonso, Gwen Sherwood, and Cori White. I would
now like to turn the conference over to Mr. Alonso, please go head sir.
Alex Alonso: Thank you. Thank you all for attending our webinar today. Good
morning, good afternoon and good evening depending upon where you are in the world.
I welcome you all to the 9th webinar in the series of the TeamSTEPPS National Implementation
Program.
Today's topic is “TeamSTEPPS and Academic Healthcare Organizations,” and how we
can really make TeamSTEPPS a valuable tool for academic healthcare organizations,
including associations, professional societies, academic health centers, etc.
Today we are joined by Gwen Sherwood; Dr. Gwen Sherwood is a critical member of
the TeamSTEPPS technical expert panel.
Before I talk to you a little bit more about Gwen however, I do want to remind you
that we ask you to be considerate of others while participating in this webinar.
Please make sure that your phone is on mute to reduce background noise.
Do not put your phone on hold if you have hold music or advertisements on your hold
line. We ask that you make sure that this conference call is as good as all other
conference calls that we've had in this series so far.
Cori at this point I want to turn it over to you so that you can remind folks or
reorient folks as far as how they can find different resources in the Live Meeting
Software.
Cori White: Hi, welcome today. I know that there are a number of people on
the webinar that have been through a couple of these. So bear with me if you feel
like this is repetitive from what you've heard before.
Most of you are logged into Microsoft Live Meeting. The major thing that you need
to know about Live Meeting is how to ask questions. If you look at the top of your
Live Meeting window there's a tab that says Q&A.
If you click on Q&A then that's where you can ask a question. And if we feel like
it's a question that the whole group would benefit from, we'll answer it publicly.
If it's something that isn’t directly related to the content of the webinar or if
it's something with which you're having an individual problem, we can answer it
there. If you're unable to ask a question in Live Meeting we’ll give you instructions
for how to do it through the phone.
Again we encourage you to ask all your questions through Live Meeting, it gives
us the best way to manage them. That way, you can ask your question when you think
of it, and when we get to our designated slide for questions, we'll make sure your
questions get answered by the facilitators.
The other thing to know about Microsoft's Live Meeting is that it gives us the opportunity
to provide you with handouts of the slides. So if you go to the top right hand side
of your Live Meeting window, there's an icon that has three pieces of paper and,
if you hover over it, it says “handouts”.
If you click there you can get PDF copies of the slides in full slide format and
in three slides with space for notes. This was pointed out early on to us as a good
way to save paper, which is quite appropriate since today is Earth Day.
The other thing to notice on the top right corner of your Live Meeting is the feedback
square. That's a good place to let us know how you're feeling. This is the place
where you would tell us that we need to slow down or that you can't hear.
The only thing is that we ask that you don’t change your feedback to a “question”
because we won't be able to answer the question since we don’t know what it is.
In order to ask a question again go the Q&A tab and enter your question in the box
there. Alex is there anything I've missed?
Alex Alonso: Nope. I think that covers it all Cori, thank you. All right,
so today's agenda again: We're going to remind you about who we are, what the National
Implementation of TeamSTEPPS Program is, and then we're going to dive right into
professional associations and TeamSTEPPS.
Gwen is going to share some of her works and some of her accomplishments as they
relate to TeamSTEPPS and her professional associations and her distinguished service
at numerous professional associations.
We're also going to talk about some recent highlights from Sigma Theta Tau and other
professional association exemplars of works going on to highlight TeamSTEPPS or
to highlight TeamSTEPPS as part of those works.
Then we'll provide you with some basic information about contacting us. Please note
that we also have set points in the conversation where you can ask questions.
Or you can ask questions at any time, but we will stop throughout the presentation
and tackle some questions that are raised by you the audience.
The American Institutes for Research is the prime contractor on the National Implementation
of TeamSTEPPS Program, which is funded by AHRQ and by the Department of Defense
Tricare Management Activity.
We are a not-for-profit non-partisan DC based research organization with 11 U.S.
locations and 12 international offices. We have staff that focus on healthcare research,
health services research, education research, assessment research and workforce
issues.
Our staff includes health services researchers, nurses, physicians, and social and
behavioral scientists. I'm sure most of you know by now I fall in that final category.
Let's see here, our mission as an organization is to better society through our
research. As far as the National Implementation Program, you may recall and all
of you should know by now, that the goal is to create a national infrastructure
to support the adoption of TeamSTEPPS throughout healthcare.
The initial infrastructure was to include Quality Improvement Organizations, and
Patient Safety Improvement Corps organizations from AHRQs patient safety program.
We also wanted to make sure that we were going to make training available to early
adopters such as High Reliability Organizations, members of AHRQs ACTION Research
Network, academic medical centers, and others.
Included in those others are professional societies that we will be talking about
here today. The goal is really to spread TeamSTEPPS and to create a large core of
master trainers.
Most of you here are master trainers or have been part of the master trainer process.
This program is supported through training at four team resource centers. The first
of which is the University of Minnesota, Creighton University is also one, Duke
University and Carilion Clinic– which is the partner hospital with Virginia Tech
Medical School.
We also have two support organizations that are QIOs or former QIOs such as Lumetra
in California, and Delmarva Foundation out here on the East Coast.
We also have two other organizations that partner with us at AIR to conduct some
of the evaluation activities and some of the actual research and development activities
for this project. Those are the Group for Organizational Effectiveness (gOE) out
of Albany, New York and Booz Allen Hamilton out of Virginia.
As mentioned earlier, our titled sponsors are the Department of Health and Human
Services and specifically AHRQ or Agency for Healthcare Research and Quality and
the Department of Defense Tricare Management Activity.
The AIR project team is headed up by David Baker who has a dual appointment with
Carilion Clinic as an associate professor in their school of medicine. I am the
Deputy Project Director for this team when it comes to research and development
products.
Deborah Milne is the Deputy Project Director when it comes to outreach user support
and just about everything else. She does the most work on this project, without
question.
Cori White is the administrative support researcher for webinars and for research.
Rachel Greenberg is the administrative researcher for outreach and user support.
However, we are all an interchangeable team. If you send anything to us at these
locations or contact any of us, we will all see it we will all be happy to respond
as a team.
If you're interested in this contact information we will provide it later on again.
Let's see here, Gwen Sherwood. Let's talk about our facilitator here today. We're
very happy to have Gwen with us here today. She is the Associate Dean for Academic
Affairs and a professor at the University of North Carolina at Chapel Hill in the
School of Nursing.
She has many examples of distinguished professional service including having been
the vice president of the Honors Society for Nursing: Sigma Theta Tau International.
She is a past president of the International Association for Human Caring; she serves
on the research committee for the National Patient Safety Foundation.
She is a member of the TeamSTEPPS Technical Expert Panel and she's an advisor to
our particular project here. She serves on the steering committee for research project
to measure impact of TeamSTEPPS with nursing and medical students.
She will describe some of that work here today. She's also a co-investigator for
Quality and Safety Education Nurses Grant from the Robert Wood Johnson Foundation.
Gwen at this point, needless to say, we are extremely grateful that you're here
with us today. And I'm going to go ahead and turn it over to you.
Gwen Sherwood: Thank you. I think we went one slide too far here. Possibly
the earlier version. Let me see what's happened. I think we can make it anyway.
Alex Alonso: Okay.
Gwen Sherwood: We're on this call because all of us have some sort of expressed
interest in teamwork obviously through the TeamSTEPPS curriculum. And today we're
going to be challenged to think out of the box. About who may be unlikely or unexpected
partners in achieving our goals for dissemination of the TeamSTEPPS curriculum because
we do believe that this does contribute to improved healthcare outcomes.
[Edited for technical difficulties]
Alex Alonso: Little bit of adjustment here, and we're uploading now; it should
take us a couple of seconds here. I apologize for any technical difficulties and
we thank you for your patience. Let's see here, at this time if anybody has any
questions now would be a good time to submit one. I know that we're a bit early
on in the conversation still but...
Gwen Sherwood: Well I think that I can be talking. Just a little bit of what
we were trying to be seeing was a slide around the, just to remind us of some of
the challenges that we face because we know the statistics. And we know some of
the data around the importance of communication and working relationships as major
factors in healthcare outcomes.
So we know that changing behaviors and changing attitudes requires dedication and
focus if we're going to overcome the barriers that we face in TeamSTEPPS education.
[Edited for technical difficulties]
Alex Alonso: Again we apologize for any delays. Okay of course email never
works as quickly as you'd like it to when you need it and we'll save here.
Gwen Sherwood: I'll continue on and be talking I think we'll be fine. We
can learn to do things without Power Point. So today's focus is to try to provide
a fresh look at the realities of how we might change the paradigm in terms of what
kinds of partnerships we might be wanting to establish. In order to gain the attention
of multiple disciplines of folks who might need to be involved in TeamSTEPPS implementation.
So if we look at what are some possibilities that we might have overlooked, who
has influence with healthcare providers, who works with large groups of providers,
and how we can gain access. We think sometimes we have to do it all ourselves, but
partnerships can lessen the burden and help achieve the goal faster.
It's almost impossible actually to get a count of how many professional associations
there are. With just a quick look we were able to identify more than 60 professional
associations for nurses. I added up that it's well more than 1/2 million members.
When we start looking at the other professions it becomes an even more dizzying
number of professional associations and members. These associations serve multiple
constituents.
I tried to just pull up a little bit from one website just to give some examples
of professional associations. You can easily see the American Association of Neuroscience
Nurses, then there's the American Association for the Neurosciences. And you can
make application to the different professions and have some idea of opportunities
that are there.
If we examine the goals among some of these healthcare associations we could begin
to categorize some of the things that are a focus for them, in terms of advancing
the science and practice of their constituency, and some of the work that some of
these associations do and specifying curriculums for healthcare profession students,
the work they do and policy and credentialing standards related to practice. Some
of them actually accredit facilities; some certify professionals and many of them
foster effective communities of care.
If we look at this, what we could begin to try to think of some similarities and
differences with the work around the TeamSTEPPS consortium. Looking at what are
some of the activities that professional associations do, we can come up with a
number of ideas that are posted on different websites. There's a good bit around
curriculum content and ways that they work with research, whether it's funding,
whether it's disseminating research findings, their work around accreditation and
determining standards and policies. Some of them work around certification and what
learning activities are required, continuing education workshops and programs.
Then opportunities for networking, meetings and annual conferences. Publications,
peer reviewed journals, publishing ventures and consumer involvements.
So how could TeamSTEPPS begin to be a player with some of these professional organizations?
We know that professional associations are not bound by geography; quality and safety
are global issues. And many organizations have international members.
This includes the International Council of Nurses; this particular group has focused
a lot of its work around nurse migration.
If we just make application across the healthcare professions we know that any time
there's migration of healthcare professionals. We have challenges in communication
and different views of what teamwork is.
Then there's the World Health Organization and various other groups in many other
countries. So what are some common themes and looking across healthcare professional
associations?
We begin to see that some of them in recent years have begun to provide work in
trying to help providers increase their skill set towards service oriented behaviors
that improves health.
One of these in particular is around patient-centered care and the particular need
to include patient and family as members of the healthcare team. Then, if we begin
to think how that might translate to the work around TeamSTEPPS, we may actually
be closer in some of the mission than we might think.
I thought it may be helpful if we could think of some exemplars and because I'm
a nurse educator and researcher and administrator. Although, I have a strong clinical
basis for my work in healthcare systems through faculty practice.
So my examples will mostly be around nursing but hopefully this will stimulate our
thinking. The Sigma Theta Tau Honor Society for Nurses is the largest nursing organization
in the world. It's by invitation, and they've inducted 405,000 members in 86 countries.
So here is an example of a global organization and with a mission of supporting
the learning, knowledge and professional development of nurses committed to making
a difference in health worldwide, keying on differences in health care.
The vision of Sigma Theta Tau is to create a global community of nurses who lead
in using knowledge, scholarship, service and learning. So if we think about the
core values of Sigma Theta Tau we see knowledge, leadership, service as a strong
value of scholarship development and evidence based practice and caring.
One of the goals there for this organization is knowledge workers who replace just
trained workers. They have a real focus on leadership development as well as knowledge
development and dissemination.
This means they could be a natural partner with TeamSTEPPS in trying to promote
team leadership. And besides, Sigma Theta Tau is also a leader in technology applications
there's a lot of potential for e-learning.
They focused attention on the impact of communication and healthcare quality has
led several prominent associations to promote teamwork as part of the work that
they're doing. TeamSTEPPS can be an exemplar program for building service oriented
skills among healthcare professionals.
TeamSTEPPS does apply across all disciplines so integration into the offerings of
key professional associations could be a value added. Not only to them but to also
help emphasize how critical this knowledge is.
I have noticed in the last couple of years that AHRQ has been a sponsor at many
of the key professional association meetings that I've attended. And I've been pleased
to see that they do have the disk available, the DVD with all of the TeamSTEPPS
material and it has been a very popular giveaway.
So that has been one way to be involved in professional associations. We've already
covered that idea. Just a couple of more comments and then we will pause for some
questions.
I wanted to use just a couple of the exemplars around professional associations
and their work in research, both in sponsoring research and disseminating.
One example to highlight is the American Association of Critical Care Nurses, AACN
and work they did around how quality impacts the work environment. And that hospitals
nationally recognize where quality has healthier work environments and higher levels
of job satisfaction among its employees.
We know that quality affects nurse satisfaction and retention. And we also know
that part of a healthy work environment is effective communication in teamwork.
Which can contribute to a quality culture which contributes to satisfaction and
retention.
So, if we believe that effective communication and working relationships help retain
nurses, how could we begin to use TeamSTEPPS and apply the research findings in
working with associations to try to feed this implementation?
Just one other example around the research agenda is the research around Magnet
Hospitals. Some of you may be employed in hospitals recognized for Magnet, which
is a recognition of nursing leadership.
Hospitals that are Magnet have reported positive work environments, strong nurse
leadership, continuous quality improvement, clear communication across disciplines,
academic and practice partnerships, and staff that are involved in professional
service.
As a result they report higher job satisfaction lower staff vacancy and improved
patient care outcomes. This is work that comes from the American Nurses Credentialing
Center one of the very prominent professional organizations that does a lot of work
in credentialing organizations.
So this is a time we're focusing our attention today in trying to think how we can
move outside the box and change our mental models, and how we may engage with professional
organizations around creating partnerships with TeamSTEPPS implementation.
So this would be a time we could pause for questions and I apologize that we're
not able to view the slides. But let's see what questions you may have, it may feel
a little disjointed because of the stopping and starting.
Cori White: Hi, well we don’t have any questions entered yet. Again I'd like
to remind you that if you have a question please enter it in the Q&A tab at the
top of your Live Meeting window.
We are working on getting our slides sorted out. I'd also like to mention that if
you would like a copy of the new slides that we've put up, I will be unable to provide
them during the webinar.
But if you send in an email to teamsteppswebinars@air.org
just requesting the slides from today I'll make sure that you get them.
Again if you have any questions please enter them it the Q&A tab of your Live Meeting
or operator could you please tell us how one would submit a question through the
phone?
Operator: Yes. Ladies and gentlemen if you would like to register a question
please press star then the number 1 on your telephone. If your question has been
answered and you would like to withdraw your registration please press the pound
key.
Alex Alonso: So Gwen it appears that we may have actually found the actual
slides.
Gwen Sherwood: They’re there, yes. Thank you very much for making this work.
We're looking at a picture of our TeamSTEPPS training with nursing and medical students
at UNC.
Alex Alonso: Okay I apologize for the inconvenience this has caused everyone
today.
Gwen Sherwood: We're good.
Cori White: And it looks like we don’t have any questions at this particular
time.
Gwen Sherwood: Okay we'll keep going and hopefully at the end we'll have
lots of time to work on that. I wanted to continue with this quote from Paul Batalden
from Dartmouth and IHI.
"We can't hope to make lasting change in the ability of healthcare systems to improve
without changes in the way we develope future health professionals. Those changes
require faculty and schools to change."
So I wanted to spend a little bit of time thinking about some of the gaps between
education and practice and how difficult it is. I can speak here as a faculty member
how difficult it is to keep our curriculum current with practice reality.
Changes happen in practice and sometimes faculty are a little bit slow to catch
on. Then we have to have catch up faculty preparation in order to fill the gaps.
I think this maybe an opportunity for partnership with TeamSTEPPS in terms of for
the most part the roll out of TeamSTEPPS is within healthcare organizations in clinical
settings. But don’t forget to include your faculty who are involved in practice
in those settings so that the message can be taken to students.
In terms of trying to change the culture to one of quality, we have been using the
mantra that knowledge workers are workers who engaged in their work as critical
questions and continually seek to improve outcomes of care.
If we want to have healthcare providers where there's an environment that encourages
inquiry, applies evidence-based standards and intervention, investigates outcomes
in critical incidents from a system perspective.
We need to be thinking about strategies to employ the strength of professional associations
in terms of trying to help us in changing healthcare communication through the TeamSTEPPS,
across both practice and education settings.
So what we're trying to do is to change business as usual so that we do create a
new paradigm in quality and safety, and do that through some innovative partnerships.
If we think about trying to look at shared goals that we have as members of the
TeamSTEPPS community, what are some shared goals with professional associations?
I hope that we'll have some opportunity to discuss some ideas that you may have
and bring this across the healthcare professions.
What are some conversations that we could begin to have that could lead to strategies
that we could accomplish mutual interest? Then, what are venues that we could convene
the players that are interested in trying to promote healthcare quality through
improved communication and teamwork?
So let's think about just a few examples because I think again exemplars can stimulate
thinking. I am part of the Quality and Safety Education for Nurses Projected funded
by RWJ. We call it QSEN and this is our website this has been funded by Robert Wood
Johnson.
We are on the third phase of our work; we now have had about $3 million in funding,
to work on trying to define the IOM competencies for quality and safety as they
relate to nursing.
Here's the opening page of our website just so you can see what it looks like. Our
goal for QSEN is to try to help healthcare professionals have the knowledge, skills,
and attitude to continuously improve the healthcare systems in which they work.
We believe that one of the main ways they are able to do that is through effective
communication and teamwork.
On this website you will see that there are definitions for the six competencies:
“Patient center care,” “teamwork and collaboration,” “evidence-based practice,”
“quality improvement,” “safety” (for our work, we separated “safety” into a separate
competency from the way it's stated in the IOM quality chasm work) and “infomatics”.
We have developed a lot of faculty development resources, including posting more
than 60 teaching strategies and we have maintained current annotated bibliography
on that website.
We have done this work around the framework from IOM. All healthcare professionals
should be educated to deliver patient-centered care as members of a disciplinary
teams, emphasizing evidence-based practice quality improvement, safety and infomatics.
In Phase 1 we have tried to define the Institute of Medicine quality and safety
competencies. We did that by trying to bring together an advisory board as well
as expert faculty and tried to build consensus, so that we could have inclusion
of these competencies and education standards and accreditation and license your
curriculum. This way, we would be able to have sustained change.
One of the ways that we tried to do that is to bring representatives from key professional
organizations and associations along with us. We wanted to have cross referencing
with what was happening with physician education.
Paul Batalden and Les Hall represented IHI, ACGME and HPEC as well act on our advisory
board and were very active members in this work.
Then you see other professional associations - the American Association of Colleges
and Nursing and the National League for Nursing. These are the two organizations
that accredit nursing schools.
So if we're going to have sustained change we have to have this as part of the accreditation
standards. Karen Drenkard from the American Organization of Nurse Execs represented
Practice, she's now the executive director for Magnet.
We knew that we would have to have some sort of buy in from the National Counsel
of State Boards of Nursing, who oversee the 50 states and their licensure process
for licensing nurses.
The American Nursing Association d uses the Safe Patient Handling Project as something
of a model for how we would go about trying to get the policy changes, and get this
to try to reach a tipping point for integration.
The National Organization of Nurse Practitioner Faculties Maryjoan Ladden from the
Inter-Disciplinary Healthcare act at Harvard and Jeanne Floyd from the American
Nurses Credentialing Center.
We felt that it was very important that these folks be involved in the discussions
all along the way. That they met with us in all of our workshops so that when we
were ready to try to implement policy changes. The leaders of these organizations
understood what the message was and then were very helpful in our trying to get
this taken care of.
In Phase 2 we had realized that we needed to learn how to do, how to integrate this
content into nursing curricula. It was not enough to just put it out there and say
“okay go everybody and put this into your curriculum”.
So, we had 15 schools that formed a pilot collaborative and when we had our end
of year meeting of these 15 schools. I was very excited that many of those schools
used TeamSTEPPS for achieving the competency related to teamwork and collaboration.
They had done that in some pretty creative ways and had found ways that they could
get the TeamSTEPPS training, so that they could put that into their pre-licensure
curriculum.
In our Phase 3 we're all about faculty development because we have learned that
faculties do not know how to teach around the new science of safety, the new science
of quality. They have very little of the knowledge around the inter-disciplinary
teamwork that we believe that redesigned systems call for.
The traditional view of teamwork in nursing, and the way it has been traditionally
taught, is nurses working side-by-side with other healthcare professionals and performing
nursing skills, very much an intra-nursing team.
Our revisioning around this work with QSEN and IOM is trying to integrate into the
curriculum the idea that teams function effectively in nursing and inter professionally,
fostering open communication, mutual respect and shared decision making to achieve
patient care quality.
Just so you see an example, this is not the totality of the competency for teamwork,
but it is an example of some of the how we have specified knowledge skills and attitudes
that define the competency.
You can go to www.qsen.org and
see that information or you can find it in Nursing Outlet May/June, 2007.
We wanted them to make this applicable for graduate education. So again we realized
that we had to have representatives from professional associations with us from
the outset of our work and planning how we would begin to implement.
This very busy slide is a list of the professional organizations that we invited
to the first meeting, to talk about what we would do to specify content for the
IOM competencies including teamwork, if we were going to get this inter-graduate
education.
What is a very interesting commentary that we learned in this meeting is that nurse
practitioners are on the frontlines of primary care. But they are educated in a
silo and educated around the individual practitioner.
We have not provided a system perspective in most nursing education for nurse practitioners. We have realized that that is a major gap and that nurse practitioners did not have the same views of teamwork.
We recognized and have continued to work with these professional associations in
trying to think about how we could do some revisioning. Working with professional
organizations to try to achieve lasting change requires that we really work with
the three organizations that really help to drive nursing education.
The National League for Nursing: we are involved with their nursing education advisory
council. In fact I'm the representative to that. We are rewriting the competencies
and I have been the one to submit the competency around teamwork collaboration.
It is very consistent with the TeamSTEPPS curriculum.
The American Association of Colleges of Nursing has already included the new language
in their essentials of baccalaureate education. It will be in the next version of
the Essentials of Masters Education and it is already in the language for the Essentials
of the Doctors Nursing Practice.
The National Council and State Boards of Nursing has been looking at transition
to practice competencies and so they will be writing this into the licensing exams.
So that new graduates will be having questions around the competencies and around
revisions of teamwork.
One of the other lessons that we learned about working with professional organizations
is that most professional organizations or at least many of them have their own
peer review publication.
So we learned that another way that we could achieve dissemination is to work with
professional organizations around special topic issues of their journals. We felt
that a special topic issue would put a greater emphasis on the message. Then we
also learned that if you have a special topic issue for that association's journal
they will put those out for free many times to the attendees at their meetings and
so you can get dissemination a lot faster.
These are just some examples of the things we have done in working with professional
associations around disseminating our work around the IOM competencies.
Well let's think of a couple of other ways that we could partner for implementation
again this is our TeamSTEPPS work, some of our TeamSTEPPS participants. Just a reminder,
and I'm sure most of you have seen this statistic, that miscommunication contributes
to as much as 70% of healthcare errors and inter-professional educational experiences
are rare.
One of the things that we've learned that has been quite startling and particularly
to share among our inter-disciplinary colleagues, is that most nurses graduate from
nursing school having never had a meaningful conversation with a physician.
We have learned that in fact, many nurse faculties systematically prevent nursing
students from having the opportunity to practice conversation with a physician and
how to convey a message.
I am very happy to report that as we have worked with our schools in the learning
collaborative around QSEN every one of them had implemented at least SBAR. They
were also working to implement other types of standardized communication so that
they could work with students around how to have a conversation with the physician.
We've also been a little bit amused that nurses are taught pretty verbose methods
of communication. We teach nurses about, you know, lots of chart entry and so on,
and it seems that that’s a different type of communication instruction than what
other healthcare professionals might receive.
So, I think this is an area where we could really spend some time working around
trying to improve communication, and where TeamSTEPPS can really be a help in trying
to revise education.
Another model that can be employed around this whole notion of trying to change
patient safety health sciences curriculum, is around the idea of think tanks, and
that I've been a part of what the University of Illinois Chicago is sponsored and
the University of Southern Illinois Schools of Medicine do, where they bring together
inter-disciplinary providers to Telluride Science Research Institute in Telluride
Colorado, with the focus of designing and implementing a patient safety health sciences
curriculum.
They have included quite a number of professional associations and organizations
as you can see there, with one notable inclusion and that is including consumers.
We have had several different representatives from consumer organizations who are
trying to influence the safety and quality work within healthcare. Some of you may
be a part of what is sometimes called Summer Camp the summer think tank that is
sponsored by Dartmouth each summer.
I wanted to tell you about one other exemplar and while this is not per se work
that involves a professional association. It did become a partnership with AHRQ
and I think it can serve as a way of just opening ourselves to thinking of possibilities
and not being afraid to ask.
We had funding from one of the drug company foundations here in North Carolina to
conduct an inter-professional safety education project. The caveat was that it had
to include Duke University and the University of North Carolina at Chapel Hill.
If you follow basketball you know that we are quite competitive in the sports arena,
but happily, we worked very well together around patient safety and teamwork.
This project’s purpose was to provide senior School of Medicine and School of Nursing
students in both those universities an inter-disciplinary patient safety focus teamwork
experience.
To my knowledge this was the first opportunity to use TeamSTEPPS for students as
opposed to practicing healthcare providers. We did partner with AHRQ and they were
very helpful in trying to help make this happen.
We used a randomized control design to evaluate our team training. We learned also
in that process that we had to engage in training faculty because faculty did not
know how to facilitate this type of training.
So what did we learn? We learned that TeamSTEPPS is a very relevant curriculum for
working with healthcare professional students (just as it is in working with providers),
and for trying to change knowledge skills and attitudes and our goal was to try
to accomplish this before the onset of their career.
We also learned that working across institutions and agencies can have a big payback.
We were able to overcome competitive relationships to achieve mutual and committed
goals.
We also learned that we needed to increase collaboration across disciplines. That
faculty and providers themselves must be able to model teamwork behaviors, if students
are going to see the relevance of improved communication and have better understanding
about their role.
We did find that in this single exposure to TeamSTEPPS that all cohorts did improve
their knowledge skills and attitudes, but they improved at about the same rate.
However, we did learn that high fidelity patient simulation produced greater satisfaction.
So our hunch is that those students might be able to sustain what they learned for
a longer period of time.
Whereas, the low fidelity role play and those who did not have any kind of interactive
experience might not have a sustained behavior change. But our design did not allow
for us to test that theory. However, we're working with some other groups that are.
So, what are some conclusions that we could begin to draw from thinking about how
we might be able to partner with professional associations? I think they can be
natural partners in the TeamSTEPPS implementation. I think that we could begin by
considering the shared mission and vision to rendition partnerships to model and
disseminate teamwork behaviors. We can examine activities supported by the associations
to see their resource allocation, which address shared goals so that then we propose
things that would help them to meet those goals.
We could include leaders from professional associations in key design phases so
that we build the shared goals and mission along the way. Certainly I think we have
the challenge to think out of the box for ways that we can achieve common missions
of improving healthcare through effective communication and working relationships.
So I think we have plenty of time now for some discussion. While you're lining your
questions up I would particularly like to hear from members of the audience who
have experiences in professional associations representing other disciplines.
Cori White: Hi again. If you have a question, please enter it through the
Q&A tab at the top of your Live Meeting screen. We currently don’t have any questions
but we have lots of room for questions and lots of time.
I'd also like to inform you that I have updated the handouts there in the handouts
tab of LiveMeeting to show the slides that Gwen has been working from, now that
we have them updated.
I also have those available if you send an email to the
teamsteppswebinars@air.org address, I can make sure you get a copy if you
need one. Operator do we have any questions on the phone?
Operator: Again if you would like to ask an audio question press star 1 on
your telephone key pad.
Alex Alonso: Or if you'd like to respond to Gwen's request to hear about
some other works and make this a collaborative discussion. I know that this is something
we haven’t always done in our TeamSTEPPS webinars but we welcome it. Please feel
free to chime in with the operator we'd be happy to share any of the information
you want to share.
Cori it looks like we have a question.
Cori White: Okay, this person says, "I have always viewed TeamSTEPPS as multi-disciplinary
training. I think having nursing education implement TeamSTEPPS training is only
addressing half of the team members. Do you have a comment about this?"
Gwen Sherwood: Yes I was just trying to get my question open here. And the
question you have is addressing only half of the team members?
Cori White: Yes it says that they think that having nursing education implement
TeamSTEPPS training is only addressing half of the team members.
Alex Alonso: So I'm assuming what this person is referring to is that we're
also leaving out the physician aspect of it, or the other healthcare aspect of it.
I think that some of the exemplars that Gwen has brought up here today are from
the nursing community however, she's also brought up some examples, especially the
GSK work that you all have highlighted from Duke and North Carolina which is collaborative
and also is multi disciplinary. Gwen am I correct in assuming that?
Gwen Sherwood: Yes, that is absolutely correct. I think that we do need to
be mindful of working to try to have some of the same communication taught across
the disciplines. I think for me, the strength of TeamSTEPPS is that it was designed
as an interdisciplinary training.
The decision that we also made here is that even though we have not been able to
accomplish inter-disciplinary education across the totality of our curriculum, we
have been able to build in a few opportunities of inter-disciplinary education (and
there are a couple of programs that we have that I didn’t mention today) where we
do bring our nursing, medicine, pharmacy, dental, social work, students together.
It is for a single evening but it is around trying to improve their teamwork and
they work with a standardized patient around a common case study. We have also looked
at it that– even if you can't achieve working in a situation where you're involved
in TeamSTEPPS across all the professions– that you work with what you have.
In our QSEN project, we spent a long time talking about nursing schools who are
located where there is no medical school, or where there is no opportunity for nursing
students to have the cross disciplinary educational experiences. We talked about
could that happen using e-learning. I know one school in Texas that is using retired
physicians to come in and do some things with their students during their health
assessments course, so that students can just practice conversation with physicians
and know how to organize information when they need to present a patient or call
a physician for help with a patient.
So there is danger in one profession having a set of communication skills and it's
not spread. But I think any time even one is able to improve their skill set around
communication. That at least they have the opportunity to model it. I'd be interested
if any other people in the call have anything else to say?
Cori White: We will get to that for sure. The next question that we have
is, "Has there been any work done in predominantly minority facilities or schools
of nursing?"
Gwen Sherwood: I do not know the answer to that, I know that TeamSTEPPS is
involved internationally and I have heard presentations from some of the facilitators
who are doing that work.
That there has been the need to make some cultural adaptations in working internationally,
but I don’t know about research. I guess the question might be historically black
universities or universities where students represent other population groups, and
I just simply don’t know the answer to that.
Cori White: All right thank you. The next question is, "What have been your
biggest barriers to change?"
Gwen Sherwood: As an educator, I would say the biggest barrier we have is
in trying to do inter-professional education here is around scheduling. We operate
on an academic calendar, and our medical school operates on a different calendar.
When I said “Oh, we have to schedule something around spring break,” they looked
at me and said “Spring break? What is that?”
So, we have these different environments even within the same setting. That has
been a huge barrier. I would also have to say another really big barrier is faculty
development. When we did focus groups with nursing school faculty, we found that
nursing school faculty did not have the skill set themselves to teach from this
perspective. When I am at Telluride each summer in that think tank there with representatives
from across the disciplines, I hear the same conversation that faculty development
is an issue.
I have heard conversations around hidden curriculum in professional education schools
around the notion that we as faculty do not always model the most effective communication
and most effective behaviors. Therefore students see a hidden curriculum of how
to do it the incorrect way. So I think that faculty development is a big barrier
for change.
I'll tell you another big barrier, speaking again from the academic perspective.
When we talk about the need to integrate this into curriculum, nurse educators just
go “don’t give me any more content.” And one of the things we're trying to help
them see is that we're not asking.
This is not necessarily required except for a course. What it requires is reframing
the case studies that you use. Reframe the examples that you use if you are teaching
from simulation you can reframe how questions are stated. You can reframe how that
scenario unfolds. It does not have to take more time in the curriculum. So we have
tried to work from a nursing perspective around that.
I think one other barrier– obviously we find many – but one other barrier I is think
that effective implementation of TeamSTEPPS requires a system perspective. We have
not always educated across the healthcare professions from a system perspective,
i.e. we teach one to one whereas care happens many to one.
We teach from the individual perspective without helping healthcare profession students
understand they're working in a system. I think that happens with healthcare providers
themselves because they have come out of these education systems.
I think we're having to kind of do a bit of a paradigm shift around the system perspective.
I'll stop there because I think that gets some of the major things that we have
tried to work with.
Cori White: All right, thank you. The next question is, "Most of your associations
that you have connected with are nurses or physicians. Have you considered the advantages
of connecting with other professionals in the healthcare environment such as radiologic
technologies, phlebotomists, respiratory care therapists, physical therapists, occupational
therapists, EMTs etc?
These are all referred to in the team structure portion of TeamSTEPPS and would
benefit from the education in their student programs and professional meetings."
Gwen Sherwood: I don’t think I could say it any better than this contributor.
You have identified that we absolutely need to be looking more than just nurses
and physicians.
We need to be looking across all providers in the healthcare setting and not leave
any out. I do think that all of these groups have professional associations who
are potential partners.
Cori White: Great thank you. Okay this next one says, "My affiliation is
with ACSM as an exercise physiologist at a health and wellness center. It seems
that there is difficulty with nurses versus health educators that are not nurses.
Also with nurses frowning on blood pressure checks being done by other disciplines
outside of nursing. Is there an additional certification physiologists and health
educators need for taking blood pressure in an outreach program environment for
health promotion.
In addition to certification received from ACSM for sports medicine or CHEST for
health educators. Should we see that nurses are on site when this is part of the
program?"
Gwen Sherwood: Oh what a good question! That gives me the opportunity to
talk about another barrier. That is: trying to recognize the role of each member
on the healthcare team. That is a teamwork skill that is included in defining teamwork
competencies: knowing the roles of everyone on the team.
For this particular question I'm not sure, I don’t know this particular certification,
ACSM, and have not looked at that. But I do know that many healthcare providers
including nurse aids are trained in taking blood pressures. And I would hearken
back to the fact that many years ago only physicians were allowed to take blood
pressures. But nurses pushed forward and said we should be allowed to take blood
pressure.
Then we learned that we could teach patients to take their own blood pressure. So
I would not see that that would be a problem, but in providing that service, it
would be good for the team to come together and decide who on the team is best suited
to take the blood pressure.
I would hope that we would be able to use some good communication strategies around
how we might decide who best to do it in a particular situation and context.
Cori White: Thank you. If you have a question please enter it in the Q&A
tab in your Live Meeting. Now we should go to the phones. Operator do we have any
people lined up on the phone?
Operator: Yes our first question comes from the line of [Participant].
Participant: Yes can you hear me?
Cori White: Yes.
Gwen Sherwood: Yes.
Participant: Yes, Gwen it's nice to put a voice with your name. I just have
two quick questions. Our work so far here has been elective work that we've done
with medical students, nursing students, exploring inter-professional communication
and understanding of scope of practice. We just did a pilot where we did a workshop
utilizing TeamSTEPPS curriculum followed by a simulation experience. Where we went
as far on the phone and in person. And we're planning for another one of those in
the fall.
I understand from your communication that the work that you've been doing it's a
required part of the curriculum for both disciplines.
Were you able to expedite that because of the QSEN work that you were engaged with?
And, you know, some of the steps that you went about to get that implemented?
And then secondary you mentioned the IPSES consortium and the randomized control
design that you utilized for that work. Is that referenced on the website or could
you share a little bit more about that?
Gwen Sherwood: Okay, yes. I'd be happy to talk about both of those. Is the
inter-professional education required for our students? The evening experience that
I mentioned is required for all students during their last semester for nursing
and medicine. I'm not sure if it's required for the pharmacy social work and dental.
But I do know that evening is required.
We have, when we did the TeamSTEPPS research project, those students in their last
semester were also required. We put it as part of their clinical work. So they were
required to do that.
At the current time we have begun to integrate the content and learning experiences
into the nursing curriculum. The hospital has begun to integrate TeamSTEPPS across
the hospital.
Physicians are starting to get it there. I'm not sure of the current state of integration
into the medical school curriculum for TeamSTEPPS. However, we at the grass roots
level decided that we weren't going to be able to get any kind of top-down integration.
So, because of these projects we did we became colleagues with people in the medical
school and in the school pharmacy who are doing similar work.
Now we just organize simulation experiences in one of our courses so that those
students come together around a simulation experience. So, in that sense: yes; but,
is it required at the level that we aspire to? No. So we still have opportunities
here.
I will say a little bit more about our TeamSTEPPS implementation work with nursing
and medicine for Duke and UNC. We set that up as a randomized control trial to try
to test the impact of (unintelligible) on their changes in knowledge skill and attitude.
As part of that we developed some instruments to measure knowledge skill and attitudes.
In the first year, everyone had a two hour lecture. They were randomly assigned
and balanced for nursing and medicine across groups. One group only had the lecture
and they were given a written case-study and that was that.
The second group had the two hour lecture; they then stayed in the room with an
audience response system. There was minimal interaction and they then selected an
appropriate response using the ARS.
The third group had what we call low-fidelity role play with trained faculty facilitators.
Everybody was still using the same case study, so they had the same core case study
to work with. The fourth group did a high patient, high fidelity patient simulation.
(Laerdal and Mackay) loaned us mannequins so we had 12 stations set up. This was
covered on NPR because it was such a remarkable coming together and such an event.
We were quite surprised when we looked at the pre-post test on knowledge and attitudes.
Everybody improved at about the same rate, however, nursing students started with
a better attitude about teamwork than medical students. Medical students started
with a slightly better knowledge about teamwork than nursing students. But the rate
of improvement was on the same trajectory. We found that very interesting because
the design was such that this was around a single dosing.
We don't know how the behavior change would be sustained. I'm working with a graduate
student at Dartmouth now who is designing a similar project and she's going to follow
the people for six months. It's people who are graduating and going into practice
and are going into a residency. She's going to follow them in six months and see
what kind of sustained behavior change exists.
This raised a lot of questions for us, we feel like more than a single exposure
is needed. We did find students were far more satisfied with simulation than with
the other models.
Does that mean they engaged more in the process? Our second year working with this
we developed a video tape. The students at UNC then did a everybody sitting in one
room web cast.
Whereas the students at Duke got it ahead of time as a Podcast. Then everybody went
through the same kind of exercise. We're still looking at that data, but we want
to see was there a difference in how they remembered content if they got it earlier
as a Podcast or if they got it just in time just before they had to practice.
We think we have some interesting data but not sure that we have definitive conclusions.
But then you wouldn’t expect that from a single study, I guess. It did help us to
establish some wonderful collegial relationships across nursing and medicine and
across the institutions that continue even though the project has ended.
Cori White: Do we have other questions on the phone or other comments?
Operator: There are no further questions at this time.
Cori White: Again if you’d like to make a comment or ask a question you can
do that over the phone by pressing star 1 or you can do it through Live Meeting
by entering it in the Q&A tab at the top of your screen.
We'll just give you 30 seconds, in case you have something get anything in so we
know that you're looking to get on the page.
Alex Alonso: Then after that we'll turn to the polls.
Cori White: Yes, we have two poll questions today that just sort of give
us a little bit of feedback on how we're doing with the webinars. Those will take
place through Live Meeting.
I will read the questions out loud for those of you that are only on the phone.
If you would like to provide feedback you can do that at
teamsteppswebinars@air.org.
It looks like we don’t have any more questions coming in through Live Meeting for
the moment. Do we have anyone on the phone?
Operator: There are no questions at this time.
Cori White: All right well then in order to give you a few more minutes to
put in questions we’ll go ahead and do the polls. Our first question is “how useful
was the information presented here to you?” This just sort of lets us know how we're
doing with our webinars and how people feel about them.
Alex Alonso: Okay Cori, go ahead and close that.
Cori White: All right I'll close this one up and I will also show you the
answers. People usually like to see how other people are responding. It looks like
you have mostly positive responses. We appreciate that, thank you.
The second question is “would you recommend these webinars to others?” This just
lets us know again a little bit about how we're doing and how you're feeling about
them.
Again while we're asking these poll questions if you have any questions of us, please
enter them through the Q&A tab at the top of your screen in Live Meeting or press
star 1 on the phone.
All right it looks like we've plateaued here, so I'm going to close the second question
and show you the results. Again it looks like you are pretty positive about these
and we really appreciate getting that feedback.
I have not seen any more questions come up through Live Meeting. Do we have any
more on the phone?
Operator: There are no audio questions at this time.
Alex Alonso: Oh, we have one through Live Meeting.
Cori White: There you are popping in. This question is about the slides.
In order to get a copy of the slides you can download them in PDF format. There
is an icon at the top right hand side of your screen that looks like three pieces
of paper. If you hover over it, it says “handouts”. The PDF copies of the slides
are available there.
We've had some feedback that some people have trouble downloading them from LiveMeeting.
So if you would like to receive them by email just send us an email at teamsteppswebinars@air.org
and we'll make sure you get a copy of them.
Alex Alonso: Okay it looks as though we have no further questions. I want
to remind you that we have additional resources available to you for this information.
First you have all the websites that Gwen provided you. We can certainly furnish
you with Gwen's contact information, if you so wish to contact her.
We also have the ahrq.gov/teamstepps website which has been active now for over
a year. We also have the TeamSTEPPS Guide to Action which is available on that website.
We have the DOD dodpatientsafety.usuhs.mil
website which is a wonderful resource also and is a great place to go for TeamSTEPPS
information.
Again we have basic contact information here for all members of the AIR team. An
additional thing for you to note would be that we also have the
teamsteppswebinars.@air.org address so you can ask us questions or provide
feedback about the TeamSTEPPS webinars.
We also want to thank you for participating here today. We really appreciate everyone
who made it out and I want to take special time to thank Gwen for coming onboard
and providing you such useful information.
Gwen I want to give you an opportunity to say goodbye to the audience. But again
I want to thank you greatly for the help that you provided us. This is an area that
we ourselves are not very familiar with and we're grateful that we have you as a
resource.
Gwen Sherwood: Well thank you. It was a pleasure to be with you and to be
able to have the conversation and I would look forward to any added thoughts and
views from the audience.
Alex Alonso: Okay operator do we have anyone on hold at all?
Operator: There are no further questions at this time.
Alex Alonso: Okay thank you all very much I hope you have a great day wherever
you are. We look forward to hearing from you again or seeing you again via the webinar
mechanism next month, when we have the tenth in the series of the National Implementation
webinars on Dosing Strategies for TeamSTEPPS.
So I thank you all and have a great day.
Operator: Ladies and gentlemen that does conclude the conference call today.
We thank you for your participation and ask that you please disconnect your line.
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