Patient Safety Academy /8/16 PROVIDING INFORMAL FEEDBACK: AN INTERACTIVE WORKSHOP. Objectives
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1 PROVIDING INFORMAL FEEDBACK: AN INTERACTIVE WORKSHOP Frank Korn R.N., MBA, CPPS Risk Coordinator 9/8/2016 Patient Safety Academy 1 Objectives At the end of the presentation you should be able to explain the concepts and importance of providing informal feedback as well as perform the activity 2 1
2 Raise Your Hands Who here is a member of a team? Who is on your team? What is feedback? Have you given or received informal feedback? 3 Informal Feedback Informal having a relaxed, friendly, or unofficial style, manner, or nature Feedback helpful information or criticism that is given to someone to say what can be done to improve a performance, product, etc Team training Business Education (including physician training) 4 2
3 TJC Root Cause Sentinel Event Data 70% of Sentinel Events involve communication issues 5 Maine Sentinel Event Data 2014 Sentinel Event Data for Maine 6 3
4 Communication Failures CRICO Benchmarking Report* 7 Harm to Healthcare Workers Harm to healthcare providers Working with patients OSHA Impact of Disrespectful Behavior on Patient Safety Hospitals are one of the most hazardous places to work 70% Linked behaviors to medical error and poor quality of care Lack of dignity and respect 65% Linked behaviors to an adverse event 2013 ISMP survey of healthcare professionals 88% 50% encountered Reported that condescending patient safety language was compromised 48% subjected to verbal abuse 25% Linked behaviors to patient mortality Emotional exhaustion or burnout 34% of nurses meet the criteria for severe exhaustion or burnout Surgeon burnout linked to medical error OSHA and ISMP Survey* 8 4
5 Diagnostic Error For the last several years there have been more outpatient claims than inpatient and ED claims combined The vast majority of these claims are around diagnostic failure (missed/delayed) CRICO Benchmarking Report* 9 The Diagnostic Process 58% of cases involve assessment failures Voids in physician s evaluation of the patient s history, presentation, differential diagnosis, and test ordering 29% testing failures Breakdowns in clinical systems for test result management, interpretation, and communication of results 46% follow up failures Breakdowns in communication among caregivers and failure to involve specialty consultation CRICO Benchmarking Report* 10 5
6 Communication And Team Training Communication and human factors are the top root causes of patient harm, and team training addresses both of these issues Team training can positively impact healthcare team processes and patient outcomes Toolkits are available to support intervention development and implementation Bundled team training interventions and implementation strategies that embed effective teamwork as a foundation for other improvement efforts may offer greatest impact on patient outcomes *BMJ Quality and Safety February 5, 2014: Team training in healthcare: a narrative synthesis of the literature Team training improved communication, task coordination and perceptions of efficiency, quality, safety and interactions among team members as well as patient perception of care coordination *BMJ Quality and Safety 2013: High performance teamwork training and systems redesign in outpatient oncology 11 Team Training Team STEPPS Framework Outcomes Shared mental model anticipating and predicting each others needs Adaptability identify opportunities for improvement and innovation for routine practices Team orientation taking into account alternative solutions provided by teammates to determine what is most correct Mutual trust willingness to admit mistakes and accept feedback Team performance increased information sharing and goal setting Increased patient safety minimizing the incidence and impact of and maximizing recovery from adverse events 12 6
7 Mutual Support Ability to anticipate and support team members needs through accurate knowledge about their responsibilities and workload Team STEPPS* 13 Defining The Team The provision of comprehensive health services to individuals, families, and/or their communities by at least two health professionals who work collaboratively along with patients, family caregivers, and community service providers on shared goals within and across settings to achieve care that is safe, effective, patient centered, timely, efficient, and equitable IHI* 14 7
8 Patient Safety Culture Results AHRQ* 15 Communication Openness Staff speak up about problems, share their ideas and suggestions, and feel free to question those with more authority AHRQ* 16 8
9 Purpose of Feedback Foster open communication and enhance teamwork Strengthen your rapport with coworkers/patients Redirect undesirable behavior Motivate and inspire a higher level of performance Contribute to others learning and development Harvard Business Review: Giving Effective Feedback* 17 Effective Feedback Shared Frequently and in context (timely) Aims to achieve a specific outcome Realistic in its expectations Respectful A two way conversation Expressed as a point of view, rather than an absolute truth Directed towards improvement Assumes opportunity for follow up Harvard Business Review: Giving Effective Feedback* 18 9
10 Barriers To Feedback Worry that feedback will make recipient dislike you or strain relationship Fear an awkward or volatile situation Recall instances in the past when feedback was not well received Assume the recipient cannot handle feedback The person is too stuck in their ways HIPAA Harvard Business Review: Giving Effective Feedback* 19 When To Provide Feedback Feedback is useful: When good work and resourceful behavior deserves to be recognized When improving skills are high and likelihood of skills again is imminent When the person is expecting feedback When a problem cannot be ignored Feedback can be detrimental: When you do not have all the information When feedback involves factors recipient cannot easily change When the person who needs feedback appears highly emotional When you do not have the time or patience to deliver it calmly When feedback is based on personal preference Harvard Business Review: Giving Effective Feedback* 20 10
11 Influencing Behavior Easy To Influence Difficult To Influence Job Skills Time and Work MGT Knowledge Attitudes Habits Personality Harvard Business Review: Giving Effective Feedback* 21 Where and How to Provide Informal Feedback Pick a quiet spot/neutral location Gather all the information available about the behavior What will you do if recipient objects to facts of shares additional evidence Create a discussion plan Craft responses to anticipated reactions Prepare yourself to listen Anticipate questions and possible responses What do you want to get out of the discussion? Long term/short term Develop an action plan Harvard Business Review: Giving Effective Feedback* 22 11
12 Planning a Feedback Session Examples: Communication Failure Patient condition Documentation Disrespectful behavior Diagnostic error 23 Providing Feedback Deliver the feedback Self Assessment What worked What could be improved 24 12
13 Contact Information Frank Korn, Risk Coordinator Maine Medical Partners This presentation is not intended to replace specific legal advice from an attorney. It is an educational program expressing views and opinions using generally acceptable risk management methodology
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