Creating a Change Team

TeamSTEPPS Creating a Change Team Objective: To assemble a team of leaders and staff members with the authority, expertise, credibility, and motivation necessary to drive a successful TeamSTEPPS Initiative. Timeline: By March 6: Assemble your Change Team. Choose the three people on the team who will attend the TeamSTEPPS master training in June. Before the June master training: Change team meets at least twice to: 1. Conduct a site assessment to identify one or more problems, challenges, or opportunities for improvement that will be targeted by your TeamSTEPPS intervention; 2. Decide what data you will collect and analyze to determine if the TeamSTEPPS intervention achieved your aims; 3. Devise a communication plan to let your affiliate staff know that TeamSTEPPS is coming; 4. Discuss preliminary plans for center-level team training after June (e.g., who, when, where, what). WE WILL SEND ADDITIONAL TOOLS TO HELP GUIDE YOUR CHANGE TEAM IN ACCOMPLISHING THESE TASKS! Tips for Success: Optimal Change Team size is 5 to 8 individuals, depending on the size of your affiliate or breadth of your team training initiative. Focus on improving processes through team training within one or a limited number of clinical workspaces initially. Choose Change Team members with relevant clinical expertise, credibility, and direct involvement in the workspaces that will be affected by your TeamSTEPPS intervention. If you haven t decided where to launch the initial training yet, then hold off on choosing all of your Change Team members until you do. As you broaden your team training initiative to other workspaces over time, the composition of your Change Team may change accordingly to assure local representation and expertise.

Essential Change Team Members: Change Team Member Name (Staff Position) Key Characteristics Primary Role(s) Senior Leader "Executive Sponsor" Enough "clout" in the organization to implement new approaches to care. Authority to allocate time and resources necessary to achieve team's aim(s.) Authority over all areas that will be affected by the change. Sponsors and visibly supports the Change Team. Creates the vision of the new system for the organization as a whole. Leads the spread of specific changes throughout the organization or system. May choose to become a member of the Change Team. Clinical or Technical Expert "The Champion" Physician(s): Nurse(s): Expert knowledge of the relevant clinical subject matter. Understands the processes of care within workspace where changes will occur. Good working relationship with colleagues and front-line leaders. Interest in driving/leading change. Responsible for being members of the instructor cadre. Responsible for coaching and role-modeling the team behaviors and skills. Responsible for keeping the executive sponsor updated. Essential to have at least one Physician Champion and/or one Nurse Champion. Front-Line Leader Understands details of the organization (unit/department). Understands effects of making changes in the institution. Able to work effectively with the physician/nurse champions. Is the critical driving force on the team. Assures that changes are tested / measured. Provides oversight for data collection. Other Members to Consider: If your affiliate has someone who is responsible for developing and delivering training programs to staff (lead educator/trainer), then involving that individual in the Change Team is essential. An individual who has expressed reservations about the initiative may raise important issues for the team to consider and help to develop strategies to overcome resistance to change. Consider involving on the ground champions who will operationalize the initiative and keep it on track.

Does our Change Team have: Support and involvement of C-level leadership? Someone with medical expertise? Someone experienced in process improvement, including performance trending techniques? Relevant skills include data collection, analysis, and presentation. Someone with staff training (and team training, after June) expertise? Please email the names and roles of your proposed Change Team members and the individuals who will attend the June master training to Guzey Ozcelik at guzey.ozcelik@armsinc.org by March 6, 2015. Our project team will review this information and may provide helpful suggestions or feedback. If you have any questions, please feel free to contact Guzey. Thank you!

Team Communication Assessment This survey pertains to your knowledge of the clinical service area(s) in which you plan to implement team training during 2015-16. If you plan to implement team training in more than one clinical service area in 2015-16, please complete a separate survey for each area. Name: Role at the affiliate: Date: Affiliate: Clinical service area: Please indicate the frequency with which the following occur in this clinical service area: Never >0 to <25% 25 to <50% 50 to <75% 75% 1. Before a procedure, the health care team pauses to identify the patient and the procedure. 2. The health care team uses a standardized format for patient handoffs (i.e. transfer of patient care due to staff or location change). 3. When needed, the health care team meets during clinic sessions to re-establish situation awareness, reinforce plans already in place, or assess the need to adjust the plan for patient care. 4. The health care team meets after routine clinic sessions to discuss what went well and what should be improved, e.g. was communication clear, were needed resources available, was the workload distribution equitable, etc. 5. The health care team meets after an event or challenging situation to discuss what went well and what should be improved, e.g. was communication clear, were needed resources available, was the workload distribution equitable, etc. 6. The health care team has been trained in a specific technique for communicating critical information that requires immediate attention and action concerning a patient s condition, such as SBAR (situation, background, assessment, recommendation and request). Page 1 of 2

Team Communication Assessment 7. How often does the health care team meet before each clinical session? Never >0 to <25% of the time 25 to <50% of the time 50 to <75% of the time 75% of the time 8. If you answered something other than never to the above question, please indicate whether the team leader does each of the following at the meeting before the start of the clinical session: Action Always Sometimes Never Unsure a. Convenes the brief by commanding the undivided attention of all team members b. Invites new team members to introduce themselves and state their roles (for that particular clinic session), as applicable c. Identifies who is responsible for addressing clinical questions or concerns during the clinic session d. Identifies who is responsible for addressing concerns or questions about patient flow during the clinic session e. Identifies who is responsible for addressing concerns or questions about other clinical operational issues (e.g., missing supplies or broken equipment) during the clinic session f. Describes how many patients are scheduled for the clinic session g. Leads a discussion on the plan of care for any patient with special needs (e.g., patients with comorbidities, such as diabetes) h. Explains any staffing shortages and how they may impact the clinic session i. Describes conditions that may affect clinical operations or care (e.g., broken equipment or shortage of certain medication) j. Asks if the team members have any questions or comments Developed by the Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, 2014. For more information, please contact obgynresearch@bidmc.harvard.edu. Page 2 of 2

This survey was developed by Dr. Beverly Henry (bwhenry@niu.edu) and is used with and distributed with permission. Patients Insights and Views Observing Teams (PIVOT) Survey Please tell us about the team of people providing care for patients in this clinic. These individuals may have worked directly with you or your family member or worked on the team in other ways. Choose the response that best fits each statement. If you really feel that you have no basis for judgment, you may leave that item blank. Not at all Rarely Sometimes Often All the time I thought the team worked together well I thought team members enjoyed working together I thought the team coordinated patient care well I thought team members kept each other informed I felt as if team members talked in front of me as if I wasn't there I felt that team members told me conflicting things I thought team members supported each other to get the work done I felt team members were considerate of one another I saw team members treating each other with a lack of respect I heard arguments between team members, inside or outside the room I was told the names of the people who worked on the patient care team I was told how the team worked as a whole People told me what their jobs were on the team I knew who was in charge I heard team members use each other s names as they worked together I felt there was good communication between team members References Henry BW, Rooney DM, Eller S, Vozenilek JA, McCarthy DM. Testing of the Patients Insights and Views of Teamwork (PIVOT) Survey: a validity study. Patient Educ Couns 2014; 96:346-51. Henry BW, Rooney DM, Eller S, McCarthy DM, Seivert NP, NBannicelli AP, Vozenilek JA. What patients observe about teamwork in the Emergency Department: Development of the PIVOT questionnaire. J Participatory Medicine, vol. 5, 2013. Available at: http://www.jopm.org/evidence/research/2013/01/30/what-patients-observe-about-teamwork-in-theemergency-department-development-of-the-pivot-questionnaire/

TeamSTEPPS Implementation Survey Thank you for completing this survey regarding your experience preparing to implement TeamSTEPPS at your affiliate. We greatly appreciate your feedback and will use it to improve the experience for the next cohort of affiliates. Your responses will be completely confidential, and all results will be reported in aggregate. 1. In September 2013, ARMS presented an introductory webinar on the TeamSTEPPS initiative. Did you attend the webinar? o Yes o No o Not sure 2. (Skip if answer to previous is no or not sure ) How did the webinar influence your affiliate s decision to participate in TeamSTEPPS? o I was not involved in the decision to participate o We did not plan to participate, but the webinar influenced us to participate o We were fairly sure we wanted to participate, and the webinar confirmed this decision o We had already decided to participate; the webinar did not influence our decision o Other (please specify): 3. What additional information would you have wanted before deciding to participate in TeamSTEPPS (check all that apply)? o None o A description of how TeamSTEPPS will work in the ambulatory setting o An outline of the timeline for deliverables due to the BIDMC research team o An outline of the time commitment required to prepare for master training o An outline of the time commitment required for post-training implementation o An outline of who would be expected to participate o Strategies for gaining buy-in from senior leadership o Strategies for gaining buy-in from affiliate staff o Other (please specify): 4. In October 2013, your affiliate completed an online invitation to participate in the TeamSTEPPS program. Which of the following apply to the invitation (check all that apply)? o I was not involved in completing the online invitation o The invitation was too long o I didn t know the answers to the questions that were asked (e.g., number of employees, number of clinic visits, etc.) o There were technical problems with completing the invitation o It provided insight into the TeamSTEPPS process o It helped our affiliate to assess the need for team training o It helped our affiliate to assess our readiness to implement a team training initiative o It helped our affiliate to identify outcomes that we aimed to improve through team training o Other (please specify): 5. In February 2014, the ARMS TeamSTEPPS project team conducted a webinar to provide additional information about TeamSTEPPS, how to choose a change team, and what to expect over the coming months. Did you attend this webinar? o Yes o No o Not sure

6. (Skip if answer to previous is no or not sure ) How did this webinar help your affiliate prepare for TeamSTEPPS? o I felt more knowledgeable about TeamSTEPPS o I felt more confident about who should be on the change team o I felt more confident about who should attend the master training course o I felt more knowledgeable about what would be required from our affiliate to participate in TeamSTEPPS o The webinar did not help my affiliate o Other (please specify): 7. In January and February 2014, the ARMS TeamSTEPPS project team joined members of your affiliate on an individual conference call. During this call, we asked you about details of your affiliate (e.g., your services and facilities, EMR, AIMS reporting), support from leadership, competing interests, and priorities for improvement. Did you participate in this call? o Yes o No o Not sure 8. What did you find helpful about this phone call (check all that apply)? o The call confirmed our decision to participate o The call made us question whether we were ready to participate o The call provided insight into the TeamSTEPPS mission o The call provided insight into what we could expect from participating o The call provided suggestions for how to gain buy-in from senior leadership and/or affiliate staff o The call helped our affiliate decide where to implement TeamSTEPPS o The call helped our affiliate decide who should be included on the change team o The call provided answers to our questions o The phone call was not helpful o Other (please specify): 9. Would you have preferred to have your individual call with the project team before making the final deciding to participate in TeamSTEPPS? o Yes o No o Not sure 10. Prior to attending the master training, did your affiliate have difficulty deciding where to initially implement TeamSTEPPS? o Yes o No o Not sure 11. (Skip if answer to previous is no or not sure ). What difficulties did you experience in deciding where to implement TeamSTEPPS (check all that apply)? o Members of the change team disagreed on where to implement TeamSTEPPS o It was unclear which area could benefit most from TeamSTEPPS o It was unclear which area had the most resources to successfully implement TeamSTEPPS o Multiple areas wanted TeamSTEPPS to be implemented o Other (please specify): 12. Did attending the master training course make your affiliate change its mind about any the following aspects of TeamSTEPPS implementation (check all that apply)? o We changed the area(s) in which to implement TeamSTEPPS

o We changed the implementation to include different or additional staff members o We changed the scope of the initial roll-out o We changed the timing of the initial roll-out o The master training did not affect our pre-existing implementation plan o Other (please specify): 13. In April 2014, your affiliate received the Teamwork Perceptions Questionnaire (TPQ). Did you encounter any of the following challenges when administering the TPQ to staff (check all that apply)? o I was not involved with administering the TPQ o It was hard to find the time to send out the survey o It was unclear who should receive the survey o Staff were reluctant to complete the survey due to privacy concerns o Staff were reluctant to complete the survey due to time constraints o There were technical problems with administering the survey electronically o There were no challenges o Other (please specify): 14. In May 2014, your affiliate received the PIVOT patient survey. Did you encounter any of the following challenges with administering the PIVOT to patients at your affiliate (check all that apply)? o I was not involved with administering the PIVOT survey o We found it challenging to suspend our own patient surveys o It was hard for staff to administer the PIVOT due to time constraints o It was unclear who should receive the survey o Patients were reluctant to complete the survey o It was unclear how long we were supposed to administer the survey o There were no challenges o Other (please specify): 15. In May 2014, your affiliate received a team communication assessment survey regarding the frequency of various forms of communication (e.g., briefs, debriefs). Did you encounter any of the following challenges with completing this assessment (check all that apply)? o I was not involved with completing the communication assessment o Completing the assessment was too time-consuming o It was unclear who should complete the assessment o It was difficult to complete the assessment for each clinical area that would be touched by TeamSTEPPS o There were no challenges o Other (please specify): 16. Your affiliate may have been asked to complete ten detailed observations of briefs. Did you encounter any of the following challenges with completing these observations (check all that apply)? o I was not involved with completing the detailed observations o Completing each observation was too time-consuming o It was unclear who should complete the observations o It was difficult to find someone who could dedicate time to completing the observations

o There were few opportunities to complete the observations because the clinical team did not meet very often o It was difficult to complete the observations for each clinical area that would be touched by TeamSTEPPS o Ten observations were too many to complete o There were no challenges o Other (please specify): 17. During the preparation process for the TeamSTEPPS program, your affiliate received several toolkit items. Please tell us how helpful you found each of these items to be. Toolkit item Creating a change team Magic wand SWOT analysis Affiliate site assessment Developing a communication plan Very helpful Somewhat helpful Neutral Somewhat unhelpful Very unhelpful I did not use this item/i can t remember Comments 18. Your affiliate spent approximately seven months preparing for TeamSTEPPS implementation prior to the master training. This length of time was: o Too long o Too short o Just right 19. Was the timing of the master training (June 3-5, 2014) convenient for your affiliate? o Yes o No 20. (Skip if previous answer is yes ) What time would have been more convenient for your affiliate? 21. Was the location of the master training (Chicago, IL) convenient for your affiliate? o Yes o No 22. Please tell us the one thing you found most helpful during the preparation process for TeamSTEPPS. 23. Please tell us about the one major challenge or barrier you encountered during the preparation process. 24. Please give us any suggestions that you have for improvements for the preparation process (e.g., new toolkit items, things we could have measured that we didn t, etc.). 25. Additional comments: Thank you very much for your time. We greatly appreciate your contributions! Developed by the Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, 2014. For more information, please contact obgynresearch@bidmc.harvard.edu.