Teamwork and communication

Communication is…• the process by which information is exchanged between individuals, departments, or organizations • the lifeline of the front line staff e.g., charge nurse, physician t

Teamwork and Communication

Paula S Kent, RN, MSN, MBA Patient Safety Coordinator The Johns Hopkins Hospital

Baltimore, Maryland

USA

pkent2@jhmi.edu

The slides and videos used in this presentation have been

customized from the Department of Defense TeamSTEPPS program

TeamSTEPPS[TM] is an evidence-based teamwork system to

optimize patient outcomes by improving communication and teamwork skills among health care professionals Slides and videos are made available through the Agency for Healthcare Research and Quality.* General permission has been given to

customize the slides to meet the needs of this program

*TeamSTEPPS™: Strategies and Tools to Enhance Performance and Patient Safety Agency for Healthcare Research and Quality, Rockville, MD

http://www.ahrq.gov/qual/teamstepps /

Teamwork is the ability to work as a group toward a common vision, even

if that vision becomes blurry.”

(Author Unknown)

“Communication is the response you get from the message you sent regardless of its intent.”

(Author Unknown)

1 Describe the importance of teamwork and

communication in the hospital setting

2 Identify challenges to effective teamwork

and communication

3 Recognize the connection between

communication and patient safety

4 Define mutual support

Communication is…

• the process by which information is exchanged

between individuals, departments, or

organizations

• the lifeline of the front line staff e.g., charge nurse, physician team leader and the direct care

providers on the unit

• most effective when it permeates every aspect of

an organization and unit

Why is Communication so Vital in

Hospital Settings?

• It affects the functioning of the team caring for

patients

• Numerous handoffs occur-between levels of care,

shifts and providers

• Many care providers are involved in the care process e.g., nurses, doctors, consult services, therapies and ancillary services

• Clinical diagnosis, therapies, procedures and the

patient’s outcomes depend on accurate information

• Communication is essential for effective patient care

in the 24X7 healthcare environment

Joint Commission: The Importance of Communication

Voluntary reporting of sentinel events to the Joint Commission reveals:

Ineffective communication is a

root cause for nearly 66 percent

of all sentinel events reported*

* (JC Root Causes and Percentages for Sentinel Events (All

Categories) January 1995−December 2005)

NUMBER 1 ROOTCAUSE

Challenges to Effective Teamwork

and Communication

• Healthcare environments challenge the

communication process in hospital settings

• Each challenge creates an opportunity for a

potential medical error

• Many factors can “fuel the fire” for ineffective communication

Factors that Challenge Effective Teamwork and Communication …

• Language barriers and varying communication styles

• Distractions

• Misinterpretation of non-verbal cues

• Personality characteristics

• Workload

• Conflict (unresolved or in progress)

• Lack of information verification

• Shift change/Handoffs

The Joint Commission has set Goals Related to Improving Communication

National Patient Safety Goals related to communication

– Improve the effectiveness of communication

among caregivers by using Read-Back and

Handoff

– Completely reconcile medications and other

treatments across the continuum of care

– Encourage the active involvement of patients and their families in the patient’s care as a patient

safety strategy

Standards of Effective Communication

Information Exchange Strategies

Information exchange strategies have the potential to reduce medical errors related to miscommunication.

Four strategies include:

• provides a framework for team members to

effectively communicate about a patient’s

condition

• communicates the following information:

– Situation - What is going on with the patient?

– Background - What is the clinical background

or context of the situation?

– Assessment - What do I think the problem is?

– Recommendation - What would I recommend?

A Call-Out is a strategy used to communicate

important or critical information during an

• A Check-Back is a strategy to “close the

communication loop”

• The Check-Back process occurs when:

• the sender initiates a message

• the receiver accepts message and confirms what was heard

• the sender verifies message received

• If a call-out strategy requires a response in the form of

an order; the order is then verified with a “check-back”

• A check-back is similar to a “read-back” for verbal

orders

A Handoff is designed to enhance the exchange of

information at critical times in the patient’s care

A handoff includes:

– transferring information (along with authority

and responsibility) during transitions in care

across the continuum (e.g., between shifts, ICU

to inpatient transfer, OR to PACU)

– providing an opportunity to ask and respond to questions

– maintaining continuity in care even though the care giver changes

What is Mutual Support?

– Mutual support is the essence of teamwork, simply stated it is “backing up your fellow team members”

– Mutual support protects team members

from work overload situations that may

reduce effectiveness and increase the risk

of error

When is Mutual Support Needed?

Any time a unit is in the “work overload” mode This can occur with

– any unexpected event on a unit

– new patients being simultaneously admitted to the unit

– other departments being backed-up and delayed

– abrupt changes in a patient’s status

Mutual Support:

What does it look like?

Back-up Behavior

• Monitoring team members performance to

anticipate if assistance is needed-constant

situational awareness.

• Cautioning team members if there is a potential for

an unsafe situation.

• Distributing and assigning work thoughtfully.

• Reassigning work if a team member gets

overwhelmed-giving a team member time to

regroup.

• Providing constructive feedback to others to

improve performance

Mutual Support: Task

Assistance

In a Culture of Safety it is expected that

assistance will be actively sought and offered as

a method for reducing the occurrence of error

Mutual Support: Feedback

• Feedback is the giving, seeking, and receiving

of performance-related information

• Feedback can be formal or informal

• Anyone on the team can give feedback

What to do when there are Differing Points of View

• Advocate for the patient or staff member even

if your opinion is not popular

• Assert your opinion in a firm and respectful

Challenges to Providing

Mutual Support

“I’d like to provide mutual support but… ”

• “I don’t have enough time to get my own work

done”

• Be adaptable: Ask someone else to provide assistance to your colleague

“I’d like to provide mutual support but… ”

• “My colleague is going to feel I am criticizing

him/her”

• State your intention-you are trying to lessen their workload or improve on their

performance

What can you do to communicate

effectively?

• Communicate with team members in a

brief, clear, and timely format

• Seek information from all available

sources (“Don’t play one man down”)

• Verify and share information

• Use communication exchange tools and

strategies daily, i.e., SBAR, call-out,

check-back and handoff

What can we do to provide

Mutual Support?

• Foster a climate of safety: be supportive of

task assistance

• Provide timely and constructive feedback

• Be assertive and advocate for the patient or a staff member

• Use the mutual support techniques: task

assistance, feedback, advocacy and assertion

• Resolve conflict through collaboration—Create

a “Win-Win” situation

In Summary

• Effective teamwork and communication

present opportunities to create a positive

patient experience and prevent medical error

• Challenges to effective teamwork and

communication are varied - SBAR, Call-Out, Check-Back and Handoff

• Communication and Patient Safety are closely linked

• Mutual support is the essence of teamwork, and involves “backing up your fellow team

members.”

Questions?