TeamSTEPPS for Office-Based Care Teaching and Coaching Office-Based

TeamSTEPPS for Office-Based Care Teaching and Coaching Office-Based

TeamSTEPPS for Office-Based Care Teaching and Coaching Office-Based Care Objectives Address teaching TeamSTEPPS tools as a part of a coursework style approach where tools are divided into levels of difficulty Define the role of a coach Identify traits and skills of effective coaches Discuss the coaching process Practice coaching TeamSTEPPS tools individually, using the 3 Is coaching method Mod Page1 205.2 Page 2 TEAMSTEPPS 05.2 Office-Based Care

Teaching and Coaching TeamSTEPPS Tools Consider the audience Consider teaching as coursework at 100/200/300 levels Make sure you support your implementation with coaching Feel free to mix and match coaching models you see fit to use in your unique environment Mod Page1 305.2 Page 3 TEAMSTEPPS 05.2 Office-Based Care 100/200/300 Level Coursework Some TeamSTEPPS tools may be easily grasped Depending on the user or the organizational culture,

they may not be easily executed One method to teaching is a leveled approach Mod Page1 405.2 Page 4 100 level: basic, easy to execute 200 level: intermediate, may take some coaching 300 level: advanced, coaching almost a certainty TEAMSTEPPS 05.2 Office-Based Care Example: An Issue of Time

Office-based care teams often face long hours made longer by lapses in communication TeamSTEPPS tools and principles can be used to address the problem Watch the video to see the problem the office is having and what the coach, a physicians assistant, recommends Mod Page1 505.2 Page 5 TEAMSTEPPS 05.2 Office-Based Care 100-Level TeamSTEPPS Tools Are easily executed and likely to be accepted with little resistance Require little coaching to put in place but need to

be practiced 100-level tools include: Mod Page1 605.2 Page 6 SBAR Brief Closed loop communication Call-out Check-back

Cross-check TEAMSTEPPS 05.2 Office-Based Care An Example at Work Watch the video to see how SBAR is introduced to the team in their weekly meeting Mod Page1 705.2 Page 7 TEAMSTEPPS 05.2 Office-Based Care 200-Level TeamSTEPPS Tools Are more advanced and more difficult to execute Allow individuals to see themselves more as one

important part of a working whole 200-level tools include: Mod Page1 805.2 Page 8 Huddle Debrief Handoff (I PASS the BATON) STEP Cross-monitoring Task assistance TEAMSTEPPS 05.2 Office-Based Care

An Example at Work Watch the video to see how the coach uses the huddle to have an important discussion on how to refocus the team Mod Page1 905.2 Page 9 TEAMSTEPPS 05.2 Office-Based Care 300-Level TeamSTEPPS Tools Are the most advanced and need focused coaching to achieve a lasting result Require team members to stand up to others, ask hard questions of themselves and others, and address issues of hierarchy in their teams Focus on conflict resolution and threat management and avoidance

300-level tools include: Mod Page1 10 05.2 Page 10 CUS Two-Challenge Rule DESC script TEAMSTEPPS 05.2 Office-Based Care An Example at Work Watch the video to see the coach help a mentee

build a DESC script See the result of the conflict resolution tool Mod Page1 11 05.2 Page 11 TEAMSTEPPS 05.2 Office-Based Care Overlap of Tools The leveled approach is not set in stone Some tools can be reinforced at multiple levels It is also good to think of coaching the tools from the perspective of TeamSTEPPS principles: Mod Page1 12 05.2 Page 12

Communication Leading teams Situation monitoring Mutual support TEAMSTEPPS 05.2 Office-Based Care Team Structure and Coaching In office-based care, teams consist of: Core clinical staff

Support staff Administration Patients Coaches can come from all categories (except patients) A coach should be available to each team member TeamSTEPPS tools are effective only when used by all team members Mod Page1 13 05.2 Page 13 TEAMSTEPPS 05.2

Office-Based Care Definitions of Coaching Coaching is providing guidance, feedback, and direction to ensure successful performance Coaching is supporting someones efforts to achieve personal and professional goals Coaching is different from traditional instruction Mod Page1 14 05.2 Page 14 Teaching implies an end at content mastery Coaching takes place over a lifetime

TEAMSTEPPS 05.2 Office-Based Care Characteristics of Effective Coaches Are competent in their skills Are influential Have strong interpersonal skills Provide effective feedback Listen actively Ask powerful questions Mod Page1 15 05.2 Page 15 TEAMSTEPPS 05.2 Office-Based Care Coaching Competencies

Mod Page1 16 05.2 Page 16 Communicatio n Relationship Managemen t Performanc e Improvemen t Execution TEAMSTEPPS 05.2 Office-Based Care Sample Coaching Models

Coaching Approach C-FAR (Homan and Miller) 3 Is (HSPH) PIDA (Outcome Engenuity) Relationship connection and sharing Connect I saw this Perceive Objectives goals and focus Focus I wonder

why Interpret I think that Decide and Act Description Mod Page1 17 05.2 Page 17 Action empowerment and challenge Activate Review celebrate or redirect Review

TEAMSTEPPS 05.2 Office-Based Care 3 Is I SAW THIS: Lay the groundwork for the coaching based on what the coach witnessed firsthand I WONDER WHY: Question the reasoning for what is done and approach it as a puzzle to be solved together I THINK THAT: Provide a solution that addresses not only the issue at hand but also the knowledge or attitudes that lead to the issue Mod Page1 18 05.2 Page 18 TEAMSTEPPS 05.2

Office-Based Care Using the 3 Is Neither judgmental (You did this wrong) Nor nonjudgmental (Guess how I think you should do this better?) Combines advocacya statement or observation With inquirya question And provides a hypothesis that can be tested Mod Page1 19 05.2 Page 19 TEAMSTEPPS 05.2 Office-Based Care Coaching Leadership Tools Coaches are both official and unofficial leaders They influence the behavior of their mentees even

when not coaching Participating in leadership tools is also a chance to coach by example: Mod Page1 20 05.2 Page 20 Briefs Huddles Debriefs TEAMSTEPPS 05.2 Office-Based Care

Coaching Debriefs Using the 3 Is How would you use the 3 Is to coach a team who just had a debrief that skipped the step to discuss whether workload was assigned equally across the team? Mod Page1 21 05.2 Page 21 TEAMSTEPPS 05.2 Office-Based Care Possible answer: I saw that the team skipped the step to discuss whether the workload was equitable during the previous shift. I wonder if individuals are uncomfortable bringing up complaints about their workload. I think that if we approach the debrief as a

nonjudgmental period of trust and truth telling, people should be comfortable bringing up issues with the workload. I also think that mutual support is a useful TeamSTEPPS principle we should use to support ourselves if we have workload issues. Mod Page1 22 05.2 Page 22 TEAMSTEPPS 05.2 Office-Based Care Coaching Communication Tools Communication is inherent in coaching Communication is more than talkingit is talking and listening, which is a key component that can be modeled via coaching Coaching in the moment helps TeamSTEPPS communication tools to stick:

Mod Page1 23 05.2 Page 23 SBAR Check-back/closed loop communication Handoff (including I PASS THE BATON) TEAMSTEPPS 05.2 Office-Based Care Coaching SBAR In the Moment Coaching in the moment

Provides immediate feedback Allows the coach to have a firsthand look at the situation Can work well for providing feedback to individuals the coach has not built a relationship with previously If SBAR (or another communication tool) is omitted or done incorrectly, it is easy to catch and fix on the spot Mod Page1 24 05.2 Page 24 TEAMSTEPPS 05.2 Office-Based Care

Coaching Situation Monitoring Tools A coach constantly engages in the situation and monitors to assess the needs of the mentees and team A coach can model these tools and help the mentees translate the tools to their own experience: Mod Page1 25 05.2 Page 25 Situation monitoring process Cross-monitoring STEP

TEAMSTEPPS 05.2 Office-Based Care Coaching Situational Awareness Using the 3 Is Consider Emily, a team member who may not exhibit very good situational awareness. She seems to walk in a cloud and not have any idea what is going on around her. In one situation she walked past a very crowded waiting room and said innocently (but too loudly) to her coworker at the front desk, These people are going to wait forever! Glad my shift is done and I can get out of this chaos! How would you use the 3 Is to coach Emily to have more situational awareness? Mod Page1 26 05.2 Page 26 TEAMSTEPPS 05.2

Office-Based Care Possible answer: I saw that you seemed unaware of the crowded waiting room and you announced in front of the patients that you were glad to be leaving the chaotic office. I wonder if that is because you didnt realize that the patients could hear you and that it would affect their experience. I think that in the future you could use situation monitoring to become aware of stress levels among team members and patients. While it was entirely acceptable for you to leave at the end of the shift, it would be better to not announce you are leaving and make a joke that could harm team morale. Mod Page1 27 05.2 Page 27 TEAMSTEPPS 05.2 Office-Based Care

Coaching Mutual Support Tools Coaching itself is a form of mutual support Coaching provides ample opportunities to model mutual support tools Coaching mutual support tools directly affects the culture of an organization Mod Page1 28 05.2 Page 28 Task assistance Feedback Advocacy and Assertion Two-Challenge Rule TEAMSTEPPS 05.2

CUS DESC script Collaboration Office-Based Care Coaching the Two-Challenge Rule Using the 3 Is You see Barbara disregard Davids use of the TwoChallenge Rule. You take David aside and learn that whenever he uses the Two-Challenge Rule with Barbara, his superior, she continues to disregard what he says. How would you use the 3 Is to coach Barbara in this situation? Mod Page1 29 05.2 Page 29 TEAMSTEPPS 05.2 Office-Based Care

Possible answer: I saw that you disregarded the Two-Challenge Rule when David used it with you earlier. After speaking with David, I learned this was not an isolated case. I wonder if you do not use the Two-Challenge Rule with David because you are his superior and have been at nursing much longer than he has. I think the Two-Challenge Rule is a useful mutual support tool. It helps us catch possible risks before they turn into actual issues. David may not always be right, but you can acknowledge that you heard his challenge and explain, even at a later time, why you disregarded it. Mod Page1 30 05.2 Page 30 TEAMSTEPPS 05.2 Office-Based Care Tying It All Together A good coach models all the TeamSTEPPS

principles He or she displays: Leadership Mutual Support Situational Awareness Communication This positively reinforces good behavior in mentees Mod Page1 31 05.2 Page 31 TEAMSTEPPS 05.2

Office-Based Care A Need for Coaching Watch the following video and answer the following: Mod Page1 32 05.2 Page 32 What TeamSTEPPS tools are being modeled by the coach? What skills is she using to teach the CUS tool to Nurse Larry? How could she continue to coach him after this initial encounter? TEAMSTEPPS 05.2

Office-Based Care Summary Implementation of TeamSTEPPS needs to be supported by considerate teaching and coaching. TeamSTEPPS tools may be taught to the staff and then rolled out in a leveled coursework format. Specific coaching models such as the 3 Is can be paired with TeamSTEPPS tools to reinforce what has been taught. Mod Page1 33 05.2 Page 33 TEAMSTEPPS 05.2

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