Enhancing Teamwork across care provider l
Due 6pm Chicago time
Pls follow the prompt
Topic: Enhancing Teamwork across care provider levels. The manager of a medical surgical unit has observed and had complaints about, lack of teamwork between the RN's and the patient care techs (PCT's). Your task is to propose a plan to enhance teamwork on the unit.
Pls use the article provided for this assignment
Student Name:
EBP Journal Article in APA format:
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Is this an Evidence Based Article? Name of Journal and Year article was written? |
Yes/No Name of Journal Year: |
.2 points |
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State the problem What was the goal of the project in the article? Does this project correlate with your problem? State how? What are you trying to achieve? Does this article support this goal? |
Problem: Goal: State how this article correlates with your group problem and goal. |
.2 points |
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Strengths (Internal) What’s was good about your article? |
Why was this project successful? List attributes of the article, i.e. support from administration, councils, colleagues, institutions. Did this implementation take place on a unit or area like yours? |
.4 points |
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Weakness (Internal)- issues |
Example: lack of education, lack of staffing, staff readiness, lack of support; size, managerial style. |
.4 points |
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Opportunities (External) |
Example: Lack of supplies, educational needs, stakeholders, baseline (your baseline data), what needs to be improved? |
.4 points |
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Threats – (External) |
Staff buy in, support, limitations and barriers, supply cost, cost of implementation, time, money, realistic? |
.4 points |
Total Points = 2 points
,
Student Name: XXXXXXXX
EPB Journal Article in APA format:
Sánchez, M., Suárez, M., Asenjo, M., & Bragulat, E. (2018). Improvement of emergency department patient flow using lean thinking. International Journal For Quality In Health Care: Journal Of The International Society For Quality In Health Care, 30(4), 250–256. https://doi.org/10.1093/intqhc/mzy017
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Is this an Evidence Based Article? Name of Journal and Year article was written? |
Yes Name of Journal: International Journal for Quality in Health Care Year: 2018 |
.2 points |
|
State the problem What was the goal of the project? Does this project correlate with your problem? State how? What are you trying to achieve? Does this article support this goal? |
Problem: Delays in the ED compromise quality of care and patient safety while simultaneously increasing mortality and healthcare costs. Internal inefficiencies and poor resource utilization may contribute to delays in care and overcrowding. Goal: The goal of this project was to achieve a target time of 160 minutes (total), per patient in the ED. · 80 minutes of “added value” (i.e. specific amount of time with a nurse and doctor for assessment, treatment, and education) · 60 minutes for lab results · 20 minutes for treatment steps that could not be eliminated using the Lean process The goal of our group project is to propose a plan to decrease wait times and improve flow to care areas. The study outlined in this article directly correlates with our group project in that its aim was to tackle the issue of increased wait times leading to delay of care and negative outcomes, including decreased patient satisfaction and the increased risk for mortality. The goal of our group project is to propose a plan to reduce wait times in order to improve patient outcomes, which is exactly what the article’s researchers set out to do by proposing the use of lean principles to eliminate the unnecessary steps/processes that add to wait times. |
.2 points |
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Strengths (Internal) What’s was good about your article? |
Staff Input: This project was heavily supported by the ED staff and administration. In fact, the ED staff were empowered to make the necessary changes by identifying steps (waste) that slowed flow and hindered the care process. They were also tasked with recognizing processes that could be standardized to improve efficiency in care. Leadership Style: Furthermore, the researchers encouraged a “bottom-up” approach (democratic leadership) to achieve a more enthusiastic acceptance and implementation of the plan. The ED executive team acted as consultants to help support and foster the new process to reduce internal resistance. Cost: The implementation of the entire project was inexpensive because it did not require third party support or additional supplies. Did this implementation take place on a unit or area like yours: Yes, this project was implemented in an ED unit. |
.4 points |
|
Weakness (Internal) |
Staff Support: According to the researchers, the most difficult problem they faced was staff reluctance to abandon their old practices and proceed with implementing the new process of standardization (which required 3 weeks of constant surveillance). Size: This study was performed in a single ED unit that did not provide services to pediatric or obstetric patients, so it is unknown how well these results might carry over to other specialized ED units. Furthermore, to ensure proper control, the study was limited to a specific unit in the ED, MAT-3, which was the busiest unit in the ED and designated solely for urgent cases. |
.4 points |
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Opportunities (External) |
Patient Satisfaction: The results of this study showed that the ED staff was able to reduce wait times, overall care times, and improve patient flow using the lean process to eliminate wasteful steps. However, the researchers could have also measured patient satisfaction to determine if the lean process also improved the correlation between wait times and patient satisfaction. Staff Satisfaction: The authors recognized that additional research should be completed to analyze how the lean process affects staff members in terms of work satisfaction, turnover, and improved use of skills. Baseline Data: The researchers found no significant differences in the revisit rate, mortality rate, or leave without being seen rate (LWBS) after implementing the lean process. Suggestions for additional research meant to address these variables were not provided but should be explored, especially due to their relationship with patient safety. |
.4 points |
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Threats – (External) |
Validity: The researchers acknowledged that one of the greatest limitations of their study was its external validity since the study was performed in only one ED unit. Their methodology might not produce the same results in a more efficiently run ED unit. Time: The researchers also agreed that the cultural change needed to fully adapt to this new standardized process would be an ongoing endeavor that would require additional time after the conclusion of the study. The researchers discounted the first 6 months of data because they anticipated that the staff would be more willing to embrace the new process, resulting in a false-positive outcome. Their aim was to observe how time also impacted the lean process in the ED unit in the following months. Staff Buy In: Finally, the researchers also felt that the cultural/local interpretation of lean principles might differ depending upon location and/or unit. Previous studies concluded that the lean process did not provide clinically relevant results in ED units due to lack of staff buy in resulting from misinterpretation of lean principles. In other words, the staff must understand that the lean process is not a solution but a methodology. |
.4 points |
Total Points = 2 points
,
1Ballangrud R, et al. BMJ Open 2020;10:e035432. doi:10.1136/bmjopen-2019-035432
Open access
Longitudinal team training programme in a Norwegian surgical ward: a qualitative study of nurses’ and physicians’ experiences with teamwork skills
Randi Ballangrud ,1 Karina Aase ,2 Anne Vifladt 1
To cite: Ballangrud R, Aase K, Vifladt A. Longitudinal team training programme in a Norwegian surgical ward: a qualitative study of nurses’ and physicians’ experiences with teamwork skills. BMJ Open 2020;10:e035432. doi:10.1136/ bmjopen-2019-035432
► Prepublication history and additional material for this paper are available online. To view these files, please visit the journal online (http:// dx. doi. org/ 10. 1136/ bmjopen- 2019- 035432).
Received 31 October 2019 Revised 27 April 2020 Accepted 18 May 2020
1Department of Health Science Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway 2Center for Resilience in Healthcare (SHARE), University of Stavanger, Stavanger, Norway
Correspondence to Dr Randi Ballangrud; randi. [email protected] ntnu. no
Original research
© Author(s) (or their employer(s)) 2020. Re- use permitted under CC BY- NC. No commercial re- use. See rights and permissions. Published by BMJ.
Strengths and limitations of this study
► In this study, the sample of both nursing staff and physicians contributes to interprofessional experi- ences in the implementation of a team training pro- gramme in a surgical ward.
► The study intervention was based on an evidence- based team training programme with a standardised curriculum.
► A longitudinal design enables data collection on three occasions.
► The sample size was small, leading to a relatively limited number of participants in the focus group interviews.
AbStrACt Objectives Teamwork and interprofessional team training are fundamental to ensuring the continuity of care and high- quality outcomes for patients in a complex clinical environment. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence- based team training programme intended to facilitate healthcare professionals’ teamwork skills. The aim of this study is to describe healthcare professionals’ experiences with teamwork in a surgical ward before and during the implementation of a longitudinal interprofessional team training programme. Design A qualitative descriptive study based on follow- up focus group interviews. Setting A combined gastrointestinal surgery and urology ward at a hospital division in a Norwegian hospital trust. Participants A convenience sample of 11 healthcare professionals divided into three professionally based focus groups comprising physicians (n=4), registered nurses (n=4) and certified nursing assistants (n=3). Interventions The TeamSTEPPS programme was implemented in the surgical ward from May 2016 to June 2017. The team training programme included the three phases: (1) assessment and planning, (2) training and implementation and (3) sustainment. results Before implementing the team training programme, healthcare professionals were essentially satisfied with the teamwork skills within the ward. During the implementation of the programme, they experienced that team training led to greater awareness and knowledge of their common teamwork skills. Improved teamwork skills were described in relation to a more systematic interprofessional information exchange, consciousness of leadership- balancing activities and resources, the use of situational monitoring tools and a shared understanding of accountability and transparency. Conclusions This study suggests that the team training programme provides healthcare professionals with a set of tools and terminology that promotes a common understanding of teamwork, hence affecting behaviour and communication in their daily clinical practice at the surgical ward. trial registration number ISRCTN13997367.
IntrODuCtIOn Teamwork is fundamental to ensuring the continuity of care and high- quality outcomes for patients in a complex clinical environment, necessitating training across professional silos.1 2 Team training has been described as a learning strategy in which a learner or group of learners systematically acquire(s) team- work knowledge, skills and abilities to impact cognition, affect and behaviours of a team.3 Teamwork is found to positively affect clinical performance.4
In hospitals, many adverse events are asso- ciated connected to surgery.5–7 A system- atic review by Johnston et al8 documented that a delayed escalation of patient care after surgical complications is associated with higher mortality rates, identifying poor communication, hierarchical barriers and high workloads as causal factors. Previous research has provided evidence for strategies such as team training to improve the surgical culture9 and have a positive effect on postop- erative patient outcomes.10–12
Several team training programmes have been developed in healthcare.13 In this paper,
2 Ballangrud R, et al. BMJ Open 2020;10:e035432. doi:10.1136/bmjopen-2019-035432
Open access
we studied the implementation of the Team Strategies and Tools to Enhance Performance and Patient Safety (Team- STEPPS) in a surgical ward. TeamSTEPPS is a publicly released, evidence- based programme based on teamwork theory14 and change theory.15 The programme was devel- oped by the Agency for Healthcare Research and Quality in collaboration with the US Department of Defense and was released in 2006.16 17 TeamSTEPPS, which is trans- ferable to any healthcare setting, intends to facilitate healthcare professionals’ teamwork by optimising team structure and the team’s communication, leadership, situation monitoring and mutual support skills. The basic assumption of the programme is that these five teamwork principles are critical for safe patient care.16
Systematic reviews have confirmed that team training affects outcomes related to the team knowledge, atti- tudes, behaviours of healthcare professionals3 18–20 and results in improved quality.3 Furthermore, increased confidence and motivation to apply learned teamwork skills in daily practice have been experienced by health- care professionals.21
Quantitative studies of the TeamSTEPPS programme have confirmed improvements in teamwork and commu- nication,22 23 patient safety culture,24–27 efficiency inpa- tient care,24 25 28 complications and mortality,29 falls23 and frequency of wrong- site/side/person surgery.22 Most of the TeamSTEPPS studies are carried out in the USA30 without any longitudinal follow- up, and there are currently only a few qualitative studies18—for example, in surgical and paediatric intensive care25 and cardiotho- racic surgery telemetry.31 However, a need persists for qualitative studies in surgical ward settings because the team structure in wards is different from that in intensive care unit (ICU) settings; physicians are not situated in the ward for extended periods, thus restricting the possibili- ties for interprofessional reflections.32 This study is a part of a larger research project, comprising mainly substudies with a quantitative design, to evaluate an interprofes- sional team training intervention in a surgical ward.33 34 In this context, a qualitative study will provide in- depth knowledge of healthcare professionals’ experiences with learned teamwork skills in a longitudinal perspective.
We aimed to describe healthcare professionals’ experi- ences with teamwork in a surgical ward before and during the implementation of a longitudinal interprofessional team training programme. The following research ques- tion guided the study: how do healthcare professionals experience teamwork skills communication, leadership, situation monitoring and mutual support before and during the implementation of an interprofessional team training programme?
MethODS Design The study used a qualitative descriptive design35 based on semistructured focus group interviews with healthcare professionals at three- time intervals.
Setting The study was carried out at a 20- bed combined gastro- intestinal surgery and urology ward at a hospital divi- sion (198 beds) in a Norwegian hospital trust. The surgical ward was selected based on practical issues and the management’s interest and motivation for improve- ment initiatives after experiencing several patient safety incidents. The study occurred from April 2016 to June 2017. At baseline (November 2015 to March 2016), the ward statistics indicated an average bed occupancy rate of 87%, a mean patient length- of- stay value of 3.46 days and an admissions rate of 192.2 patients per month. Moreover, the ward’s number of full- time positions was 13 physicians, 17.25 registered nurses (RNs), 4.95 certified nursing assistants (CNAs), 1.0 head nurse and 1.0 clinical nurse specialist.
The patient care was organised into two interprofes- sional teams, where the primary members were RNs, CNAs and physicians. The composition of the teams and their duties were predetermined by a daily worklist for the nursing staff, while the physicians had their worklist, clarifying weekly duties such as surgery, polyclinic and doctors’ rounds.
Sample A convenience sample36 of 11 healthcare professionals divided into three professionally based focus groups comprising physicians (n=4), RNs (n=4) and CNAs (n=3) were recruited from the surgical ward. The inclusion criterion for participation in the study was that healthcare professionals from the surgical ward had participated at a minimum of 1 day of the interprofessional team training programme (41 participants). The ward management decided which professional groups participated in the TeamSTEPPS training programme. A request for infor- mation about the study and researchers was distributed to all healthcare professionals, where 11 confirmed their participation, thus constituting the study sample. The sample comprised eight women and three men with varying work experiences and employment within the ward. To secure the participants’ anonymity, no specifica- tion of their background is presented.
team training programme The longitudinal interprofessional team training programme was planned and implemented according to the TeamSTEPPS- recommended ‘model of change’ and was organised into three phases16 (see table 1 and box 1). A research group initiated the programme as part of a larger research project.34 Two nurses (one leader) and two physicians (leaders) from the surgical ward had the main responsibility for the training and implementation of the programme. Before the training, the four health- care professionals conducted the TeamSTEPPS V.2.0 Master Training Course and were certified as instructors. A more detailed description of the programme can be found in Aaberg et al.37
3Ballangrud R, et al. BMJ Open 2020;10:e035432. doi:10.1136/bmjopen-2019-035432
Open access
Table 1 Implementation of tools at phase 2 and phase 3 of the team training programme
Phase 2 Phase 3
2016 Tools Implementation arena 2017 Tools Implementation arena
May
Closed- loop Communication
Exchange of critical information
January
Debriefs Leadership
Once a week— manager with nursing staff
Task Assistance Mutual support
Distribution of workload
June ISBAR Communication
Communicating critical information
February STEP Situation monitoring
Updated in electronic care plan
August Briefs Leadership
Start of every shift March Two- Challenge Rule Mutual support
When an initial assertive statement is ignored
September Huddles Leadership
At patient safety whiteboard meetings
May I- PASS Communication
Handoffs with focus on patient safety risks
October Cross- monitoring Situation monitoring
Double control by intravenous medication administration
I- PASS, illness severity, patient summary, action list, situation awareness and contingency planning; ISBAR, introduction, situation, background, assessment, recommendation; STEP, status of the patient, team members, environment, progress towards the goal.
box 1 team training programme based on teamStePPS
Phase 1: set the stage and decide what to do—assessment and planning (January 2016–April 2016)
► Site assessment. ► A lesson about teamwork in relation to promoting patient safety was conducted with all nurses and physicians to create an awareness of the need for improvement.
► A training and implementation plan was developed. Phase 2: making it happen—training and implementation (May 2016–December 2016)
► One day of interprofessional team training in a simulation centre was completed for all healthcare professionals (n=41) in the surgi- cal ward, comprising 6 hours of classroom training (lectures, videos, role plays and discussions) and 2 hours of high- fidelity simulation.
► A change team with members from all ward professions and a for- mer patient was assigned.
► An action plan was established, based on identified patient safety issues in the ward.
► The TeamSTEPPS tool was systematically implemented every month (see (table 1)).
Phase 3: making it stick—sustainment (January 2017–June 2017) ► The initiatives from the action plan were coached, monitored and integrated.
► Implementation of a monthly TeamSTEPPS tools continued. ► Small victories were celebrated. ► TeamSTEPPS refresher courses were held after four (nurses and physicians) and 11 months (nurses).
TeamSTEPPS, Team Strategies and Tools to Enhance Performance and Patient Safety.
Data collection Ten focus group interviews of healthcare professionals were conducted before the team training implementation
(baseline=T0), with follow- up interviews after 6 months (T1) and 12 months (T2) (see figure 1).
All the interviews occurred in a meeting room at the hospital during the daytime. A pilot interview was conducted to validate the thematic interview guides developed from a literature review on teamwork (online supplementary files 1 and 2). The interviews were conducted as a dialogue and started with a clarification of the study aim. The thematic interview guides, including the four teamwork skills at T1 and T2, were used to ensure that all themes were explored during each focus group interview. The participants were encouraged to complete an open collective activity with a reflection on common experiences.38 The same questions were posed to all focus groups, and follow- up questions were used to encourage the participants to elaborate and/or clarify their responses.39 One moderator and one observer (who made field notes) were responsible for conducting the interviews, with the third author (AV) as a moderator at T0 and the first author (RB) as a moderator at T1 and T2. At T0, the interview referred to generic questions about teamwork at the ward (see online supplementary file 1); at T1 and T2, the interview questions referred to learned teamwork skills based on the TeamSTEPPS framework (see online supplementary file 2). The field notes were approved by the participants after the interview. The interviews lasted from 25 to 60 min (mean=33 min). All the interviews were digitally recorded, transcribed verbatim and anonymised before the analysis.
Data analysis Based on the aim and research question of our study focusing on healthcare professionals’ experiences with teamwork skills during a team training programme, a
4 Ballangru
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