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Mobile Infirmary Healthcare

Comments and Observations from 6 Month Feedback Session with the Mobile Infirmary Health Care Professionals that We Trained Last July

Background

This was a beta test of our latest hands-on Healthcare Training. Training schedule was an 8 hour agenda:

  • Opening Keynote: Introducing the Flawless Execution Model and its relevance to healthcare. 1 hour
  • Mission Planning Exercise: Military Themed exercise that introduced vernacular, set the stage to discuss collaboration, teamwork and collaboration; and finally was the case study to demonstrate the Stealth Debriefing. 2 hours
  • Introduction to the Six Steps of Mission Planning and implementation in the Daily Healthcare Environment: Used medical (Med Surg Unit Typical) case study vignettes as a platform to implement a Daily Plan. 2 hours
  • Execution Keynote: Becoming a LOCKED ON Team. Focus on tools for leadership, communication and teamwork that apply to the small high performing team. 1 hour
  • Introduction to the STEALTH℠ Debriefing Model: Used medical (Med Surg Unit Typical) case study vignettes as a platform to implement the STEALTH℠ debriefing process. 2 hours

Training Goal

Create High Performing small teams through the implementation of a Daily Plan, Briefing, and Debriefing. The concept is that a team that starts the day with a plan to deal with the overarching team issues of the day, briefs the team on the plan, and, at the end of the cycle conducts a short debrief that captures areas for improvement; will fundamentally be a better and more successful team.

Debriefing

On Apr 20, 2010 we conducted a debriefing that looked back on the training with a focus on what is still working after 6 months and what team dynamics have been impacted. These are some of the comments recorded:

  • Daily plan is used every day; it is developed at the beginning of the shift and posted in the Nurse Lounge. Debriefings are accomplished on an as-required basis. This process and knowledge has improved the team's performance. (Med Sur Unit)
  • Daily plan is developed and posted on a white board. Additionally the Mission Planning process is used to solve unexpected issues as they are identified.
  • The "Patient Fall Team" routinely uses the STEALTH℠ model to conduct the debriefing of a fall event. "It fits so well" and has in fact been adopted system wide as the standard.
  • Critical Care Unit: "We tried to implement the daily plan but found that our day was so unpredictable that we stopped trying, we felt unsuccessful in the planning effort" However the Flawless Execution vernacular is still used to for ad hoc collaboration as events occur. It is a "natural fit." ( I believe they are missing the true value of the daily plan: it is designed to take care of the known's so that they have more energy and are more prepared to deal with the contingencies' that arise in the day. The daily debrief should look back and ask: "how could we have been better prepared for our actual day" ; this cycle creates better daily plans, better team outcomes and a constantly improving process)
  • The "Code Blue" and "Stroke Teams" are using the STEALTH℠ debriefing process to determine how they could improve. The member stated that: "it is amazing that as we have created a culture of debriefing, new and less assertive members of the team are speaking up more and bringing their ideas to the operation." This thought that the process improves team communication, collaboration and general teamwork was highlighted in several discussions.
  • Pulmonary group is routinely debriefing their performance.
  • The overall culture has adopted an attitude: "when something is wrong, we stop and debrief, and then fix the problem."
  • Labor and Delivery. Routinely debrief, to include a focus on positive outcomes.
  • Surgery Units: "more involvement in the room- strong interaction with doctors." "Members are more assertive, closing the loop."
  • Clinical Coordinators: "see staff bring up areas and saying: "can we do better?"
  • Nurse Assistants: Less experienced employees are more willing to step up and get involved. Creates almost a "reward" environment.
  • Personal Story: "My father was a patient in the unit, he fell, it was not the teams fault, but I was very concerned about his future safety. After watching the "Fall Team" debrief the event and act on Lessons Learned, I was totally at ease and confident that he would be kept safe in the remainder of his hospitalization."

Conclusion

This quick review highlights very positive improvement to the team dynamics. The question regarding the length of the training is always under consideration. I think we can reduce the program to 4 hours and still obtain positive results... But it will be a fast 4 hours!