ORGANIZATIONAL ASSESSMENT 11
Organizational Assessment
Geri Sanfillippo
Thomas Edison State College
August 18, 2013
ORGANIZATIONAL ASSESSMENT 11
Abstract
According to the Institute of Medicine in (IOM) 1999, tens of thousands of patients still die unnecessarily and hundreds of thousands are injured by medical mistakes each year (Nance, 2008). Since this report was published several organizations, including the Agency for Healthcare Quality (AHRQ), have become leaders in the patient safety movement and identified the importance of teamwork in patient safety (King et al., 2008). Our object is to determine whether or not team strategies and tools to enhance teamwork and communication can effectively improve patient safety through the use of TeamSTEPPS framework and concepts.
Need
Medical errors continue to occur despite multiple strategies created for their prevention. AHRQ, a federal government’s quality and patient safety organization, has developed a patient safety and communication program known as TeamSTEPPS. This program was developed in an attempt to improve the dynamics that exist between health care workers. According to patient safety movements, poor communication and lack of team work in the health care arena are major causes of errors leading to patient morbidity and mortality. (Sheppard, Williams, & Klein, 2013)
The healthcare system I am currently working with was recently involved in a patient complaint to the Joint Commission requiring an action plan to be developed. A young woman presented to the Emergency Department (ED) with a note from her nurse at college identifying flu like symptoms for an extended period of several days. Triaged, she was returned to the waiting area until a bed in the main ED became available. During this time a change in the patient’s condition was identified by her family. The patient had begun to have increased weakness and difficulty speaking, symptoms of an acute stroke. Both the family and non-clinical staff in the waiting room identified the changes as significant and requiring immediate attention. The clinical staff was notified of the change but the patient remained in the waiting room until her condition required emergent attention. The family felt their communication with non-clinical staff and subsequent communication with nursing did not result in prompt care for their loved one.
The Root Cause Analysis (RCA) identified opportunities to improve in areas of communication and team building. Human factors have a significant effect on patient safety, with approximately 4 percent of all sentinel events have reported a communication factor.
Context
TeamSTEPPS provides strategies and tools to enhance performance and improve team work and communication with an objective of creating a culture of safety. Through the implementation of a program design to improve teamwork and communication with all members of a care team it will ultimately create a culture of safety for the organization. Through the use of Team STEPPS Healthcare Team Training (HTT), and teleconferencing with consultant Dr. John Webster, a master trainer for STEPPS, a culture of safety will result from the creation of high performance teams. To be successful, the program must be sustainable and the staff needs to be empowered to make change happen. TeamSTEPPS focuses on four modules that include; leadership, situational monitoring, mutual support and communication. For the purpose of this project the initial focus will be on mutual support. Mutual support is the essence of teamwork. It protects team members from work overload situations that may reduce effectiveness and increase the risk of error.
The initial outline for the program will include
1. Introduction to Team STEPPS
2. ED readiness assessment for change
¨ Patient safety focus
¨ Importance of leadership support
3. Overall Team STEPPS plan
¨ Workshop with consultant
¨ Pre-post conference work plan
4. Identification of 2 tools
¨ Two – challenge rule – ensure you have been heard and your statement acknowledged – repeated a second time if not acknowledged and concern taken to the next step in not acknowledged at all
¨ CUS ( I am Concerned, I am Uncomfortable, This is a Safety issue)
5. Sustainability- Making it stick
¨ Integrate teamwork into daily practice
¨ Monitor and measure ongoing effectiveness
¨ Spread success throughout the organization
("Team STEPPS,)
Findings
The Emergency Department at Hopewell is a suburban setting triaging approximately 35,000 patients annually. The core staffing consist of approximately 40 Registered Nurses (RN’s), 10 patient care assistants (PCA’s) 20 healthcare specialist provided by a contracted physician group both physicians and physicians assistants and various support staff. As in many organizations, there have been significant changes within the organization and the ED that have greatly impacted the function of the ED. A major move of the organization to a new location, a increase in the size of the department, several changes in leadership both nursing and physicians with no change in staffing patterns. The changes reflected in the baseline data prepared by Press Ganey during the period of 5-1-13 to 7-31-13. The overall ranking was 79 percent satisfaction with questions related to arrival. Two opportunities identified for immediate improvement were helpfulness of the first person seen and courtesy of the triage nurse. A thorough assessment of the ED also identified the need to review the triage policy for more defined reassessment time frames for all patients remaining in the waiting area for treatment. Individual roles of the various members of the team were well-defined and shared with all members of the team and finally a surge algorithm needed to be designed on the steps to follow during periods when demands exceed available resources. A literature review supports the implementation of pilot projects of TeamSTEPPS to be effective leading to measureable improvements in teamwork, communication and patient satisfaction (Sheppard et al., 2013).
TeamSTEPPS is based on years of research related to teamwork, team training and culture change according to information provided by AHRQ (Butler County Health Care Center [BCHCC], 2012) Creating a culture of safety in healthcare organizations requires the participation of all members since healthcare delivery requires multiple caregivers working together as an effective team with the goal of achieving desired patient outcomes and preventing harm (Thomas & Galla, 2013).
Conclusion
“TeamSTEPPS by itself doesn’t solve your patient safety problems, but it gives you the tools to work together and identify those root causes better.” (BCHCC, 2012). TeamSTEPPS addresses leading causes of medical errors and improves quality, safety and effectiveness in healthcare. It is part of a culture change about interprofessional communication within the healthcare settings as it relates to patient safety and a means to hold staff accountable for team behavior (Turner, 2012). TeamSTEPPS is comprised of five core principles; team structure, leadership, situation monitoring, mutual support and communication. An interdisciplinary approach to training is essential to the acceptance and commitment of the different departments involved in the training. The process of implementation should be standardized and be a rapid structured approach. It is important to engage senior leadership before the implementation of the project. If you include this group in the training process it could be positively perceived by staff as a commitment to improving patient safety and staff morale. One of the challenges facing the program is mandatory attendance elicits negative feelings in those attending the session.
Strategy
The method to be used to implement change will initially begin with an assessment of the Emergency Department leadership to determine how committed they are to change within the department. The project requires leadership support to be successful. Next is a consideration to the human factors that may be present working in a busy emergency department. Determine what the current method of communicating the needs of the patient between the non-clinical and clinical staffs.
The project will be rolled out in phases and will be introduced in a joint meeting of Emergency Department staff and leadership and other vital members of the team to include security, patient access and guest relations leadership. Phase one will introduce tools for staff and leadership to enhance communication that include a badge buddy describing the two challenge rule and CUS and the use of posters in the department. Through a collaboration with the Clinical Nurse Specialist of the ED, myself and the Staff Development Coordinator a series of educational session were designed that would present the same information to each member of the team. Each session would be 45 minutes to an hour long allowing for feedback from the participants.
Phase two will bring in a consultant to provide 3 conference calls and a training session to train the trainer on Team STEPPS concepts.
In addition to meeting with staff and ongoing training sessions, a shared drive on the hospital computer will be developed where items can be placed for ED specific safety training.
Resources
The success of any project is determined by the availability of appropriate resources. For the TeamSTEPPS project to be success the initial investment was that of senior leadership. It was essential they had a firm understanding of the importance of the project to improve patient outcomes and to provide backing for the education and implementation of the proposed project. Well planned, staged and phased interventions that enhance teamwork are more likely to support and sustain organizational change (Castner, Foltz-Ramos, Schwartz, & Ceravolo, 2012). The core team for this project consisted of a team leader from regulatory, an RN specializing in patient safety from our quality department and myself. Prior to my joining the team in July, the existing members attended an educational session on TeamSTEPPS provided at the New Jersey Hospital Association to train the trainers. Additionally the ED provided immediate training to all staff on the process of when to call a rapid response and the chain of command. The organization has committed time and resources to make this project successful and sustainable. Funding was obtained from the hospital foundation to contact and engage Dr.Webster, one of the developers of TeamSTEPPS, to provide an additional train the trainer session at the facility and to act as a consultant for the implementation of the project and has been available via telephone to help set up the program. This training session is a 2 day course with 50 attendees consisting of staff from the Ed, patient access and security areas. All training materials used for staff have all been obtained through the AHRQ site offered free of charge. Posters and pocket guides are also available for a small fee though AHRQ which were purchased by the facility for reference for the staff.
It was agreed that all educational materials be provided to staff for reference on their individual department webpage for later reference. Each individual unit is responsible to absorb the educational cost for their employees mandated to attend the training sessions.
Project Management
A timeline has been designed to use as a tool to measure and evaluate the progress of the project as it moves forward.
Tasks / Projected TimeframeJuly / August / September / October / November / December
Meet with Core team / X / X / X / X / X / X
Project Design / X
Lit Research / X / X / X / X
Kickoff to leadership
Power point presentation / X
Purchase and design of tools / X / X
Development of staff educational power point presentation / X / X
Review of Press Ganey and Patient Complaint data base
Patient safety reporting system / X / X / X / X / X
Attend TeamSTEPPS train the trainer session / X / X
Incorporate education into hospital computer system / X / X
Successful transition to organization / X / X
References
Butler County Health Care Center. (2012, August). TeamSTEPPS encourages teamwork, communication. Healthcare Risk Management, 91.
Castner, J., Foltz-Ramos, K., Schwartz, D. G., & Ceravolo, D. J. (2012, October). A leadership challenge: Staff nurse perceptions after an organizational TeamSTEPPS initiative. The Journal of Nursing Administration, 42, No. 10, 467-472.
King, H. B., Battles, J., Baker, D. P., Alonso, A., Toomey, L., & Salisbury, M. (2008). TeamSTEPPS: Team strategies and tools to enhance performance and patient safety. Retrieved from
Nance, J. J. (2008). Why hospitals should fly. Bozeman, MT: Second River Healthcare Press.
Sheppard, F., Williams, M., & Klein, V. R. (2013). TeamSTEPPS and patient safety in healthcare. American Society for Healthcare Risk Management, Vol 32, Number 3(3), 5-10. http://dx.doi.org/10.1002/jhrm.21099
Team STEPPS: Improving patient safety. Retrieved July 2, 2013, from http://teamstepps.ahrq.gov
Thomas, L., & Galla, C. (2013). Building a culture of safety through team training and engagement. Journal of Postgraduate Med, 89, 394 - 401.
Turner, P. (2012). Implementation of TeamSTEPPS in the emergency department. Critical Care Nursing, 35 No. 3, 208-212.