ESQUEMA GENERAL Y ETAPAS DEL PARDEAMIENTO NO ENZIMÁTICO

 Status of the patient  Team Members

 Environment

Another TeamSTEPPS tool focuses on the individual team member‘s responsibility to monitor their own situation, which could impact team functioning and possibly patient outcomes. This tool, called the, ―I‘m Safe‖ checklist, is a tool for self-awareness and self-assessment. The tool provides a way for a team member to assess whether his or her functioning might be affected by illness, medication, stress, alcohol/drugs, fatigue or hunger.

3. Mutual Support

Successful teams will also employ mutual, supportive behaviors, sometimes referred to as ―back-

up behaviors.‖5

Mutual support is the ability to anticipate other team members‘ needs based on the knowledge of personnel stressors and shift workload to achieve balance during periods of

high workload or pressure.6 In order for teams to engage in mutually supportive behaviors, they

need to become proficient with five TeamSTEPPS actions:

1) task assistance which protects other team members from work overload;

2) feedback, or giving as well as receiving information to improve team performance; 3) advocacy when team member‘s viewpoints don‘t coincide and assertion of the need for a

different solution; 4) conflict resolution: and 5) collaboration.

These behaviors allow teams to self-correct, compensate for one another, reallocate functions based on resources and provide information to one another. Teams become proactive rather than reactive.

4. Communication

This definition of communication on the right, as it pertains to culture is interesting, given that it emphasizes what was heard and not the message that was sent. We often just think of communication as the messages that we send and not what was heard or the responses from what was heard. At the beginning of this chapter, communication was compared to the blood in the arteries that supply teamwork and ultimately forms culture. Communication serves as a supporting structure

for teamwork. The leadership must use communication to convey information, to determine roles and responsibilities, discuss the progress of the improvement team and to formulate action plans with the team. Team members must monitor situations by communicating changes to the team. Communication fosters mutual support as a mechanism for team members to inform one another of when assistance is needed. However communication is defined, it is ultimately the lifeline for teams and culture.

How important is communication for the healthcare team? The principle accrediting organization for US hospitals, The Joint Commission (TJC), collects and analyzes sentinel event data for hospitals. During a 10-year period (1995 to 2005) TJC listed ineffective communication as the

“Communication is the response you get from the message you sent

regardless of its intent”

root cause for 66% of reported errors. In 2006, TJC added standardized handoffs as a National Patient Safety Goal, reinforcing the need for standard communication. In general, healthcare providers have not traditionally learned about standard communication tools, and healthcare disciplines communicate very differently. For example, nurses are taught to be broad and

descriptive, whereas physicians are taught to be concise and get to the ―headlines quickly.‖7

The principles for effective communication apply to any team. Communication must be complete, clear, concise and timely. Incomplete information negatively affects the goal of a team. Early and frequent communication is essential to the success of any initiative, especially when communicating to multiple teams within a hospital, unit or work area. John P. Kotter, a well-known author and Harvard business professor, wrote in his book Leading Change, ―Leadership should estimate how much communication of the vision is needed, and then

multiply that effort by a factor of ten.‖8

Effective communication exchange involves sending, recurring, verifying and validating

techniques.9 Sending techniques seek information from all available sources. Recurring

techniques involve analyzing the information provided and synthesizing it into content. Verifying techniques involve checking with the sender to assure the intent of the information received. Validating techniques confirm the intent of the sender. These techniques help to confirm that the message, as intended, was received.

Communication can be verbal and non-verbal. Nonverbal communication includes gestures, eye movements, body language and written communication. This last type of nonverbal

communication is evolving with technology to include email, texting, electronic chatting and tweeting. Common communication methods are newsletters, posters in common areas, staff meeting agenda items, and face-to-face meetings.

When communicating, it is important to consider the audience to whom the message is being sent. This may alter the mode and the method of communication that you use. If communicating with a busy physician, a brief call to convey the information may be most appropriate. If you are communicating with a younger team member, the preferred mode of communication may be electronic, such as a text. It is also important to consider the type of information that needs to be conveyed and its level of urgency, as this will alter the mode of communication as well. Team interactions, if at all possible, should be conducted in-person.

A study done in 1971 by Albert Mehrabian found that there were three elements of any face-to- face communication; words, tone of voice and body language. Words accounted for 7%, tone

accounted for 38% and body language accounted for 55% of the message meaning.10 Caution

must be used when choosing the mode of communication, especially for the direct care provider team. Written or electronic communication should be verified with follow up oral

communication when possible.‖ Even verbal communication, when it involves important pieces of information, should be verified. The healthcare team, borrowing from the aviation industry, now uses read-backs to verify a verbal physician‘s order.

The TeamSTEPPS tool SBAR (Situation-Background-Assessment-Recommendation) provides a framework for communication between members of the health care team about a patient‘s

condition. SBAR is an easy-to-remember, concrete mechanism useful for framing any

conversation, especially a critical one that requires a clinician‘s immediate attention and action. It allows for an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of safety.

There is not one implementation plan for communication and teamwork tools that will work for each hospital or for each unit. Culture is local, and it is adaptive work. Therefore, culture must be worked on at a local unit or department level. There must be unit champions in the unit to lead this effort. This is the work of the project team members, as are the steps necessary to develop processes to prevent CAUTI. It will be up to the project team to implement communication and teamwork tools. However, the senior leadership gives the necessary support for this local level cultural change by setting improved communication and teamwork as an organizational goal. TeamSTEPPS tools can be accessed at http://teamstepps.ahrq.gov .