for OFFICE-BASED CARE Teaching and Coaching - PowerPoint Presentation

Slide1

for

OFFICE-BASED CARETeaching and Coaching

®

Slide2

INTRODUCTION

SAY:Welcome to the Coaching and Teaching module for TeamSTEPPS for Office-Based Care.  Coaching is a good way to foster continual development and process improvement and is vital to sustaining lasting culture change. It is an important element to include when you

fully implement TeamSTEPPS in your institution. Coaching can be both formal and informal and should be woven throughout the entire implementation, spread, and sustainment processes.

MODULE TIME:

50

minutes

MATERIALS:

“An

Issue of Time” (video) “Having an Important Discussion on a Common Issue” (video) “How to Dive Deeper” (video) “How to Coach the DESC Script” (video)“Coaching in the Moment” (video)

Slide3

OBJECTIVES

SAY:As a practice facilitator you’ll take the material you learn here

to prepare your change team members to also be coaches. It is important that you do not take on all of the coaching responsibilities alone. In fact, depending on the size of your practice you may need more than the members of your change team to be coaches.

The coaching methods covered in this toolkit are suggestions and different coaching methods can be combined successfully with different TeamSTEPPS tools.

Upon

completion of this module you will be able to:

Address teaching TeamSTEPPS tools as

part

of a coursework style approach where tools are divided into levels of

difficultyDefine the role of a coach

Identify traits and skills of effective coachesDiscuss the coaching processPractice coaching TeamSTEPPS tools individually, using the 3 I’s coaching method INSTRUCTOR NOTE:Coaches are important members of any TeamSTEPPS implementation team. The practice facilitator is a coach, but can’t handle all the coaching responsibilities alone. That is why it is important for each member of the change team to also be trained as a coach.The coach is vital for implementation, spread, and sustainability. Be sure to impart the importance of learning the basics of coaching so that individuals can be prepared to address how to coach specific TeamSTEPPS principles.

Slide4

TEACHING AND COACHING TEAMSTEPPS TOOLSSAY:

Your team will need consistent support even after the initial introduction to TeamSTEPPS that you provide. This is where coaching comes into the equation. First, it is important to consider the audience. Before coaching even begins, you might want to approach your implementation by teaching TeamSTEPPS in a gradual, leveled coursework approach. Consider it to be similar to a college, where material in one subject becomes more advanced as time goes on.

Then, when coaching, consider different coaching models to use with different key principles.The following slides will focus on teaching TeamSTEPPS as coursework. Then

we will discuss a coaching model matched with key TeamSTEPPS principles. As we progress, remember that it is important to customize your approach for your audience. Mix and

match different coaching

models

that might

work

better for you and your organization.

Slide5

100/200/300 LEVEL COURSEWORK

INSTRUCTOR NOTE:Consider using this college coursework analogy with those you are teaching. Colleges and universities break down subjects into different levels. The courses at the

100 level are for beginners while the 200- and 300

-level courses are for people who have much more experience. SAY:

Let’s

first consider the leveled coursework approach and how TeamSTEPPS can be taught

this

way.

Some TeamSTEPPS tools are basic and easy to execute and in use already at many offices around the country. These can be considered 100-level tools

. Other tools build on the skills of the 100 level examples and can be considered 200- or even 300-level tools. These upper level tools will need strong teachers and coaches to support their success.

Slide6

EXAMPLE: AN ISSUE OF TIME INSTRUCTOR

NOTE:On this slide you will lead discussion of a video. The video, called “An Issue of Time,” is part one of a multipart video that will be used in this module. SAY:Next you will watch a video that will show a common problem in medical offices—working past closing time.

  DISCUSSION:What are some of the issues that can occur if staff consistently have to work past closing time? (Possible answers include: low employee satisfaction, low patient satisfaction, and exacerbated lapses in communication because of fatigue.)

 

Slide7

100-LEVEL TEAMSTEPPS TOOLSSAY:

Examples of 100-level tools are SBAR, briefs, call-outs, and check-backs. They need very little support after initial training and are often easily grasped by team members. However, even the most basic 100-level tools will need support from coaches after they are initially used by the organization.

The success of these tools is predicated on the culture of the organization. If there is resistance of any kind either by individuals or inherently by the culture itself there will almost certainly be a need for coaching even at the 100 level.

DISCUSSION:How can team events such as Briefs, Huddles, and Debriefs help the coach grow his or her competency as a relationship manager?

Slide8

AN EXAMPLE AT WORK INSTRUCTOR

NOTE:On this slide you will lead discussion of a video. The video, called “Having an Important Discussion on a Common Issue,” is part two of the multipart video. SAY:We’ll now see how to introduce a 100-level solution to address the problem at hand in the office. Watch the video to see how

SBAR is introduced at the weekly meeting as a solution to begin addressing the problem. As a 100-level tool, SBAR doesn’t necessitate a lot of coaching support.   DISCUSSION:

Do you think SBAR, briefs, call-outs, and check-backs are all tools that can be easily accepted in your office? It is important to realize that all offices are different. Do you think that you’d consider these to be 100-level skills in your office environment?

Slide9

200-LEVEL TEAMSTEPPS TOOLSSAY:

The tools at the 200 level are more advanced and build on the skills at the 100 level. As they are more difficult to execute they may need more coaching to support. Some of these 200-level tools, such as cross-monitoring and task assistance, allow individuals

to see themselves as part of a larger whole. The 200-level tools include:HuddlesDebriefs

Handoffs (such as the I PASS the BATON tool or others)

STEP

Cross-monitoring

Task assistance

 

DISCUSSION:Why do you think briefs are considered at the 100 level but huddles and debriefs are at the 200 level?

(Possible answer: With the advent of checklists, briefs have become a more common occurrence. However, huddles and debriefs ask people to stop mid-action or converge at the end of an episode. These are less common in the culture and prone to more resistance.)

Slide10

AN EXAMPLE AT WORK

INSTRUCTOR NOTE:On this slide you will lead discussion of a video. The video, called “How to Dive Deeper: Having an Important Discussion,” is part three of the multipart video. SAY:Watch the video to see how the coach

uses a simple tool to continue addressing the problem. It is important to see that during the implementation of TeamSTEPPS, problem solving does not always have to be time consuming. 

DISCUSSION:What is the tool that the coaches in this video use to understand their problem about SBAR not being used?

(

Answer: Huddle

)

What

might have happened if the coaches didn’t have this huddle? (Possible answer: Each of them might have tried to solve the problem in a different way. SBAR implementation may have stopped

.)

Slide11

300-LEVEL TEAMSTEPPS TOOLSS

AY:The tools at the 300 level certainly necessitate coaching. They require individuals to stand up to others, ask hard questions of themselves and others, and address issues of hierarchy in their teams. These tools focus on conflict resolution and threat management. The tools at this level

include:CUSTwo-Challenge

RuleDESC script

The

video on the next slide completes the story. In it,

an individual benefits

from some “coaching in the moment” on using a 300-level tool.

Slide12

AN EXAMPLE AT WORK INSTRUCTOR

NOTE:On this slide you will lead discussion of a video. The video, called “How to Coach the DESC Script,” is part four of the multipart video.SAY:The DESC Script is a powerful conflict resolution tool. However, since it involves conflict between two

individuals, it may be daunting to attempt and is therefore considered a 300-level tool. For these

300-level tools, coaches are a necessity. Watch the following video to see how the coach helps in building a DESC script. 

DISCUSSION:

Imagine that the individual in this video came back and said that the DESC Script didn’t work because the other individual was unresponsive. How might you approach the other individual and coach him or her about DESC?

Slide13

OVERLAP OF TOOLS

SAY: The levels of the TeamSTEPPS tools are not set in stone. Often tools

can shift to different levels. It all depends on the background of the individuals and the culture of the institution. That is the most important consideration for the practice facilitator and his or her coaches to take into account when using this approach.

Slide14

TEAM STRUCTURE AND COACHING

SAY:Team structure is the foundation that TeamSTEPPS is built on. The TeamSTEPPS tools are successful only when used by all members of the team. In office-based care, the team includes not only the clinical staff, but also support staff

and administration. Patients are also an important part of the care team and can be involved in the use of particular tools such as briefs and debriefs. Coaches can and should come from all categories, except patients. Each team member should have access to a coach. Coaches are taught by and assist the practice facilitators in implementing, spreading, and sustaining

TeamSTEPPS programs.

Slide15

DEFINITIONS OF COACHINGSAY:

There are many different definitions of coaching, but the following elements are common to most coaching frameworks:Coaching involves providing guidance, feedback, and direction to improve performance.Coaching is supporting

someone in his or her efforts to achieve personal and professional goals.Coaching differs from traditional instruction because coaching takes place over a lifetime.

Whereas teaching implies an eventual end point and aims at content mastery, coaching develops in others the ability to put knowledge into practice. What I am doing now is teaching. Coaching is more interactive and supports practice transformation by encouraging information sharing and effective training.

Within

the

office-based

care setting, coaches are valuable team members who help guide the practice and staff to achieve improvements in quality, patient safety, and efficiency.

Slide16

CHARACTERISTICS OF EFFECTIVE COACHES INSTRUCTOR

NOTE: On the following slides, you will also periodically see the discussion session. This is a place that connects the coaching principles to specific TeamSTEPPS principles that have already been addressed in the Fundamentals modules. Use these as a springboard for discussion. SAY:Effective coaches

are:Competent in the skills in which they are training teammates or mentees. Are influential.

Have a strong interpersonal style.

Provide effective feedback.

Effective

coaches also listen actively and are adept at asking their mentees powerful questions to get at the heart of hidden assumptions or barriers.

DISCUSSION:

A coach in a TeamSTEPPS setting might have to probe as to why an individual feels uncomfortable in situations where he or she should use CUS.

This person may entirely understand CUS in theory but may not put it into action. Asking questions could get to the reason CUS is not being used. It may also lead to answers that point to issues with the broader culture of the

office and concerns from the individual about the hierarchy’s response to being questioned. EXERCISE:Discuss the types of questions a coach might ask to help him or her understand why someone is not using the CUS tool.

Slide17

COACHING COMPETENCIESSAY:

The skills or competencies required to be an effective office-based practice coach fall into four basic categories: Communication Relationship management

Performance improvementExecution

Having expertise in these skill areas is essential, as coaches should be able to model the behavior that those they coach will emulate.

Slide18

SAMPLE COACHING MODELSSAY:

C-FAR, the Three I’s, and PIDA are three examples of coaching models that are well suited to the office-based care environment. Although these three models differ and each has distinct strengths, they each contain in some capacity the four common coaching elements of Relationship Building, Objectives,

Action, and Review. The

C-FAR model was developed by Linda Miller, Madeleine Homan, and Scott Blanchard of the Ken Blanchard Companies. C-FAR is an acronym that stands for “Connect, Focus, Activate, and Review.”

The

“Three I’s”

model, which we will discuss more in depth in the following slides,

was developed at the Harvard School of Public Health and comprises the statements, “I saw this,” “I wonder why,” and “I think that.”

The

PIDA model is often used in the Just Culture mindset developed by David Marx and Outcome Engenuity. It is short for “Perceive, Interpret, Decide, and Act.”

Slide19

THE 3 I’sSAY

:The 3 I’s is one of the coaching models we will focus on in this module. The I’s stand for:I SAW THIS: Lay the groundwork for the coaching based on what the coach witnessed firsthand

.I WONDER WHY: Question the reasoning for what is done and approach it as a puzzle to be solved together

.I THINK THAT: Provide a solution that addresses not only the issue at hand but also the knowledge or attitudes that lead to the issue.

Slide20

USING THE 3 I’s SAY:

The importance of the 3 I’s is that it puts the onus on the coach. By not using “you” statements the coach creates a safe environment. The coach does not judge or create a situation where the individual has to guess at what the coach is thinking. The coach is straightforward and provides a possible solution. This solution is only “possible”—a hypothesis to be tested. This opens up a field where the coach and

the individual being coached can work together toward a solution. DISCUSSION:Effective use of the 3 I’s coaching method can be considered an opportunity for modeling the DESC script tool found in the Mutual Support module of TeamSTEPPS. DESC can be difficult for individuals to use by its very nature as a conflict resolution tool. However, the 3 I’s model shares many similarities with DESC and using

it as the need arises can help others become more comfortable with the activities prescribed by it and therefore more likely to use it to resolve conflict.

Ask

how the DESC script tool might mirror the

3 I’s

.

Possible answers include: “I saw this” reflects the

Describe phase of DESC. “I wonder why” encompasses the Express phase.

“I think that” is similar to Suggest and Consequences as the third “I” provides both a solution and an understanding of the effect of the actions on other goals and team members.

Slide21

COACHING LEADERSHIP TOOLSSAY:

All coaches are leaders whether or not they are officially in a leadership role. They are leaders because they have the opportunity to influence the behavior of others—even when not coaching. Individuals look up to their coaches. By the very act of using leadership tools, coaches are coaching by example. However, coaches can also officially coach the leadership tools (briefs, huddles, and debriefs).

Slide22

COACHING DEBRIEFS USING THE 3 I’s SAY:

The 3 I’s (I saw this, I wonder why, and I think that) is an excellent tool for coaching individuals in how to perform a proper debrief. The coach can observe a debrief without being obtrusive. This is especially the case if the coach is the member of the same care team with the individual. Then, they can discuss the effectiveness of a debrief

using the 3 I’s method. The coach can lead by example by discussing the individual’s debrief while using the debriefing tool itself.

  DISCUSSION:How would you use the 3 I’s to coach a team who just had a debrief that skipped the step to discuss whether workload was equitable?

Continued…

Slide23

COACHING DEBRIEFS USING THE 3 I’s INSTRUCTOR NOTE:

Give participants a few minutes to give examples;, then provide the sample answer.(Possible answer:

I saw that the team skipped the step to discuss whether the workload was equitable during the previous shift.

I wonder if that is because individuals are uncomfortable bringing up complaints about their workload

.

I think

that if we

approach

the debrief as a nonjudgmental period of trust and truth telling, people should

be comfortable bringing up issues with the workload. I also think that mutual support is a useful

TeamSTEPPS principle that we should use to support ourselves if we have workload issues.)

Slide24

COACHING COMMUNICATION TOOLSSAY:

Communication is inherent in coaching. A coach needs to do more than talk; a coach needs to listen as well. The coaching models presented in this module are predicated on communication as the key component.Approaching an individual “in the moment” to address use of these tools is effective. The

TeamSTEPPS communication tools are:SBARCheck-back

Handoffs (including I PASS THE BATON)

Slide25

COACHING SBAR “IN THE MOMENT”SAY:

Coaching stems from the coach having firsthand knowledge of the situation. He or she can provide immediate feedback to the individual. Coaching in the moment is also a coaching model that does not require any training as the other models do. Anyone can use coaching in the moment if they notice a tool omitted or used incorrectly.If, for example, a nurse goes to a physician’s assistant to provide an update and doesn’t use SBAR, the PA can use the moment to help the nurse build

an SBAR based on the information. There may not be an official coaching relationship between the PA and the nurse, but the real-time coaching can help both of them come to a shared mental model.

DISCUSSION:What are some other times that you unofficially “coach in the moment” already in your daily lives? Is it effective or ineffective?

Slide26

COACHING SITUATION MONITORING TOOLSSAY:

A coach can model the situation monitoring tools in his or her daily work. A good coach constantly monitors the situation to make sure that the team is using the TeamSTEPPS tools. By monitoring the situation and helping the team come to a shared mental model on using the TeamSTEPPS tools, the coach effectively models the correct situation monitoring process

.It is important for the coach to help individuals translate the situation monitoring process, cross-monitoring

, and STEP into their daily routine. While monitoring the actions of others is important to the success of the whole team, it is just as important that the coach explain that “watching each other’s back” might sometimes be construed as “being a busybody.”

Therefore,

the coach must ensure everyone understands that the purpose of these tools is to help everyone work

toward

eliminating error and not to “get in each other’s business.”

Slide27

COACHING SITUATIONAL AWARENESS USING THE 3 I’s

SAY:Consider Emily, a team member who may not exhibit very good situational awareness. This individual seems to “walk in a cloud” and not have any idea of what is going on around her. In one situation she walked past a very crowded waiting room and said innocently (but

too loudly) to her coworker at the front desk, “These people are going to wait forever! Glad my shift is done and I can get out of this chaos!”

DISCUSSION:How would you use the 3 I’s to coach Emily to have more situational awareness?

Slide28

COACHING SITUATIONAL AWARENESS USING THE 3 I’s

INSTRUCTOR NOTE: Give participants a few minutes to give examples, then provide the sample answer.(Possible answer: I saw that you seemed

unaware of the crowded waiting room and that you announced in front of the patients that you were glad to be leaving the chaotic office.

I wonder if that is because you didn’t realize that the patients could hear you and that it would affect their

experience

.

I

think

that in the future you could use situation monitoring to become aware of stress levels among team members and patients. While it was entirely acceptable for you to leave at the

end of the shift, it would be better to not announce you are leaving and make a joke that could harm team morale.)

Slide29

COACHING MUTUAL SUPPORT TOOLSSAY:

Coaching itself is a form of mutual support. Coaches give individuals the tools to better do their work and, as the tools are used, the entire team becomes stronger. Coaches can reinforce the tools they are coaching by modeling the tools. The mutual support tools directly affect the culture of an organization.

They are not only about bettering communication, but also about breaking down any perceived hierarchies on a team. This, of course, can cause serious issues within a team or organization if not everyone is sharing the same mental model. These tools need to be used

properly and it is a coach’s job to support that after the initial education on them. The mutual support tools are:Task assistance

Feedback

Advocacy and assertion

Two-Challenge Rule

CUS

DESC script

Collaboration

Slide30

COACHING THE TWO-CHALLENGE RULE USING 3 I’sSAY:

All coaching models allow coaches to support others. The 3 I’s model especially allows the coach to create a comfortable and safe environment for the individual. This is essential when coaching the mutual support tools as they are sometimes used to challenge the others within the team

.Consider the following situation:You see Barbara disregard David’s use of the two-challenge rule. You take David aside and learn that whenever he uses the two-challenge rule with Barbara, his superior, she continues to disregard what he says.

DISCUSSION:

How would you use the 3 I’s to coach Barbara in this situation?

Slide31

INSTRUCTOR NOTE: Give participants a few minutes to give examples, then provide the sample answer.(Possible answer:

I saw that you disregarded the two-challenge rule when David used it with you earlier. After speaking with David, I learned this was not an isolated case.

I wonder if you do not use the two-challenge rule with David because you are his superior and have been at nursing much longer

than he has. I think that the two-challenge rule is a useful mutual support

tool

. It helps us catch possible risks before they turn into

actual issues.

David may not always be right, but you can

acknowledge that you heard his challenge and explain, even at a later time, why you disregarded it.)

COACHING THE TWO-CHALLENGE RULE USING 3 I’s

Slide32

TYING IT ALL TOGETHERSAY:

Coaches should model the behaviors that they coach. For a TeamSTEPPS implementation to work, the coach needs to be a champion of the implementation and will most likely serve on the change team. You as the Practice Facilitator cannot always be present, and the training you provide will certainly need reinforcement regardless of the level of difficulty of the tool. Many coaching tools can work for coaching any of the TeamSTEPPS tools. It is important that the coach choose the right tool for the right person and the right moment. This is

why the coach’s fostering of the personal relationship with the individual is vital.

Slide33

A NEED FOR COACHING

INSTUCTOR NOTE:Watch the video “Coaching in the Moment.”  DISCUSS:Watch the video about the unfortunate occurrence between Nurse Larry and Dr. Saleb. Then answer the following questions.

What TeamSTEPPS tools are being modeled by the coach? (Possible answers: Situational awareness, mutual support, huddle)What skills is she using to teach the CUS tool to Nurse Larry? (Possible answers: Coaching in the moment)How could she continue to coach him after this initial encounter?

(Possible answer: By checking in with Larry and using one of the other coaching tools such as 3 I’s

or C-FAR. She could also coach

Larry

in the use of the DESC script.)

Slide34

SUMMARYSAY:

In summary, implementation of TeamSTEPPS needs to be supported by considerate teaching and coaching. Coaches should be members of each specific team in the office. They can be useful in rolling out TeamSTEPPS tools to the staff. A leveled coursework format of 100-, 200-, and 300-level tools is one way to approach this rollout.

Specific coaching models, such as the 3 I’s, can be paired with TeamSTEPPS tools to reinforce what has been taught and rolled out in the organization.