for Office-Based Care Online Challenges and Successes in the Small

for Office-Based Care Online Challenges and Successes in the Small Office Setting

Small Office Setting This Webinar and Future Webinars Webinar a part of a library to support and amplify your work on TeamSTEPPS TeamSTEPPS for Office-Based Care Online is funded by AHRQ Mod 1205.2 Page 2 Slide TEAMSTEPPS 05.2

Small Office Setting Presenter Ken Plitt, CRNA, M.B.A. Principal, Senior Trainer and Consultant TEAM IQ, LLC Seattle, WA Mod 1305.2 Page 3 Slide TEAMSTEPPS 05.2

Small Office Setting Disclosures Independent contractor in consulting and training roles No financial arrangements with any referenced products or businesses Mod 1405.2 Page 4 Slide TEAMSTEPPS 05.2

Small Office Setting Objectives 1. Evaluate characteristics of the office environment that make it susceptible to breakdowns in communication and team performance. 2. Explore opportunities to develop “change capacity” within the medical office. 3. Consider practical tips used by master trainers within an office setting to select, introduce, and embed TeamSTEPPS techniques as part of a broader culture of safety. Mod 1505.2 Page 5 Slide TEAMSTEPPS 05.2

Small Office Setting Nature of Risk in the Medical Office Mod 1605.2 Page 6 Slide TEAMSTEPPS 05.2

Small Office Setting Nature of Risk in the Medical Office Mod 1705.2 Page 7 Slide TEAMSTEPPS 05.2

Small Office Setting Medical Errors in Ambulatory Care Each year in the United States: More than 1 billion ambulatory visits 12 million ambulatory care patients with a diagnostic error Paid medical liability claims (Bishop, et al., 2011): Half related to events in the outpatient setting 76% due to errors in diagnosis or treatment Mod 1805.2 Page 8 Slide TEAMSTEPPS 05.2

Small Office Setting http://effectivehealthcare.a hrq.gov/index.cfm/search-f or-guides-reviews-and-rep orts/?pageaction displaypr oduct&productid 2322 Mod 1905.2 Page 9 Slide TEAMSTEPPS 05.2

Small Office Setting Key Informant Findings Safety Topics Mod 110 Slide 05.2 Page 10 Focus of Safety Strategies Medication Safety Communications Diagnosis Health IT Transitions Teams/Teamwork Referrals Patient Engagement Testing Organizational Approaches Safety Culture TEAMSTEPPS 05.2

Small Office Setting Office Characteristics That Affect Team Performance and Safety Small practices lack sophisticated EHR and other technological tools: Budget constraints also affect equipment quality and redundancy. Referrals and diagnostic resources may not be readily accessible. Traditional visit-based model of care: Mod 111 Slide 05.2 Page 11 Periodic, short visits over long course of time Practice objective of maximizing volume/throughput Lack of support staff dedicated to care coordination Reliance on patient’s/family’s ability to self-manage TEAMSTEPPS 05.2

Small Office Setting Office Characteristics That Affect Team Performance and Safety Nature of Staff-Patient Encounters Mod 112 Slide 05.2 Page 12 Sequential (norm in most offices) Many individual, autonomous activities Reliance on multiple handoffs Pros/cons of duplicative patient assessments Team Encounters Lead Assistant TEAMSTEPPS 05.2

Small Office Setting Let’s Recognize Elephants in the Room Office By Bit Boy - Flickr: The Elephant in the Room, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid 20972528 Mod 113 Slide 05.2 Page 13 TEAMSTEPPS 05.2

Small Office Setting Let’s Recognize Elephants in the Room Office 1. The “MD-eity” Effect By Bit Boy - Flickr: The Elephant in the Room, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid 20972528 Mod 114 Slide 05.2 Page 14 TEAMSTEPPS 05.2

Small Office Setting Let’s Recognize Elephants in the Room Office 2. Power of the Office Manager By Bit Boy - Flickr: The Elephant in the Room, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid 20972528 Mod 115 Slide 05.2 Page 15 TEAMSTEPPS 05.2

Small Office Setting Let’s Recognize Elephants in the Room Office 3. The Office Naysayer By Bit Boy - Flickr: The Elephant in the Room, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid 20972528 Mod 116 Slide 05.2 Page 16 TEAMSTEPPS 05.2

Small Office Setting Let’s Recognize Elephants in the Room Office 4. The “Change Team” By Bit Boy - Flickr: The Elephant in the Room, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid 20972528 Mod 117 Slide 05.2 Page 17 TEAMSTEPPS 05.2

Small Office Setting Tuckman’s Four Phases of Growth Adapted from Tuckman, Stages of Group Development. 1965 Mod 118 Slide 05.2 Page 18 TEAMSTEPPS 05.2

Small Office Setting Organizational Capacity for Change “ the overall capability of an organization to either effectively prepare for or respond to an increasingly unpredictable and volatile environmental context. [OCC] enables an organization to upgrade or revise existing organizational competencies while cultivating new competencies that enable the organization to survive and prosper.” (WQ Judge, 2011) Ingredients: Mod 119 Slide 05.2 Page 19 Human skill sets and resources, Formal systems and procedures, and Organizational culture, values, and norms. TEAMSTEPPS 05.2

Small Office Setting How Change Capacity Fits A Core Business Activities WORK Change Efforts: B WORK All change programs intended to improve organizational performance Change Capacity: Organizational competency in planning, leading, and sustaining change efforts C WORK Mod 120 Slide 05.2 Page 20 TEAMSTEPPS 05.2

Small Office Setting Leveraging Different Approaches to Change Individual www.vitalsmarts. com Mod 121 Slide 05.2 Page 21 Working Team Chip and Dan Heath Organizational Amy Edmondson TEAMSTEPPS 05.2 John Kotter

Small Office Setting Master Trainer in the Office: Many Roles/Many Challenges Strategic planner Project lead Evangelist Staff training and development QI/safety officer Coach “Real” job Mod 122 Slide 05.2 Page 22 TEAMSTEPPS 05.2

Small Office Setting A Few Lessons Learned 1. Appreciate the difference between Ownership and Buy-in Mod 123 Slide 05.2 Page 23 TEAMSTEPPS 05.2

Small Office Setting Ownership vs. Buy-in “Ownership” means You own or share the ownership of an idea, a decision, or an action plan. You have participated in its development and you chose on your own accord to endorse it. You understand it and believe in it. You are both willing and ready to implement it. “Buy-in” is the opposite: Someone else or some group of people has done the development, the thinking, the cooking and now they have to convince you to come along and implement their ideas/plans. Henri Lipmanowicz – Liberating Structures http://www.liberatingstructures.com Mod 124 Slide 05.2 Page 24 TEAMSTEPPS 05.2

Small Office Setting A Few Lessons Learned 2. Conditions established by senior management override everything else Mod 125 Slide 05.2 Page 25 TEAMSTEPPS 05.2

Small Office Setting Patient Safety Adapted from Salas High-Reliability Organization High-Reliability Teams Cooperation Coaching Coordination Communication Mod 126 Slide 05.2 Page 26 TEAMSTEPPS 05.2 Cognition Supportive Organizational Conditions Conflict

Small Office Setting Business Case for Safety Initiatives “Activities to promote safety are strong contributors to stakeholder satisfaction (patient/family/staff) and the organization’s vision, mission, and values. The degree to which these activities are efficiently and effectively carried out has a direct impact on the financial bottom line.” Paul Schyve, M.D. Joint Commission Mod 127 Slide 05.2 Page 27 TEAMSTEPPS 05.2

Small Office Setting Business Case for Safety Initiatives How does the activity contribute to ? Effective? Efficient? Mod 128 Slide 05.2 Page 28 TEAMSTEPPS 05.2

Small Office Setting A Few Lessons Learned 3. TeamSTEPPS principles and tools can thrive within a broader approach to a culture of safety (“stealth” strategies work!) Mod 129 Slide 05.2 Page 29 TEAMSTEPPS 05.2

Small Office Setting A Few Lessons Learned 4. Leverage opportunities for training, coaching, monitoring, and sharing progress wherever found Mod 130 Slide 05.2 Page 30 TEAMSTEPPS 05.2

Small Office Setting A Few Lessons Learned Leverage opportunities: Dedicated training time vs. ad hoc Replace mandatory drills with simulations: Technical component Teamwork component Communicate/reward “wins” Mod 131 Slide 05.2 Page 31 TEAMSTEPPS 05.2

Small Office Setting DISCUSSION Mod 132 Slide 05.2 Page 32 TEAMSTEPPS 05.2