TeamSTEPPS® Primary Care Module

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Slide 1

TeamSTEPPS® Primary Care Module

Richard Ricciardi, PhD, NP
Agency for Healthcare Research and Quality
Center for Primary Care, Prevention and Clinical Partnerships

Slide 2

Acknowledgement

Deborah A. Milne, RN MPA
American Institutes for Research

Slide 3

First Step

• Convened Technical Expert Panel (TEP) December 2010
  • Representatives from AHRQ and DoD.
  • Experts in primary care and quality improvement.
  • Interprofessional primary health care providers.

Slide 4

Laying the Groundwork

• Defined the "team."
• Identified the "system."
• Evaluated the challenges.
• Decided areas of focus.

Slide 5

Primary Care Office (PCO) Team

• Technical Expert Panel defined the scope of "team" for purpose of this project
  • Focus of the project was intended to be on optimizing teamwork within the medical office.
  • Caveat - it was noted that external care coordination is of extreme importance for future work.

Slide 6

Primary Care Team Structure

Image: Pairs of green arrows pointing in opposite directions form a circle. At the top of the circle is a penguin in a white medical coat with the caption "Clinicians." On the right-hand side of the circle are two penguins, one in a pink shirt and the other carrying a clipboard, captioned "Clinical Support Staff". On the bottom of the circle are two penguins in white coats examining an X-ray, captioned "Ancillary Support Staff". On the left-hand side of the circle is a penguin sitting at a desk and working at a computer, captioned "Administrative Staff". At the center of the circle, connected to each of these staff penguins by double green arrows, are a pair of penguins, one large and one small, captioned "Patients."

Slide 7

Primary Care Office Environment

Image: A team of penguins are working in an office environment made out of snow and blocks of ice.

Slide 8

Some of the Inputs

• Patient phone calls/Emails.
• Scheduling.
• Medication refills.
• Interruption of patient flow.
• Walk-ins, lab results.
• Formulary questions.
• Missed appointments.
• Population data management.
• Information from insurers.
• Urgent appointments.
• Calls from consultants/external providers.
• Personnel transitions.

Slide 9

Challenges to Teamwork in Primary Care Offices

• Quality Measures (Process and Outcome).
• Standardization.
• Definitions.
• Role Ambiguity.
• Non-linear work flow.
• Assumptions/Habits/Change.

Slide 10

Curriculum Training Structure

• When training teams to implement TeamSTEPPS:
  • Developed to be taught in conjunction with TeamSTEPPS Essentials.

OR

• When training Master Trainers:
  • To be taught as an addition to TeamSTEPPS Fundamentals.

Slide 11

Next Steps

• Literature review.
• Curriculum design guide development.
• Developed draft curriculum slides and instructor guide.
• Begin preliminary scripts for video vignettes:
  • We asked all TEP members to send us brief "stories" that represented actual scenarios they had experienced.

Slide 12

Field Testing

• Two sites.
• TeamSTEPPS essentials followed by Primary Care Office Module.
• Data collection.

Slide 13

Highlights of Field Testing Focus Groups

• "What parts of the module are most relevant to primary care?"
  • Patient advocacy and communication.
  • Conflict resolution.
  • Situation monitoring.
  • Debriefing.

Slide 14

Highlights of Field Testing Focus Groups

• "What improvements could be made to the module?" More emphasis on roles of non-clinical staff in the care team. More case-based scenarios, especially across team roles.

  Non clinical staff felt that they often had important information to communicate but no process to do so

  Quote: "Little bits that you don't automatically put into the records as a formal thing are so important."

• Resulting module change:
  • Included 4 scenarios in module that emphasize non-clinical staff.

Slide 15

Highlights, cont...

• "What parts of the module do not make sense?"
  • Definitions of "Huddles" and "Briefs" conflicts with NCQA Primary Care Medical Home (PCMH) language.

  Quote: "PCMH designates the TeamSTEPPS Brief as a Huddle. We all need to know what we mean in terms of what we're doing."

• Resulting module change:
  • More emphasis on flexibility/customizability throughout the curriculum, as long as each team member shares the same mental model.

Slide 16

Video Production

• Scenario video production—4 paired scenarios (right way and wrong way)
  • Script changes influenced by field testing results.
  • Each based on an actual event.
  • Leadership, Communication, Mutual Support, Situation Monitoring.

Slide 17

Leadership in the Primary Care Medical Office

Let's watch the primary care team demonstrate proper team leadership.

Image: A woman is working at a computer at a reception desk; a man is working at another desk in the background.

Slide 18

Questions?