Implement Teamwork and Communication

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Slide Number Slide Content Content for Alternative Text (Illustration)
and Title

Slide 1 (CUSP Toolkit logo) The “Teamwork and Collaboration” module of

Cover Slide the CUSP Toolkit. The CUSP toolkit is a
modular approach to patient safety, and
modules presented in this toolkit are
interconnected and are aimed at improving
patient safety.

Slide 2 1. Recognize the importance of effective

Learning communication
Objectives 2. Identify barriers to communication
3. Describe the connection between communication
and medical errors
4. Identify and apply effective communication strategies
from CUSP and TeamSTEPPS®

Slide 3 Provider A – Sender and Receiver Graphic description of the basic components
Basic Noise and process of communication. The
Components A’s Context communication that takes place between two
and Process of Encoding and Decoding people is exposed to many roadblocks in
Communication2 Messages between its transmission from one individual
Channel to another. First, the sender encodes, or
Provider B – Sender and Receiver creates, the message, which is influenced by
Noise the sender’s context, and then transmits the
B’s Context message to the receiver, who then must
Encoding and Decoding decode, or process, the message, based on
the receiver’s context. While the message is
being transmitted, it is exposed to noise
interference that affects the context and
clarity of the message that is sent and
received.

Slide 4 Complete TeamSTEPPS logo and penguin

Four Key Clear
Components of Brief
Effective Timely
Communication1

Slide 5 Interruptions Team members separated by barrier

Elements That Task absorption representing possible disruptions to effective
Affect Verbal abuse communication.
Communication Fatigue
and Information Not following plan of care
Exchange Ambiguous orders or directions
Change in team members
Work load
Slide 6 Root Causes of Treatment Delays (1995-2004) Root Causes of Treatment Delays (1995-
Communication Communication 86% 2004)
Breakdowns Patient Assessment 77% The root causes of treatment delays are as
Cause Continuum of Care 52% follows:
Treatment Orientation and Training 41% Communication 86%
Delays3 Availability of Information 39% Patient Assessment 77%
Competency and Credentialing 35% Continuum of Care 52%
Staffing 25% Orientation and Training 41%
Care Planning 20% Availability of Information 39%
Leadership 19% Competency and Credentialing 35%
Environmental Safety and Security 19% Staffing 25%
Organizational Culture 18% Care Planning 20%
Procedural Compliance 17% Leadership 19%
Environmental Safety and Security 19%
Organizational Culture 18%
Procedural Compliance 17%

Slide 7 Root causes of infection-associated events (2005) Root causes of infection-associated events
Communication Communication 75% (2005)
Breakdowns Environmental Safety/Security 50% The root causes of infection-associated
Cause Continuum of Care 39% events are as follows:
Infection- Competency or Credentialing 38% Communication 75%
Associated Procedural Compliance 38% Environmental Safety/Security 50%
Events3 Patient Assessment 25% Continuum of Care 39%
Leadership 25% Competency or Credentialing 38%
Staffing 13% Procedural Compliance 38%
Availability of Information 13% Patient Assessment 25%
Orientation and Training 12% Leadership 25%
Organizational Culture 12% Staffing 13%
Availability of Information 13%
Orientation and Training 12%
Organizational Culture 12%
Slide 8 Think of a defect that has occurred in your unit due to a Exercise icon
Exercise communication breakdown. Using the standards of
effective communication, list three to four ways in which
communication could be improved to reduce the risk of
similar defects occurring.
Slide 9 Working Conditions: Three rectangles, one for Working
Barriers to Team Lack of coordination or followup Conditions, one for Resources, and one for
Effectiveness1 Distractions Team Composition:
Misinterpretation of cues
Hierarchy TeamSTEPPS logo and penguin
Physical proximity
Shift changes

Resources
Lack of time
Workload
Processes
Technology

Team Composition
Inconsistency in team membership
Lack of role clarity
Defensiveness
Conventional thinking
Conflict
Fatigue
Complacency
Varying communication styles
Personality

Slide 10 Reduced length of stay A nurse and physician conferring with their
Positive Higher quality of care patient and the patient’s family member.
Outcomes of Better patient outcomes
Effective Greater ability to meet family member needs
Teamwork Improved patient experience with care scores
on Health Care4 Lower nurse turnover

Slide 11 Helps: Two CUSP team members walking.

Shadowing Team members gain perspective of other roles
Identify issues affecting teamwork and
communication that may affect patient care,
patient care delivery, and outcomes
Who should shadow?
Unit teams using CUSP
Staff of patient care units where culture scores
indicate a poor score in teamwork and safety
Units with little collaboration between disciplines

Slide 12 This tool is used by team members to improve

Daily Goals communication among the patient’s care team and
Checklist family members regarding the patient’s plan of care
The checklist provides a care plan that prompts
health care staff to focus on tasks to accomplish that
day to safely progress the patient closer to discharge
People and organizations that create explicit
objectives, and provide feedback toward goals,
achieve more results than groups that do not
communicate defects
 Discussion during rounds is divergent
(brainstorming) rather than convergent (following an
explicit plan)

Slide 13 (vignette still) Video icon

Daily Goals Click to play

Slide 14 Be explicit Team members walking.

How to Use the Ask important questions:
Daily Goals What needs to be completed for discharge?
Checklist What do we hope to accomplish?
What are patients’ greatest safety risks?

Slide 15 (vignette still) Video icon

Using the Daily Click to play
Goals Checklist
Slide 16 Four Components of Effective Teams Leadership: A table showing four components of effective
Selected Brief teams
TeamSTEPPS Huddle In the first column, Leadership tools include
Tools1 Debrief brief, huddle, debrief
In the second column, Situation Monitoring
Situation Monitoring: tools include STEP and I'M Safe
STEP In the third column, Mutual Support tools
I’M Safe include Task Assistance, Feedback,
Advocacy and Assertion, Two-Challenge
Mutual Support:
Rule, DESC Script, CUS, and Collaboration
Task Assistance
In the fourth column, Communication Tools
Feedback
include SBAR, Call-Out, Check-Back, and
Advocacy and Assertion
Handoff (I-PASS the BATON) TeamSTEPPS
Two-Challenge Rule
logo and penguin
DESC Script
CUS
Collaboration

Communication:
SBAR
Call-Out
Check-Back
Handoff (I-PASS the BATON)

Slide 17 A briefing is a discussion between two or more people, Team members standing in discussion
Briefing1 often a team, using succinct information pertinent to an TeamSTEPPS logo and penguin
event.
A briefing immediately:
Maps out the care plan
Identifies each team member’s role and
responsibilities
Heightens awareness of the situation
Permits the team to plan for the unexpected
Allows team members’ needs and expectations to be
met
Sets the tone for the day
Encourages team members’ participation

Slide 18 (vignette still) Video icon

Briefing in Click to play
Action
Slide 19 Employs ad hoc planning to re-establish situational Team members engaged in a huddle.
Huddle1 awareness, reinforce plans that are already in place, TeamSTEPPS logo and penguin
d d dj h l
 and assess any need to adjust the plan
Gathers team members to review patient data and
decide on a course of action
Can be requested by any team member at any time
Uses the SBAR tool frequently

Slide 20 Informal information exchange session designed to TeamSTEPPS logo and penguin
Debriefing1 improve team performance and effectiveness after each
review. Debriefings answer:
What went well?
What should change?
What do we need to adjust?

Debriefing Checklist:
Is communication clear?
Are roles and responsibilities understood?
Is situational awareness maintained?
Is the workload distributed equally?
Is task assistance requested or offered?
Were errors made or avoided?
Are resources available?

Slide 21 Status of the patient TeamSTEPPS logo and penguin

STEP1 Team members
Environment
Progress toward goal
Slide 22 I = Illness TeamSTEPPS logo and penguin
I’M Safe1 M = Medication
S = Stress
A = Alcohol and Drugs
F = Fatigue
E = Eating and Elimination

Slide 23 Team members protect each other from work TeamSTEPPS logo and penguin
Task overload situations
Assistance1 Effective teams place all offers and requests for
assistance in the context of patient safety
Team members foster a climate where it is expected
that assistance will be actively sought and offered

Slide 24 Timely—given soon after the target behavior has TeamSTEPPS logo and penguin
Feedback1 occurred
Respectful—focus on behaviors, not personal
attributes
Specific—be specific about what behaviors need
correcting
Directed toward improvement—provide directions for
future improvement
Considerate—consider a team member’s feelings
and deliver negative information with fairness and
respect

Slide 25 Advocacy and assertion are used to support the TeamSTEPPS logo and penguin
Advocacy and patient when a team member’s viewpoints do not
Assertion1 coincide with those of the decision maker
When advocating for the patient, team members
should assert their opinion in a firm and respectful
manner, providing evidence or data to support their
concerns
 An assertive statement should:

- Open the discussion

- State the concern
- State the problem—real or perceived
- Offer a solution
- Obtain an agreement

Slide 26 Used when there is an information conflict and an TeamSTEPPS logo and penguin
Two-Challenge initial assertion is ignored
Rule1 Rule requires team members to state their
observation at least twice to ensure that their
interests and observations are being addressed
The Two-challenge Rule empowers any team
member to stop the action if he or she senses, or
discovers, an essential safety breach that hinders
patient well-being

Slide 27 A constructive approach for handling and managing TeamSTEPPS logo and penguin
DESC Script1 personal conflict, the DESC script helps unit teams
resolve these disputes.
Describe the specific situation
Express your concerns about the action
Suggest other alternatives
Consensus should be stated

Slide 28 I am CONCERNED! TeamSTEPPS logo and penguin

CUS1 I am UNCOMFORTABLE!
This is a SAFETY ISSUE!
Slide 29 Achieves a mutually satisfying solution resulting in the TeamSTEPPS logo and penguin
Collaboration1 best outcome
Win-Win-Win for patient care team(includes the
patient, team members, and team)
Commitment to a common mission

Meet goals without compromising relationships

Slide 30 Provides a framework for effective communication TeamSTEPPS logo and penguin
SBAR1 between team members for the following information:
Situation―What is happening with the patient?
Background―What is the clinical background or
context?
Assessment―What do I think the problem is?
Recommendation―What would I recommend?

Slide 31 A strategy used to communicate critical information to all TeamSTEPPS logo and penguin
Call-Out1 team members to prepare them for the upcoming
procedures.
Informs all team members simultaneously
Helps team members anticipate next steps
Directs responsibility to a specific individual
accountable for carrying out the task

Slide 32 A strategy that ensures messages are received. Diagram depicting how check-back works:
Check-Back1 Sender initiates message The sender initiates a message to the
Receive accepts message, provides feedback receiver, who loops back his or her
confirmation understanding and feedback to the sender.
Sender verifies message was received The sender then verifies the message was
received. TeamSTEPPS logo and penguin
These three steps are sections of a closed loop
communication
Slide 33 Transfer of information, along with authority and Two team members conversing.
Handoff1 responsibility, during transitions in care across the TeamSTEPPS logo and penguin
continuum, and includes an opportunity to ask
questions, clarify, and confirm
Tool used: I PASS the BATON

Slide 34 Introduction TeamSTEPPS logo and penguin

I PASS the Patient
BATON1 Assessment
Situation
Safety Concern

(the)
Background
Actions
Timing
Ownership
Next

Slide 35 When team members use situational awareness, they: TeamSTEPPS logo and penguin
Situational Know the game plan through briefings and team
Awareness1 management (e.g., workload and workflow
management, task coordination, policies, and
procedures)
Have an understanding of what’s going on and what
is likely to happen next
Check-back and verify information
Provide ongoing updates—briefings, call-outs, and
check-backs
Implement team huddles

Slide 36 Identify opportunities to improve teamwork and

Implement communication by reviewing barriers the team
Teamwork and identified while learning from a safety defect
Communication: Discuss with frontline providers how and where they
What the Team want to improve communication
Needs to Do Select a tool that best addresses providers’ concerns
Use teamwork and communication tools and
incorporate them into team meetings and other
relevant project processes

Slide 37 Effective communication plays an integral role in the

Summary delivery of high-quality, patient-centered care
Barriers to efficient teamwork and communication
influence the outcomes of the unit team
Research supports the connection between
communication errors and patient care delivery
CUSP and TeamSTEPPS employ successful tools
and strategies that unit teams can implement to
improve the effectiveness of teamwork and
communication on their units

Slide 38 Morning Briefing Tools icon

Additional Observing Patient Rounds
CUSP Tools Team Check-up Tool
 Slide 39 1. Agency for Healthcare Research and Quality,
References Department of Defense. TeamSTEPPS.
http://www.ahrq.gov/teamstepps/instructor/index.html
2. (Adapted from) Dayton, E, Henriksen, K. Joint
Commission Journal of Quality and Patient Safety.
2007 Jan;33(1):34–47.
3. J Point Commission on Accreditation of Healthcare
Organizations. Sentinel Events Statistics. Root
Causes of Sentinel Events, 2005.
http://www.jointcommission.org/sentinel_event.aspx

4. Shortell SM, Marstellar JA, Lin M et al. The role of

perceived team effectiveness in improving chronic
illness care. Med Care 2004 Nov; 42:1040–1048.

Page last reviewed April 2013

Page originally created April 2013

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