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The Tools

Tools for Effective Teams


If you have read the section on "Basics and Behaviors," you understand the basics of See It, Say It, Fix It.  Now we will discuss the "tools" used by HROs to coordinate action and communicate precisely.  We will also illustrate a few of these tools with examples that were modified for healthcare teams.

SEE IT

Sharing the Mental Model begins with the planning process.  Ideally, team members would plan a shift, procedure, or set of procedures as an integrated team.  In reality, we seldom have the resources to make that happen.  Planning for a cardiac catheterizaton, for instance, begins with a physician's examination of a patient and identification of tests that help him or her make a diagnosis.  He or she may then present the case to a broader team of experts at a service specific planning conference (ex: cardiac cath conference).  Meanwhile, professional staff in the cath lab prepare the facility according to a standard set up (preference cards) designed to support specific procedures. 

Checklists.  Checklists consist of a standardized list of events to be executed by a given stage in a process.  Pilots typically "pre-flight" their aircraft before taking their place in the cockpit. 

Briefing.  A pre-procedural briefing can be used effectively to bring the team together one last time to review the planning. 

SEE IT


SEE IT

Sharing the Mental Model begins with the planning process.  Ideally, team members would plan a shift, procedure, or set of procedures as an integrated team.  In reality, we seldom have the resources to make that happen.  Planning for a cardiac catheterizaton, for instance, begins with a physician's examination of a patient and identification of tests that help him or her make a diagnosis.  He or she may then present the case to a broader team of experts at a service specific planning conference (ex: cardiac cath conference).  Meanwhile, professional staff in the cath lab prepare the facility according to a standard set up (preference cards) designed to support specific procedures. 

Briefings - Briefings are designed to share a mental model of what is about to happen with all team members.  They are typically standardized, scripted, and very brief.  There should be an opportunity to ask questions.

Huddles.

Checklists - Checklists are designed to standardize certain baseline functions.  They are good tools for room and instrument set up, patient preparation and assessments.  A single checklist can be designed to serve as an orientation tool, a daily procedure and an emergency checklist. 

Red Flags.  One effective method for team identification of potential adverse events is for the team to agree upon a basic set of Red Flag indicators.  Two examples might include a) conflicting inputs and 2) violation of procedures.   Some units have established physiological parameters as Red Flags, such as blood pressures or oxygen saturations exceeding certain limits.  Effective teams ensure that all team members are trained on recognition of Red Flags.

Say It


SAY-IT
.  In addition to sharing the mental model and identifying potentially adverse events, good team learn to communicate concisely and precisely.  These teams learn to avoid the "hint and hope" method of talking around an issue (ex: "Are you sure you want to do that?").  While effective teams know how to address routine issues, they learn different techniques for calling attention to more critical needs.  They also learn how to handle these situations in an escalating fashion.

Relay Information.  The lowest level of communicating a potentially adverse event is simply relaying information.  "Doctor, the blood pressure is continuing to drop."

Add "Check" to input.  The next level of adding emphasis to a statement.  "Doctor, check the blood pressure."

Use Assertive Statement.  A more formalized statement of urgency.  Designed to get the attention of a specific person and to ensure that action is taken to stop progress of a potentially adverse situation.   A effective Assertive Statement is designed to address a critical deviation from the shared mental model in a timely manner, while avoiding defensiveness from any team member.  The assertive statement looks like this:

Get someone's attention.  Do so by identifying the person by name.  "Doctor Jones...

Express personal concern.  A good expression of personal concern is to say "...I am concerned."  The purpose of this statement is to reflect the concern on you and avoid defensiveness by another team member.

Objectively State the Problem.  Now that you have someone's attention, objectively state what you see... "...blood pressure is now 72 over unreadable."  Try to not make this a statement of judgment such as, "... the blood pressure is way too low!"

Recommend a solution.  Now it is time to recommend a solution in order to ensure that the message has been received and that the team members are engaged in fixing the problem.   It is best to state this as a "we statement."

Let's try to put this together.  Here is what the statement might sound like:

"Doctor Jones, I am concerned.  The blood pressure is now 72 over unreadable.  I recommend that we stabilize blood pressure before proceeding."