WAS I DREAMING? PART TWO

TEAMLast week, I attended the second and last part of the TeamStepps workshop. In another post (“Was I Dreaming?”) I described the first workshop and my surprise at how the doctors willingly and enthusiastically participated in the dialogue and group activities. What would I find this time around?

TeamStepps is a program that promotes teamwork and teaches “team strategies and tools to enhance performance and patient safety.” The audience was a group of professionals who worked in the surgical area of a large teaching hospital. I volunteer at the hospital and attended as an observer, although I did participate in some of the exercises.

The first thing I noticed when I entered the room was the empty chairs at each of the four tables. After we finished with introductions, it was clear most of the absentees were doctors/surgeons. I felt disappointed. Was their eager involvement at the last meeting just a charade?

This seminar was pivotal for implementing TeamStepps. The group in attendance—nurses, OR techs, surgeons, anesthesiologists—were to be the “coaches” who would model effective team work and help “change the culture” of the hospital. The leaders of the workshop, two doctors and four nurses, were poised to teach how to be an effective coach. Furthermore, there had been homework. Each table had been given a “discussion question” at the end of the last meeting with the expectation that the group would present a three to five minute demonstration. The occupants at my table included two nurses, one OR tech and an orthopedic surgeon who was preoccupied with the open laptop in front of him. I had already excused myself from participating in the skit.

When time came for the demonstrations to begin, those at my table seemed to be looking at the question for the first time. The other three groups appeared to be scrambling also. In the meantime, some doctors had slowly been slipping into their seats. Two appeared at our table and joined the activity. The surgeon at the end of the table had closed his laptop. Unbelievably, to me, each group, in turn, stood in front of the room and showed, as instructed, the right and wrong way to address their question.

(Our table was to communicate how the team would handle a situation when a necessary piece of surgical equipment fell to the floor and was contaminated).

In the skits, the surgeons played nurses, the nurses played doctors, OR techs were the anesthesiologists. The shows prompted much laughter and recognition of obnoxious and unprofessional behavior in the “wrong way” skit and applause for “right way” team interaction.

For the remainder of the meeting the leaders introduced peer-to-peer feedback, not easily understood by some of the surgeons who saw themselves as designated leaders and superiors and staff as subordinates. The coordinators, especially the nursing coordinators, gently suggested that the team was made up of peers regardless of occupational titles.

Like the first TeamStepps session, I was impressed with the positive vibes and enthusiasm from the audience. My world of hierarchical structure and deference paid to the medical staff was changing. I believe that this change in culture will bring a safer patient environment.

On the last page of the handout this statement stood out:

Important that staff realize this is not a passing phase—it is our model for patient safety moving forward.

 I think this model will indeed move forward at this hospital even though the ride may be a bit bumpy.

WAS I DREAMING?

I have been a nurse for eons. Sometimes I feel I go back to Flo’s era. Even though I have been retired for ten years, I try to keep current with nursing/health issues. One evening two weeks ago I attended a TeamStepps workshop sponsored by the large teaching hospital where I volunteer. The purpose of the seminar was to promote teamwork among the hospital staff to ensure patient safety. As a member of an advisory committee, I was encouraged to attend in order to learn about new initiatives at the hospital. I walked out of the workshop four hours later wondering if I had dreamt the whole scenario.

There were about 50 folks in attendance. I approached my assigned table where one woman was seated, a nurse who worked in the operating room. Attendance was mandatory, she told me. She was paid for her time. A few minutes later a skinny guy in scrubs plopped down next to me and said, “What the hell is this all about?” I answered his question by introducing myself. He was an orthopedic surgeon, as were two other men who later joined our table.

Would any of the three last the whole four-hour session? I braced myself for a lot of muttering and antisocial behavior. In my biased mind, orthopedic surgeons stand out as the most paternalistic of all the medical specialists.

A second nurse and a cardiologist rounded out our group.

After we finished introducing ourselves, I realized most worked in surgical areas (The cardiologist inserted stents, a surgical procedure that he performed in the OR).

What followed was not what I expected. The main leaders, one older orthopedic surgeon, who asked to be called by his first name, and two nurses, led the group though team building exercises, videos and discussions. The nurses, OR techs and doctors in the audience, including those at my table, participated. To my surprise, my table built the highest Lego tower demonstrating our superior use of “team work.”iLEGO TOWER

'Relax - we're all in this together.'
‘Relax – we’re all in this together.’

What the workshop demonstrated to me was that the team had replaced the doctor as “Captain of the Ship.” Or at least team members had a say in what happened at the bedside, or in the OR. All professionals were encouraged to speak up if they saw something that would negatively affect a patient outcome. In fact, a bright yellow card to wear hidden behind the staff’s nametag was inserted into our handout folder. It said “I Need Clarity.” It could be flashed at the attending/surgeon, or any team member, so as not to cause a patient anxiety. The team would then go out of earshot of the patient and family to discuss the potential problem. Every team member’s input was important.

As I walked to the parking garage at the end of the class, I wanted to call my old nursing school classmates so they could appreciate along with me how far physicians had come in becoming team players. My classmates and I came from the old school when nurses stood when doctors entered a room. We endured prima donna surgeons that had temper tantrums and threw instruments in the OR when they were angry. The doctors I had just observed took part in an effort to discard old actions and engage in team building behaviors.TEAM BUILDING

Well, things were changing. Okay it’s only one workshop, but it so impressed me.

I am going back for the second half this week. Let you know if I had been dreaming.