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Teamwork Data
Armstrong Institute for Patient Safety and Quality
Presented by: Heather Halvorson, MD; Nana Khunlertkit, PhD; Ayse Gurses, PhD
© The Johns Hopkins University and The Johns
Hopkins Health System Corporation, 2011
Goals
• Thinking about keeping patients safe during
entire episode of inpatient care
• Increased cross-unit interactions would
encourage shared goals and problem-solving
with respect to quality and safety issues/
initiatives across units within a hospital
• Improved understanding and interactions
across units within a hospital
Toolkit
3
Armstrong Institute for Patient Safety and Quality
Teamwork Across Units Activity
Methods
• Collected from Teamwork Across Units Activity
– May 24, 2012 face-to-face meeting
• Performed analysis of prioritized needs
• Included ‘triangle’ and ‘circle’ needs
– Coded and analyzed coded data for themes
– Coded prioritized needs into themes
– Analyzed the coded data
Teamwork Across Units Activity
Results
• Total of 399 needs reported
– ‘What do they need from my unit?’ = 225
– ‘What do I need from them?’ = 168
– Across unit needs = 6
• Total of 59 needs prioritized
–
–
–
–
‘Challenging to meet’ / ‘Most frequently not met’
‘What do they need from my unit?’ = 28
‘What do I need from them?’ = 30
Across Units = 1
• 10 Barrier Themes defined
Teamwork Across Units Activity
Results
Teamwork Across Units Activity
Results
Teamwork Across Units Activity
Results - Barrier Themes
8
Armstrong Institute for Patient Safety and Quality
Teamwork Across Units Activity
Barrier Themes, cont.
9
Armstrong Institute for Patient Safety and Quality
Teamwork Across Units Activity
Barrier Themes, cont.
10
Armstrong Institute for Patient Safety and Quality
Teamwork Across Units Activity
Results
Teamwork Across Units Activity
Results
Teamwork Across Units Activity
Results
Teamwork Across Units Activity
Results
Teamwork Across Units Activity
Results
Teamwork Across Units Activity
Results
Teamwork Across Units Activity
Results
Teamwork Across Units Activity
Results
Teamwork Across Units Activity
Results - Summary
• Who identified the prioritized needs?
– ~ 35% reported by one site
– ~ 40% reported by ICU
• What was reported?
– 10 barriers themes identified
– Variation in barrier themes between units and sites
• Top three – all units
– Delay in care
– Variation in care process
– Lack of standard communication
Teamwork Across Units Activity
Results - Summary
– ICU:
• delay in care, lack of standardized
communication, barriers to team work
– Floor:
• delay in care, lack of standardized
communication, variation in care process
– OR:
• variation in care process
– Prep/Recovery:
• lack of shared patient information, variation in
care
Teamwork Across Units Activity
Results - Summary
• Barrier theme arising from:
Responding Unit
What they need
from my unit
What I need from
them
All
48%
52%
ICU
58%
42%
Floor
57%
43%
OR
27%
73%
Prep/Recovery
33%
67%
Teamwork Across Units Activity
Results - Summary
• ‘What they need from my unit’
–
–
–
–
Delay in care
Lack of standard communication
Variation of care process
Barriers to teamwork
• ‘What I need from them’
– Variation in care
– Delay in care
– Lack of shared patient information
Teamwork Across Units Activity
Recommendations / Strategies
• Review site specific results with team
– Review barrier themes for each unit
– Prioritize barriers
• Impact on care, impact on teamwork, ease of
solution, team buy-in/ownership
– Solicit team recommendations to address
identified barriers
• Repeat exercise with additional staff
Results of Teamwork Data Analysis
Recommendations / Strategies
• Barrier Theme: delay in care
– Identify reported causes
• Staffing? Equipment? Space? Medications?
– Evaluate organizational/cultural factors
• Barrier theme: variation in care
– Search for source of variation
– Is a standardized process in place and not being
adhered to?
– Is an acceptable standard process available that
can be implemented?
– Evaluate organizational/cultural factors
Results of Teamwork Data Analysis
Recommendations / Strategies
• Barrier Theme: lack of standardized communication
– Is a standardized tool / process in place and not
being adhered to?
– Is an acceptable tool available that can be
implemented?
• Checklists, forms, communication technique
– Can an acceptable tool be developed to that
supports needs of involved units?
– Evaluate for organizational/cultural factors
• Share lessons learned
Discussion about the tool
• Usage of the tool back at the unit
• Usability of the tool
– Barriers
– Improvements
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Armstrong Institute for Patient Safety and Quality