Peer Coaching:Teamwork and Communication

Gateway to a Culture of Patient Safety!

Situational LeadersAny team member who has the skills to manage the situation

“The principle role of a Situational Leader is to mobilizeand support the Situational Awareness of the team.”

James Reason, 1990

Innovation is difficult when……

OR Critical Events….

Uncommon

Life threatening

Situational leadership

Teamwork and Communication

Simulation

IH Massive Hemorrhage Protocol

Clinical Designate Role

Clearly articulated job description

Facilitate situational awareness

Improve communication and teamwork

Ziewacs, J et al; J. Am Coll. Surg., 2011; 213:212-219

Objectives……

…share the knowledge

…standardize the approach

…improve communication

…improve teamwork

…improve outcomes

Simulations

Power Distance Index

The higher the power distance in a culture, the less likely those in subordinate roles will question the actions or directions of individuals in authority.

“Power distance is the extent to which the less powerful members of organizations and institutions accept and expect that power is distributed unequally.”

Geert Hofstede’s Power Distance Index

www.Clearlycultural.com

Questions to ask yourself?

• Are you aware of how others react to you?

• Do they start or stop talking when you enter the room?

• Do you feel you cannot talk to higher levels in the organization without permission.

• Does your organization encourage the use of titles and position

Patient prepped and drapedfor Right THA.

Surgeon technically excellent,but ‘grumpy’ with history of‘abusive’ behavior.

In the midst of the ‘timeout’…

Communication

Approaches• Command

• Team Obligation Statement

• Team Suggestion

• Query

• Preference

• Hint

Slide courtesy of Ron Collins, 2014

Hint

• Is intended to be very general. A hint does not have any personal reflection or engagement in it; it is not a personal statement! Think “insinuation, innuendo, pointer, whisper….”

For example: “It would be nice to get through the day without making any mistakes.”

Preference

• A weakly stated request that recognizes that several options exist. The person stating the preference does take personal ownership of their idea or request, but it lacks a really strong stance.

For example: “I wish I was in another OR right now!”

Query

• A query is a question to draw other’s attention to a situation without being very direct. The person asking the question is weakly attempting to raise the situational awareness of the rest of the team by calling into question the validity or accuracy of an emerging situation.

For example: “Is that the correct X-Ray?”

Team Suggestion

• Elevates the personal statement of one member of the team to engage the situational awareness of the rest of the team. It may be couched as a personal statement, but it clearly raises the comment to the level of the team; look for ‘we’! The suggestion is not a command and does not suggest an obligation to act: it is only raising awareness.

For example: “Can we check the X-Ray please?”

Team Obligation Statement

• A team obligation statement is a strong call to mobilize the situational awareness of the team. It involves a ‘we’ but includes a ‘must’ or a ‘should’ as well.

For example: “Before we go any further, we need to verify which side this patient has consented to.”

Command

• A command is the highest form of one member of a team raising the situational awareness of the team. It is an imperative to either act or to not act due to impending harm.

For example: “Stop! We are about to make a mistake that will harm this patient

Peer coaching

Get into groups of 4.

One person will be an observer and providing feedback at the end.

One person will role play the “person” who walked into the room.

One person will role play the “surgeon”.

One person is another team member in the room.

You walk into the OR as the patient is being prepped. The surgeon has just finished putting the tourniquet on the patient’s right leg. You notice the patient’s left knee is marked by the surgeon.

Things you could say…

The observer’s role is to

• What are you looking for?

• What do you see?

• What did you hear?

• Was there a power distance index?

• What was the environment like?

• What assumptions have you made?

Who are “you”?

• One person will role play the “person” who walked into the room. The other team member will select another role.– Medical student

– OR nurse

– Surgeon colleague

– An anesthesiologist

– Quality and safety specialist

– Administrator

– Someone else…

You walk into the OR as the patient is being prepped. The surgeon has just finished putting the tourniquet on the patient’s right leg. You notice the patient’s left knee is marked by the surgeon.

Things you could say…

Things you could say…

Team obligation statements:

“Before we go any further, we need to verify which side this patient has consented to.”

• Resident

• Senior Surgeon

• Nurse

Debrief

• What did you observe?

• What went well?

• What could have gone better?

• Was communication clear?

You are observing (sort of eavesdropping) on a conversation between a co-worker clinician and a patient who has been discharged to go home. The patient appears overwhelmed by the instructions provided and your colleague doesn’t appear to notice.

Things you could say…

Debrief

• What did you observe?

• What went well?

• What could have gone better?

• Was communication clear?

You go into the OR and notice the anesthesiologist has a bunch of medications laid out for the procedure but they are not labeled. You are concerned about the patient safety issues related to this.

Things you could say…

Debrief

• What did you observe?

• What went well?

• What could have gone better?

• Was communication clear?

The surgeon and anesthesiologist will not talk to each other in the OR. They are only communicating through the circulating nurse.

Things you could say……

Support Options for BC Teams

Allison Muniakamuniak@bcpsqc.ca