Using TeamSTEPPS To Create Change at the Organizational, Team, and Individual Level

Using TeamSTEPPS To Create Change at the Organizational, Team, and Individual Level


– [Brandon] Ladies and gentlemen, thank you for your patience and holding. We now have your speakers in conference. Please beware that each of your lines is in a listen-only mode. I’ll now turn the conference
over to Chris Hunt. Sir, you may begin. – [Chris] Thank you, hi. Good afternoon, everybody. Or good morning, depending
on where you are. Welcome to Using
TeamSTEPPS To Create Change at the Organizational,
Team, and Individual Level. It’s this month’s monthly
TeamSTEPPS webinar, and it’s part two of three. Last month we had our
same speakers with us to talk about just the
fundamentals of TeamSTEPPS and getting started. This month we’re gonna be getting
into talking about change, and a unique way of looking
at change in multiple ways. So thanks very much for joining us. As Brandon said, my name is Chris Hunt, Director of Quality
with the Health Research and Educational Trust. We’re part of the American
Hospital Association. We’re happy to be with you here today. Just some rules of engagement for the day. If you’re listening to this
over your computer speakers, you’re gonna want to mute
your computer speakers, just so you don’t hear, I’m sorry. That’s pretty funny. Of course you want to listen
to it on your computer. You’re not muting your speakers. If you’re listening to it over your phone, you’re gonna want to mute
your computer speakers, because if you don’t do
that you’re gonna get a lot of funny feedback. But please, if you’re on your computer, don’t mute your speakers. We are going to do a Q and A session at the end of the presentation, but what we really stress and hope you do is chat your questions
in the general chat box that’s on the right-hand
side of your screen as you’re looking at it. This way we could answer
questions as we go, and then if it’s something
that we think would be great for the whole group to hear about, we’ll keep it towards the end and then I’ll do a
moderated Q and A session with our speakers at the end. That’s how we’re gonna
go about things today, and that’s how we normally do it. Seems to work well. If you ever have any
questions about TeamSTEPPS now or in the future, or
about TeamSTEPPS’ offerings, you can always e-mail
[email protected], or give us a call on that
help line right there. Those are two great ways
to get in touch with us. If you’re having trouble right now with something on the webinar, please use that chat function
because we’re all on the phone and we’re all engaged with this webinar, so we wouldn’t be able
to pick up the phone. Okay, today’s presenters. Very happy to introduce them. All three of them work for the University of Washington Medicine, the WWAMI Institute for
Simulation in Healthcare, and they have also all been
involved with TeamSTEPPS for many years. The University of Washington has been a TeamSTEPPS
regional training center for seven or eight years, I believe. So we’re very happy to
have them here today. We have Ross Ehrmantraut,
who is a nurse by background and Clinical Director of
Team Performance with WISH. We also have Megan Sherman, who is an associate director of WISH, as well as Farrah Leland, who’s also an associate director of WISH. All of them have brought
a lot to the table over the past years about TeamSTEPPS, and I think that you’re going to get a lot about how to really effect change and how to get people
to really take ownership of their TeamSTEPPS work and not just sit there
and passively buy in. With that, I’m happy to
turn things over to the team from the University of Washington. – [Ross] Thanks, Chris. And as Chris said, I’m Ross Ehrmantraut. I am a nurse by background, and I’ve worked in the UW health system for over 30 years now. Most of my career was
critical care, at the bedside, at Harborview Medical Center, which is one of the
regional trauma centers. It’s actually the only level
one regional trauma center in the area. WWAMI stands for
Washington, Wyoming, Alaska, Montana and Idaho, and those
are the areas that we cover within our health system. I’m gonna hand it over to
Megan to introduce herself. – [Megan] Hi, everyone. I’m Megan Sherman. I am the associate director at WISH. I’ve been working in healthcare, mainly healthcare simulation, for the past 10 years now, and in that time have been
very involved with TeamSTEPPS and team training and how it can be used both in a clinical and non-clinic setting. So I’m happy to be here. – [Farrah] Hi, I’m Farrah Leland. I’m the other associate director
of WISH, like Chris said, and I have a non-clinical
background like Megan, a law background. I’ve been doing TeamSTEPPS with
the national training center since about 2009. Happy to be here today. – [Megan] UW Medicine,
a little bit about us. We have over 200 clinics
and four hospital systems within UW Medicine, as
well as Airlift Northwest. We also have around 2,400 faculty members in over 30 departments, 4,700 plus clinical faculty
across that WWAMI region, as Ross described. We have 4,500 students and trainees, which includes medical
students, residents, fellows, PAs, and PhD students,
medical technologists. All sorts of different types of students. We have over 27,000 employees. Our objectives, what we’re hoping to get out of this webinar today, is to identify and address
resistance strategies to change it at its source/core level. Understand the difference
between ownership and buy-in. We’ll talk a little bit about that. And then identify
opportunities to incorporate… We’ll talk a little about
different models of change, but focusing on one in particular. I know it’s hard to see, you guys, but if everyone can just cross
their arms like the picture, the image you see. Take a second to cross your arms. Okay, and now reverse which arm’s on top and cross them the other way. Kind of uncomfortable. It’s hard to do, it’s
not what you’re used to. It can be uncomfortable,
even something as simple as crossing your arms. Focusing on from the TeamSTEPPS
Master Trainer Course, if you took it, or if you’re
familiar with the TeamSTEPPS, they talk about the Kotter Model. That we kind of categorized as
at the organizational level, changing the organization. Then there is change in the individual. What we used as the model
for that is the Influencer, and there’s the six-box model. But what we’re really gonna focus on today is the change of the team, and the model that we like to use as kind of a starting
point is the Switch Model, and Ross is gonna talk about
what the Switch Model is. – [Ross] I don’t know who’s
familiar with this bridge. It’s the Choluteca Bridge in the Honduras, and this is designed by a
group of architects from Japan. This bridge was designed to withstand the worst possible natural disaster that could ever come about, tornadoes, hurricanes,
earthquakes, whatever. So they were pretty proud of
what they did with this bridge, and as you can see, it’s quite nice. And then in 1995 or in the mid-90s, Hurricane Mitch came through the Honduras, and it was a very strong hurricane, and as you can see, the bridge
withstood the hurricane, but what happened is the river moved. That’s kind of where we are
in healthcare right now. We gotta continue to move with the river. Just because the bridge is
still standing where it is doesn’t mean it’s doing what it has to do. With healthcare changes,
with the Affordable Care Act, and now who knows what’s gonna happen with our current
environment with healthcare, we have to able to change with healthcare. Using these three models that Farrah just quickly talked about, we’ve been able to incorporate that into a lot of what we
do here at UW Medicine. All of them overlap a little bit, so it’s not like one is
specific to organization, one is specific to team, and
one is specific to individual. But we like to use those three models for those specific areas. But they are definitely interchangeable. If you’ve been in healthcare
for any amount of time, this is generally how we make
change in an organization. I think most of you will agree. We’ll send out an e-mail with a PowerPoint attached to that e-mail, or a link to a learning management system, and say, hey, follow this PowerPoint, get on this LMS, and then this change is
gonna occur September 1st. We know we have to do the
education and whatnot, but it’s probably not
the most efficient way without doing some other things as well. For those of us who took any
kind of courses in college related to biology or
the brain or whatever, we know that there are two
independent systems of our brain. We have the rational system. That’s the conscious, the
deliberative side of the brain. That’s the part that analyzes everything. And then we have the emotional system. That’s the unconscious or the
automatic side of the brain. Within the Switch Model, which
is what I’m gonna focus on for the next probably 30 minutes now, they call this the giant elephant. We’re gonna get into that
as we move forward here. Within Switch, there’s
a three-part framework, and Switch is by Dan and Chip Heath. They have several books out, and this is a book that we
encourage people in our system when we work with change teams to read the book. We also go over it pretty extensively, because as we start
implementing TeamSTEPPS in any of our groups, we use this model and walk through it systematically to develop the implementation plan. So within the Switch Model, there’s the three part framework. There’s direct the rider,
there’s motivate the elephant, and then shaping the path. And we’re gonna touch on each one of these moving forward here. First of all, directing the rider. If you think about that picture
I had just a second ago, you saw the rider on top of the elephant, and the rider generally thinks
that he or she is in control. But if that elephant wants to do what that elephant wants to do, there is now way that
rider’s gonna stop them. And so we have to be able
to tap into all three areas. Now directing the rider, a lot of what we run into with change is people may not understand
where we want them to go. You have to do the PowerPoints. You have to have the LMS. You have to have the
education and training. You even have to have protocols in place. But you still need to be clear on what the destination postcard is. And really, that’s where
our ultimate goal is. An example up here is, “You’ll
be third graders soon.” And this is talked about in the book. This is a first grade teacher that went in this low
income school district. This district was so low income they didn’t have kindergarten, so most of the kids
coming into the school, first grade, not only couldn’t read, but couldn’t even recognize
letters in the alphabet. So she told them on day one, “You’re gonna be third graders
by the end of the year.” She gave them something to shoot for, and then she called them
scholars instead of students, and they started calling
each other scholars. Gave them something to shoot for and reminded them of that destination
postcard moving forward. Long story short, at the end of the year, all these students, or
90% of these students were reading at a third grade level, and this classroom had
the lowest absentee rate ever in that school district. She was able to give them
something to focus on, a long-term goal, and kept working
systematically to get there. Now, when we work with a
team, teams in our system, that’s one thing we ask them to do, is to put together a destination postcard. And the example I’m gonna
use today throughout this is our operating room at one
of our hospitals in our system, Harborview Medical Center. Early on, when we were going
through the Switch Model, this is what they came up with on their destination postcard. First of all, they came up
with their problem statement: “There is a common
disconnect in developing “a shared mental model for all cases “throughout the day.” And then a pretty generalized postcard: “Implement a morning brief in every OR “to plan for the entire day in each room.” So there’s 26 ORs in this hospital. Their destination postcard was, we are gonna have a brief
in every single room before the start of the
day for that entire day. Now, as you can imagine, when you come up, the change
team came up with that and started talking to people, there was some resistance. Right away we find people
will always wanna go to why something doesn’t work. I’m gonna hand this over
to Megan for a few minutes and she’s gonna talk a
little bit about resistance and how we address it. – [Megan] Yeah. Thank you. Starting off, it’s important
to recognize that change, even small change, can really generate deep
feelings of resistance. Understanding why is it that
we’re resistant to change, so what I want to do
is invite everyone to, in the text box there in the chat, just type in some ideas that you may have why we’re averse to change. Fear. That it’s scary, it takes work. Oh, lots of them, okay. It’s uncomfortable, there’s fear. It’s unfamiliar, it can be painful. It’s unknown, there’s a sense
that it might be too hard or there’s uncertainty. Too much work. That we’re happy with the status quo. Great point, Vicki. I think that’s a big one. In the work that we do, some of the ideas that we’ve come up with for why people resist change are these ideas of fear, or that there’s distrust in the messaging. There’s maybe a lack of communication between where we’re going
and where we need to be and how we’re going to make that change. Oftentimes people feel that change, it’s just a fad, that this is something, it’s a flavor of the month
and it’s gonna be gone, and if I can just ride it
out, I’m going to be set. And things will go back to normal. Other resistance might be that it challenges our specific routine, that people might be resistant because they have so much going on. There’s just too many
initiatives going on, that they can’t take on something. Or it could just be plain and simple that they don’t understand
what the change is all about. On a personal level I think
change can arouse our anxieties ’cause we’re unsure
specifically whether or not our existing skills or contributions are gonna be valued moving forward. At the organizational level
when we’re talking about change, sources of resistance
can really be attributed to three specific sources. There’s technical resistance. This comes from a habit of
following common procedures and consideration of
the costs and resources associated with that change. This would be, we’ve already
spent so much time and money on something that we
need to keep it moving, we need to keep this project moving. We can’t give up on it. Other sources might be political,
or the top-down approach. This often arises when
an organization changes. They threaten powerful stakeholders, or call into question the
past decision of the leaders. Saying that, oh, we’ve
already been told by the board this is how something should be done, and so we’re gonna keep
doing it that same way. Finally, the third source
of change would be cultural or individual change. And this really emerges in the form of the systems or the procedures that reinforce the status quo. This is promoting existing norms and/or assumptions of how
things really should operate. That we just need to stay
doing what we’re doing. This is how we’ve always
done it and it’s worked. If it’s not broke, don’t fix it. So really recognizing change
through a resistance audit may be beneficial. It’s an important step in prepping your environment for change. Performing a resistance audit could be looking at observable behaviors. Often resistance manifests
itself as behaviors that can often be misread
or misinterpreted. And so by understanding
what these are or might be or how they might manifest themselves, we’re able to address those
changes from the get-go. So for example, if there’s an individual who’s constantly delaying
or providing excuses for why something’s not being done, a step in the process, this oftentimes by a
manager or even a colleague can be read as, they’re just incompetent, or that they really don’t
like what they’re doing, they have a poor attitude. And we can kind of write it off as such. In fact, if you’re looking at it from a resistance audit standpoint, maybe the individual
is really just confused over what role they play in the change and what the priorities
of the organization are. By resolving this through things like providing explicit instructions or really having a proactive conversation about what the organization’s
priorities are, how we’re moving towards change, those are all ways to overcome
those manners of resistance. Additionally I think we can
share this slide, as well. Other observable behaviors
might be obsessive questioning, errors, or derailing or acting out. All of these have steps
that are identified to help resolve resistance
to change in that manner. – [Ross] Alright, so as we start getting
through our resistance, then we start taking it to the next level and we’re gonna go back to the direct the rider
discussion a little bit. And the second part of directing the rider is finding the bright spots in there. Finding the bright spots is just looking for what’s already working, and then how do we build from that. Some of you might be
familiar with Jerry Sternin. He was the guru of positive deviance, which is really just
finding out what’s working and really going to the
people doing the work and say, hey, what’s working here, and how do we build from that? Jerry Sternin back in 1990
was asked by an organization to go to Vietnam to help
with some malnutrition, the malnutrition in Vietnam for children. Back then in 1990 there
was a 70% malnourished rate for children under five. And the Vietnam government
was not interested in having him there. They said, you can come for six months. And all of Jerry’s friends
said, well, that’s crazy, Jerry. You’re gonna go over there for six months and you’re not gonna have
any chance to make a change. There’s a huge undereducated population. Poverty’s huge in Vietnam,
and some other things. Jerry, basically his
response is, that’s TBU, which is true but useless information. He ended up going and he took
his wife and he took his son, and they went over and
started meeting with people. The first village they went to, met with some people from that village and asked them about their kids. And sure enough, their
kids were malnourished. Asked them what they were doing for food, and just like everybody
else in the village, they were getting two bowls of rice a day, one in the morning and one
in the afternoon basically. He asked if there was
anybody in this village whose kids were not malnourished, and it turns out there
were a couple families. Asked them what they were doing, and nobody seemed to know, so they went and met with them and asked them what they were doing, thinking, well, maybe
they have a rich uncle that was bringing them food or whatnot. What turned out is these families were actually taking those
two bowls of rice a day and splitting them into
four bowls of rice. So it’s the exact same amount of food, just splitting it into smaller
portions throughout the day, and then going out to the rice paddies and getting shrimp and crab and just grinding those down and getting some sweet potato greens, throwing that all in there
for some protein and whatnot. And that’s all. Wasn’t costing anybody a dime. So within this case of positive deviance, they found out that
somebody in that village was already doing something that worked. Went back to the rest of the group. They were willing to try it. Long story short, they let
Jerry stay for over two years and his family. And what he did is he worked
with that first group of people in the village, in that first village, and had them go out and teach
other people in other villages to do the same thing. Over that period of time, 200
villages, two million people, the malnutrition rate went
from 70% to less than 30%. So he was able to find what was
working and build from that. We talk about in our system a lot when we go out and work with groups, ownership versus buy-in. There’s a good article on that, and we can send you
the reference for that, but it’s basically when I say I want you
to buy into something, that means it’s my idea. I think this is a good idea. Now I want you to think
it’s a good idea too and I want you to do it. Ownership is, I think we should do something, but you get to decide
how it moves forward. And that’s how we approach all of our TeamSTEPPS implementation. This is not a top-down process. It has to be owned by
the front line staff. So when you meet with change teams, you go, well, TeamSTEPPS is happening. That’s probably not an option. It’s gonna happen, but you get to decide how it’s gonna be implemented
in your department. And so given that ownership, it no longer becomes a top-down thing. You saw the resistance slide. Megan said a little bit of
that political top-down thing. As soon as it comes from the top, people are gonna have some resistance. So again, figure out what’s
working in the units, ask the front line
staff what’s gonna work. A little bit like high reliability
organizations and such. That’s the second part
of direct the rider. Third part is script the critical moves. Decrease the amount of
things you put in at once. I saw one of the answers
in the slides were, yeah, we got too much all at once going. Let’s shrink the change. Let’s make it a little bit smaller. Ask them to do one small thing. And I’m gonna give you an example here in my slides here with the Harborview OR. So here we go. We already gave you the
destination postcard. This is simplified. This was much, much more
comprehensive when we sat down, but for this webinar we just wanted to put
something short together. For finding the bright spots,
we had a new faculty member, was huge, come from another institution where they were doing
briefs with great success. He stood up in front of
400 surgical services, staff, and faculty, and said, yeah, it took a
while to get people going, and there was a lot of resistance, but now it’s part of the
culture in that institution and they would be upset if
the morning brief wasn’t done. So we had him talking about what happened in
another institution. Then we had several
surgeons at the hospital that were willing to
implement briefs and trial it, and they had great success
and got positive feedback from other providers, as well as the staff that were working, the surge techs, the
RNs, anesthesiologists. People were excited about
how these were working. They shared that information. It came from then, not the director of the surgical services, not from us, but from them. And then when they went to
script the critical moves, they made it very easy. Here’s who needs to be at
the OR brief in the morning: the surge tech, the circulator, the surgeon, the anesthesiologist. At least those four. The resident can attend,
and they should attend, but it’s not required. And if there’s some
radiology component in there, then they try to attend as well. So made it simple, clear
instructions on what to do. Now we’re gonna move into the next part of the Switch framework, which
is motivating the elephant. And this is really where you start tapping into that side of the brain that wants to do what it wants to do. We travel a lot. We do these talks all over the country. And quite often after a two-day
course, we’re pretty tired. We enjoy what we do, but we’re tired. We get to the airport to fly home, and we know we should probably
have a salad for dinner, but then we walk by Cinnabon. We smell the Cinnabon, and we go, wow. I worked really hard the last two days. I know I should have a salad, but I deserve a Cinnabon. And so then we go in the Cinnabon. That’s the elephant taking over. We need to tap into the elephant. We have the direct the rider, but we need to tap into the elephant. First of all, finding the feeling. What works? What motivates people? We all know TeamSTEPPS is
just the right thing to do. It’s a patient safety issue. But it has other things. It makes employees happier. So it motivates employees to want to stay where they’re staying. The chemo video game is something they talk about in the book, where apparently teenagers
are non-compliant with chemo once they get out of the hospital. And somebody came up with this idea to put a chemo video
game together, 20 stages, every stage would take about a half hour, and if the teenagers got
through all 20 stages they would probably be more compliant. Well, what they found is none of them got through the 20 stages, but just by playing this video game that appealed to teenagers, they found a 60% increase
in compliance with chemo once they got out of the hospital. You have to find what motivates. Everybody’s different. What motivated a hand surgeon to want to do a brief in the morning? You had to ask them
that, and quite honestly, most of the answers, just nothing. We’re already too busy. But then you start tapping into, well, what if we can look at turnover
rates getting a little bit, turnover times getting
better during the day because you are more efficient because you realize you need
something later in the day, at 7:00 in the morning
when you did the brief? So thinking about that, and
again, we’ll have examples. Shrink the change, this is a lot like scripting
the critical moves. Call it the five-minute rescue. You have a kid, you tell
them to go clean their room, and generally they just make it worse than when they started. But if you put an egg timer in there and set it for five
minutes and say, you know, you only have to clean
your room for five minutes, then you can be done, well, once those five minutes are up, they tend to have a little bit of momentum and can continue moving forward. So don’t give them multiple things. Give them one thing to start with. And then growing your people. I told you I’ve been in this
system for over 30 years, and it was a long time before
somebody ever came up to me and said, hey Ross, what
keeps you in this system? We have to find out what
keeps people moving forward. What motivates them to want to be here? What can we offer them to improve what they already are experiencing? So here’s some examples
we talked about in our OR when we implemented the brief. So how do we find the feeling? Well, first of all, we
shared success stories. In fact, I kinda
mentioned the hand surgeon because one of them was quite adamant that he didn’t have time to do it. Well, we talked to him
and said give it a try, here’s some possibilities
that might occur. He is one of our biggest champions now. He shares those success
stories from the pilot, how it’s made a difference
in his entire day in his ORs. The nurses, the circulators,
and the surge techs are using the template, which they hadn’t really
talked about up front, but now they’re using it for a handoff tool for break relief and finding it very helpful, which also the surgeons
and the anesthesiologists appreciate that, too, because
when there’s relief going on, those people know what’s happening. And then addressing some
of the financial aspects of what goes on in an OR. There’s a huge potential to save money through better use of supplies. We may find at 7:00 a.m. that
we don’t need a certain kit for later in the afternoon, so we’re not opening it and wasting it. That is something that
we’re measuring now, and we think we’re gonna see some pretty good results from that. So multiple, you have to figure
out who you’re talking to, ’cause everybody’s different. A surge tech, what motivates
them might be different than what motivates the anesthesiologist. You have to make sure you
tap into all of these people when you’re making these changes. Shrinking the change, we reinforced that it could
be done in three minutes. Everybody was concerned it
would go on for 10 minutes. We’ve actually been timing it, and it’s right at three minutes, a few seconds over three minutes average. So it’s not taking up a
huge part of the morning. We developed, I should say, not we, they developed a simple
template for the brief. And it started out pretty comprehensive and they quickly were able
to make it smaller and easier and so people were using it. And then we have safety
summits where everybody, we close the OR for one hour once a year and sit everybody in the room, 400 people sitting in a room, and they use this safety summit to showcase those who
are consistently doing it and doing it well, and had those people go up and talk about what was working for them. Since then they’ve
presented at a conference and also at multiple
patient safety committees. There’s an opportunity to reward those who have really done the work. And then finally, shaping the path. This is really human factors engineering at its best, I think. It’s just making the right
thing the easy thing to do. Or you could flip that around and say making the wrong
thing the hard thing to do. So tweaking the environment. What can we put in place
that makes it easier for people to do the right thing? Visuals, I mean, if you’ve
flown in an airplane anytime in the last 15 years, you probably know that if
you go into the bathroom, in order to turn on the light
you have to lock the door. Nobody sent you a PowerPoint
attached to an e-mail, telling you how you lock the door or how you turn on the light
in the bathroom on an airplane. You just figure it out, it’s intuitive. That’s what we were
trying to make from this. How do we make this easy
to do the right thing? How do you build habits? That’s the second one. Well, checklists. We have lots of checklists
in healthcare now. The central line checklist, it’s actually dropped our
complication rate here at UW from 15% to less than 1%, just putting in the
central line the same way every single time,
following the checklist. So checklists are a good thing. And then there’s action triggers, which don’t actually
make you do something, but it makes you think about it. For those of you nurses out there, or anybody in healthcare, but you think about the Pyxis machine. A lot of institutions
have put a red carpet or something around their Pyxis machine, meaning if I’m standing
at the Pyxis machine, you shouldn’t talk to me. That doesn’t mean you can’t, it just encourages you not to. That’s an action trigger. And then finally, rallying the herd. We want to do what other people are doing. Behavior’s contagious. Good behavior’s contagious,
bad behavior’s contagious. We’re in Seattle, where
Starbucks is probably, they’re like 20 feet from
each other in the city, and nobody comes to work without
going to Starbucks first. I get to Starbucks every morning, and I’m there about the
time they’re opening ’cause I come to work. And inevitably when I go in there, even if they’ve just
unlocked the door for me, I walk in there, there’s
already money in the tip jar. And the reason they do that is it just makes me
want to not be the jerk that doesn’t tip, too. So they do things like that. We want to do what other people are doing. Same thing with hotel towels. You go into a hotel, you stay in a hotel, and you find everybody has the sign that says, save the
planet, reuse your towel. Which is a great idea, but it’s
a little overwhelming to me. How do we narrow that down a little bit? Well, we want to do what
other people are doing. Two hotels decided to put
signs in their rooms that said, most of our guests reuse
their towel in this hotel. And that’s all they did, nothing fancy. They had a 60% increase in
reuse of towels in that hotel. So think about who’s doing it well, how do we build off of that? Here’s a great example
of shaping the path. You can’t make this stuff up. This was the Amsterdam Airport. The custodians were complaining
about what they called spillage around the urinals. Somebody came up with this idea, it’s where that red circle is, somebody came up with
the idea to etch a fly into the urinal, effectively putting a
target in the urinal. Right away at the Amsterdam Airport spillage dropped to almost nothing. They didn’t have to put a sign up, they didn’t have to send out a PowerPoint. It was just intuitive that
people would aim at the fly. Probably a little bit more
information than you want, but it’s a great example
of putting systems in place that make it easier for
people to do the right thing. Here’s what we did with Harborview. Again, this is really simplified for the purposes of this webinar, but you can get the idea. One, tweak the environment. How did we tweak the environment? Well, first of all, they
revised the template to make it streamlined. That made it easier. Then they placed the
template in a visual spot in every single OR room. So you walked in, I mean,
even if you didn’t think about doing the brief, it was there. They tweaked the timing for the brief so all could attend. Struggled with that a little bit trying to find the right timing for it. And then they came up with a plan to let people phone conference
in to conduct a brief. Mostly for the surgeons,
because they might be on rounds. And at first they were coming
up with all kinds of reasons why they couldn’t do it. Well, okay, how about phone conferencing? Now I can tell you
Harborview’s been doing it for eight, almost nine months now, and they complete the brief
about 80% of the time, which I think in a change
going from 0% to 80% in eight months, a change of that magnitude
was pretty impressive. They built some habits by making
the template simple to use. That was no longer a barrier. They advertised how often
the brief was occurring. Reminded people, yeah,
okay, now we’re at 40%. Here’s where it’s occurring. Then they used the templates
to track significant info. And this is really a big one. Because individually people
didn’t know how much difference it was gonna make, but over time, as they tracked this
significant information, they found that 70% of the time they were finding information
that was significant for the rest of the day. And I’ll get a little bit more into that on rallying the herd, which I’ll just go into that now. Frequent reports to staff and
providers of good catches. That was huge. That goes back to
tracking significant info. Needed an implant later in the day that maybe wasn’t in our implant room, and they had to get it from
another hospital in the system. Or positioning plans. Things change through the
day that people didn’t know, and they were able to
address these early on. And finally, had informal
and formal leadership share how the brief was working for them. Again, I’ll go back to the hand surgeon, but we’ve had multiple surgeons
and anesthesiologists… Well, everybody in the OR that’s been involved in the briefs, they’re at a point now
where they’re almost angry when they don’t occur. There are still some people
that are resisting them, and we’re trying to work on that, but mostly we’re working
on who wants to do it, who’s doing it well, and how do we keep moving it forward instead of focusing on those
that don’t wanna do it? Again, this is the Switch framework that we just went through. We’ve talked about this
for about 30 minutes now. We spent a lot of time
with our groups with this, but before we did, we
practiced it a lot ourselves. I made it sound a little
easier than it is.’ I would encourage you to
read the book, to begin with. And we get no royalties from it. And then practice working
through it yourself, maybe within your own team. How are we gonna direct the rider? In fact, that’s the easiest part. Directing the rider is the easiest part. But how are we gonna
motivate the elephant, and how are we gonna move
forward to shape the path? When Megan asked about resistance and you put things up there, there were some really good ones. One of my favorites that
I’ve seen before is, you like change? Well, then you go first. We have to keep in mind, though, if you want change, failure
is part of the deal. And quite often what we see, as soon as something goes wrong, people are ready to
throw in the towel on it. You have to keep your destination postcard in sight at all times. That shouldn’t change. What might change is the
process on how you get there. So keep in that in mind, and we remind our change
teams all the time, and we do that proactively, hey, there’s things
that are not gonna work. And then we’re gonna come back and we’re gonna reevaluate this. Basically, for all of us that are involved in quality
improvement, the PDSA. Looking at how do we plan,
do, study, and act this as we move forward. And the change model that we use has been very effective for us. So here is our contact information. With that, I know Farrah and Megan have been answering questions as we go, but I’ll turn this back over to Chris for any other questions. – [Chris] Thanks, Ross. Thanks for the great presentation. Really appreciate it. And yes, there’s been some
good questions coming in that both Megan and
Farrah have been covering. I grabbed a couple of those
that people may have missed, didn’t get a chance to read the answers to that we might want to circle back on. And then there’s also
a couple of other ones. Right at the end there you were talking about how directing the rider is probably the easiest part of this, and that it’s hard to
motivate the elephant, and hard to shape the path. Somebody asked, would you
recommend shaping the path first? Coming up with those processes
and ways of doing work before you tap into both the
rational and emotional sides. – [Megan] I would argue
that yes, the environment, it’s a great place to start if
you think it’s an easy start. However, don’t underestimate the power of the rational story
or the emotional impact of really getting this change going. So yes, you might be able
to tweak the environment as kind of your early starting place, but the other two,
specifically the emotion, really drives a lot of individuals towards really embracing
change as it comes up. – [Ross] Yeah. But I also think that there is no, even though that’s the way
they’re written out in the book and how we presented them, I would say whatever… Each group’s gonna be
a little bit different, and if I really had to rank
them in order of difficulty, motivating the elephant is the hardest, shaping the path second hardest, and then direct the rider
would be the easiest. I guess we like to go with
the low-hanging fruit, too. What are some areas we can
address pretty quickly there? And usually education’s the easy one. So trying to work those so you
don’t have to systematically work through all nine steps. You might end up bouncing around. – [Chris] So you’re combining this with your ideas that you’re bringing up about how it’s better to get people to take ownership as opposed to buying in. Would you want them to
help shape the path, because they’re shaping the
direction things are going and how work is being done? Is that going to be important to the idea of them being
owners of what’s happening? – [Megan] Yeah, I think absolutely. I think to engage as many folks
as you can in the process, shaping what the process looks like, and that means shaping the path as well, that is a critical step in providing that sense of ownership, I think. – [Ross] One example we
didn’t even talk about. We worked with one of our
groups in our health system, and their change team decided
that they wanted everybody to go through the Switch Model, so during our trainings,
we spent an hour and a half presenting the Switch Model and then they went through the nine steps. And what we did was broke
them into different groups. One would direct the rider, one
did motivating the elephant, one did shape the path. And they wanted to
implement a couple tools. They went through that process. Everybody on the entire staff, faculty, so over 200 people were
involved and developed. That’s ownership at its highest level that we’ve been able to get. Most of the time it’s our change teams that we deal with. – [Chris] Got it. So when you’re thinking about folks that you’ve been involved with this, taught people about Switch, what percentage of people, and you maybe don’t know
the exact number here, but what percentage of
your management team throughout UW has really demonstrated consistent ownership of this model? Are people using it after
you’re teaching them? – [Ross] Yeah, I think after the groups that we’ve worked with, the teaching on the model, definitely. We also have another department
that we’ve worked with, our organization development and training. We’ve worked on this program
together with them originally. It’s working, not only
for the TeamSTEPPS thing, but they’re introducing it in
the things they’re doing too. It’s a huge system, and like anything, everything moves slow. But yeah, definitely the ones
that we’ve worked with on it are using it. And one of our groups, like for example that OR
group example we used today, they actually bought the book for all members of their change team. Which was extremely helpful, too. – [Chris] I could imagine that this also, being involved with this would also help with some satisfaction,
workplace satisfaction issues. I know I was reading the comments here and I know that either
Megan or Farrah wrote that’s something that you’re currently starting to track in UW. If this has been helpful in improving workplace satisfaction, but without data do you have any… General feeling or any stories, anecdotes that you’ve heard that you could share? – [Ross] That’s a great question, Chris. It’s interesting, because just recently we’ve received two e-mails from leadership in departments we’ve worked with that on the employment engagement survey, which occurred here, I’m
losing track of time, but within the last five months or so. One of the common themes
in the units were, they really appreciated the
implementation of TeamSTEPPS. And I’m just paraphrasing
what they said, obviously, but it’s made a difference on how they’ve worked as a team and stuff, and people really like it and are actually asking
for ongoing and more of it. That would be the closest we
would have to hardcore data from that employment engagement survey. And one of the things we do
look at is turnover rates. We have had one of the
areas we worked with, their turnover rate over
the years has decreased. We like to take credit for that. I don’t know that we
can take all the credit, but we like to take as much as we can. It was pretty cool to get
those unsolicited e-mails from leadership from two
different departments just recently, saying a common theme was they liked the TeamSTEPPS, they liked how they were
a part of the process versus a top-down thing. I think that’s what we
run into all the time, is front line providers and staff, they’re told that we’re gonna do things. We have outside consulting
groups coming in. We have new EMR, and they’re just told without much input on how it’s gonna work. And that’s the difference in
how this program, I think, that’s what makes a huge
difference in this program. – [Chris] That’s great. Yeah, that was great to get that feedback. There was a question that
came in pretty early on that was about, what does it mean to adapt people… Using their strengths for a better fit, finding a better fit. And Megan and Farrah had a
great comment about this, and answered this. I’m wondering if they
could kind of reiterate what they said in the chat area in case people didn’t
have a chance to read it as the comment was scrolling by. – [Megan] Farrah’s looking
it up right now, hang on. – [Ross] Sorry, I was talking, so I didn’t get to see all the comments so I’m not sure which one
you’re talking about, Chris. – [Chris] It was the aces
in their places answer. – [Farrah] Yeah, go ahead, Megan. – [Megan] Just kind of this adapting, finding what’s gonna work
best for the individual. This actually I’m gonna credit
a past working at Jamba Juice in my younger. But this is the mentality
that came from them. Putting aces in their places
was how they did business. It’s really identifying
what are the critical steps that need to be done, and
who’s best suited to do those. So if you have an individual
who’s resistant to change, really identifying, okay, well what is it? The pace of change? Is it that they don’t feel
like they can complete their responsibilities or their roles? And identifying, are there other areas that you could deploy them that they’ll be more successful in helping the change progress, whether it be a slower pace, or even a faster pace? Maybe they’re resistant
because it’s taking stuff off their plate that they
don’t want off their plate. So giving them more to do. It’s just really identifying what’s going to be best-suited area for these individuals on your team and deploying them there. – [Chris] That’s great. Sorry, Ross. – [Ross] There was just this
question about any experience with this in a GI single specialty. We have worked with, not in
an ambulatory surgery center, but within our health system, we’re working extensively
with a GI group right now. It’s pretty much at the
infant stages of it, but again, this is a
group that has worked on, their change team has
done some Switch work and they’re starting their training, actually have done their training, and now are implementing
some stuff in there with pretty good early successes. One of the things we found early on is you can’t expect a
lot to happen quickly. If you do, you’re gonna be disappointed. So keeping moving forward
is what we’re doing with that group, and we just, again, had
another meeting two days ago, and they’re moving forward. The model’s been effective with addressing some of the issues they
have with the providers and some of the staff there, too. I can’t remember whose name that was, but you can e-mail us and we’d be happy to give you more information on what we’re doing with program. – [Chris] Thanks, Ross. You had said earlier when you were talking about buy-in versus ownership, that it’s easier, or not easier, but more successful of
course to go to somebody and say, we’re gonna do TeamSTEPPS and I want you take ownership
in how it’s rolled out or how you’re gonna
use some of these tools to solve some of your challenges. That seems like it would be easier for somebody in leadership or a peer to come to somebody and say that. What do you do if the person maybe is not a provider, somebody in education that might be going into
a group of physicians and saying, we want you to do this, and we want you to
figure out how to do it? That seems like that may not work as well. So how do you get that
ownership starting up when you’re dealing across
the hierarchy gradient? I guess would be the best way to say it. – [Ross] I’m glad you asked that question, because I should have clarified that a little bit better earlier. In our model here we
use the consulting model that Megan, Farrah, and
I spent a lot of time going into departments. That is my full-time job. But we still guide them, okay. We do go in and say, we
want you to own the process, but we’re gonna help you. We’re not just gonna say,
go forth and prosper. I’m trying to find my words here, but we’re gonna guide
you through the process. Giving you the experience
of what we’ve seen works and what doesn’t work. We’re not gonna let you
go down the wrong street. Now the flip side of that is, you also have to get the right people on your change team to begin with. And you’re always gonna find people like you just said, Chris,
that aren’t gonna wanna do it, but there are people that do wanna do it, and I don’t care what their profession is. Physical therapist, a
nurse, a physician, a PA, there’s always somebody on a team that’s gonna want to be involved
in pushing this forward, because they see the value in it. Those are the ones that
you get to turn around. You guide them and then they turn around and they bring the rest of
the people in their profession on board with this program. We don’t go in and say, hey,
you guys are doing TeamSTEPPS. You get to figure out how to do it. We guide you on how to do it. We don’t dictate, but we do guide. We might even push you down a certain way, knowing from experience, but ultimately they walk out feeling like, yeah, we own how this is gonna happen. And every group we’ve done that with I think we can safely say that it was not a top-down thing, that they felt like
they owned the process. – [Chris] Got it, thanks. I know this is something that we’ve kind of chatted about before in regards to TeamSTEPPS, but there’s a question here from Randolph about integrating lean engineering work with the Switch methodology. I thought about that. I know that we’ve done some discussing about lean being a crosswalk over to some of the TeamSTEPPS tools, and that people can
feel free to contact us and we can send you some resources and point you towards some folks that have talked about that before, but Ross, I don’t know if
you’ve ever talked to anybody about the Switch methodology, maybe especially in the
shaping the path mode of things and linking into lean. – [Ross] Yeah, I mean, I
think that’s a great question, and one that I think a
lot of people are still trying to figure out how best to… To cross those bridges or
to integrate those together. I can tell you groups that we work with, we do some process mapping up front and do the little sticky
notes on the wall and whatnot to figure out, depending
on what the process is, they wanna look at. And then using that and
using the Switch Model, as well as the TeamSTEPPS tools, we try to figure out… Where can we fit into these processes? Our department is called the transformation and care department. Trying to work with them
as much as possible, because I know lean, but
I’m not an expert in it, so we do utilize those guys. And they call on us a lot to come in and work with
them on different projects related to the opening of new clinics. Even the GI group that I was mentioning, we were very involved with lean or worked with them on
doing some of the work with our GI group. I know that’s not the answer
you’re looking for, Randolph, but you can’t do them
separately, obviously, because it is too much on people’s plates. But you can start to integrate them by tapping into those people that do have a lot of lean
experience to figure out, okay, how can we make sure
these two go together? Like Chris said, they have
some pretty good information from other facilities that are doing it. Sorry, that’s about the best
I come up with for that one. – [Chris] That’s great, and
I think we’re getting close to the end of the time here. I wanted to put a plug in
for the webinar next month, as Ross, Megan, and Farrah
complete the trilogy here of the series we’re doing. The title of the webinar
is Maintaining the Gains and Continued Evolution
of the TeamSTEPPS Program. It’s gonna be on Wednesday,
September 13th, same time. So that’s 1:00 to 2:00 Eastern time, 12:00 to 1:00 Central. It’s the final, like I said,
of the three-part series, and they’re really going
to be getting into… How their implementation
process has been sustained, how they’ve looked for the bright spots. What we learned here in the Switch Model, how they took those bright
spots and really leveraged them. And how they go about
evaluating the process and adjusting as they go along. I’d like to invite you
all to join us for that and I’d like to thank
you all for attending, and then also thank Ross,
Megan, and Farrah very much for being able to join us
today for this presentation. It was great, thank you. – Thanks, everyone.
– Thank you. – [Brandon] Thank you,
ladies and gentleman. This concludes today’s conference. You may disconnect your
lines, log off the webinar. Have a great afternoon.

Leave a Reply

Your email address will not be published. Required fields are marked *