AHRQ Grant Update

Physicians Insurance is partnering with the University of Washington and participating hospitals and clinics on a three-year demonstration project, designed to improve communication to prevent adverse events and to communicate more effectively when events occur. The project is funded by the Agency for Healthcare Quality and Research (AHRQ).

Avoiding Adverse Events Through Better Communication and Teamwork
When an adverse event occurs in the health care setting, people may assume it’s because of a lack of clinical knowledge or skill. But to the contrary, several studies show that most are the result of poor communication or teamwork.

“Communication is a major contributor to 60 percent or more of all health care errors according to the Joint Commission,” says Sarah Shannon, PhD, RN, who is leading the communication training core for the AHRQ demonstration project.

That’s why communication training is a major part of the AHRQ demonstration project. A key component of the curriculum that’s being used is called TeamSTEPPS.

William Hurley, MD, an emergency physician at Seattle’s Harborview Medical Center, co-teaches the curriculum to our partner hospitals along with other University of Washington (UW) faculty. He helped develop the precursor program for TeamSTEPPS in the 1980s. Adapted from the aviation industry, it focuses on teamwork and communication as drivers of patient safety. The training is intended for interprofessional teams of physicians, nurses, pharmacists, medical assistants, and other team members.

“TeamSTEPPS makes communication intentional and focused on safety,” says Dr. Shannon, an associate professor at the UW School of Nursing. “It also addresses the conflicts that can occur among teams in providing care.”

Clinicians learn to call out their concerns in the health setting and ask for briefs and huddles to plan care and solve problems. Many teams struggle because some clinicians aren’t comfortable speaking up, so members learn standard language to express their concerns. Participants learn how to be active team leaders and team members, and to move between these roles when necessary.

Dr. Shannon goes on to mention, “Our project will supplement TeamSTEPPS with additional tools to deal with the entrenched conflicts that can go on for years, helping clinicians to reopen communication.”
Conflicts may typically exist among nurses or physicians, between specialties, or between members of a health care team with a rigid hierarchy.

Tackling honest mistakes and “undiscussables”
In 2005, the study Silence Kills: The Seven Crucial Conversations for Healthcare defined two types of errors. The first are “honest mistakes” where—for example—someone might say the wrong order or an error occurs because of poor handwriting. “These are somewhat inevitable and we do our best to correct them through tools like checklists, protocols, and automated systems,” says Dr. Shannon.

Then there are the “undiscussables.” Examples might involve a clinician witnessing a mistake and not speaking up, or a team taking a dangerous shortcut. It might involve disrespect amongst clinicians or overloading a colleague without seeking help. TeamSTEPPS can help address both types of errors, but the additional conflict training is intended to help with the “undiscussables.”

Providence Everett kicks off training
Providence Everett Medical Center was the first AHRQ partner hospital to get its training under way this spring. Providence Everett sent 10 health care professionals for Master TeamSTEPPS training at the UW’s Institute for Simulation and Interprofessional Studies. UW faculty came to Providence for a Grand Rounds targeted to emergency-department physicians, administrators, and nurses.

Every partner hospital will customize its incorporation of the project to improve team communication to focus on a specific service line.

A glimpse of the future
While this demonstration trains physicians, nurses, and other clinicians already in the field, training for students is already becoming the norm.

“Communication and teamwork are skills that some physicians develop over time while others have never recognized the need. We didn’t learn it in medical school,” says Dr. Hurley. “However, today at the UW, medical, nursing, and pharmacy students are trained together. I encourage physicians to open their minds, study the literature, and embrace the opportunity to learn something different. We have a real opportunity to lead and promote safety for our patients.”