Hello, good afternoon. Welcome to today's HRO Session my name is Victor Gonzalez. I am a Quality Improvement Specialist and I'll be your host today. It is my privilege to welcome you back in 2022. The topic that we're going to cover is Cultivating Teamwork and Collaboration. It's my privilege to introduce our speakers today. I'll do that in just a moment, but 1st of all. Let me extend a warm. Welcome to you. And thank you for the work that you're doing in a very tough situation, uh, these days we appreciate you taking time out and, uh, focusing. On improving the delivery of Quality in healthcare and the work that you do, it is phenomenal and we're in all of your ability to do that and share your time with us today. So let's get on, um, with our presentation we've got a lot to cover today. I want to let, you know, that you've got a couple of ways that you can communicate with us. And if you joined early, you saw the Pre slides. I weren't going to cover them quickly for those folks who are just kind of making their way in the door. You can definitely use the Q and a feature to do that. Uh, today it's going to be a little bit smaller group a little bit less formal. Um, you're welcome to use the Q and a, we'll be monitoring that, but we also have turned on. Chat, so you'll be able to do chat. We'll cover that in just a moment. Another way that you can participate in this conversation is by selecting the hand icon to the right of your name. I'll find you unmute your line and then the appropriate time. You'll be able to ask your question, verbally and participate in the conversation that way as I mentioned chat is not only gonna be for links today. It's a 2 way feature. We've turned it on both directions. So feel free to drop in comments and into chat. Uh, I know our speakers sometimes will prompt the audience to answer questions as we're having our conversation was certainly helps create a dynamic in the information that we're delivering for you today. Well, with that further, do it is my pleasure to welcome back our friends and colleagues from safe and reliable health care. Today, we're joined by Don doctor Don, who is a physician leader, and a senior HRO expert he has focused half of his 35 year career on improving the quality and safety of patient care. Dr. Kelly has spent the last 3 years sharing lessons learned with consulting clients. Committed to the journey of delivering care that we'd all want for our own families. Dr. Kelly received a BA from Harvard College and an empty and PhD degrees from Washington University in St Louis where he also did his internal medicine residency. He's published over 50 papers, or book chapters received a variety of awards served on federal and regional advisory committees, and served as a founding board member of to patient centered, nonprofit organizations. He's joined today by Jeff Dunaway. Uh, Jeff joined safe and reliable in March of 2020 and is the primary focus of supporting the high reliability journey in the he has practice as a registered nurse for 25 years with the last decade, uh with the last, um, in the last decade dedicated to the performance improvement space. Excuse me Jeff is I tried to make you 100 years old Jeff. But, um, but I was thinking the wrong thing here. So, decade is 10 years. We didn't make you a century today, but Jeff has a passion. He's passionate about helping health care at both a national and local level through the environment of frontline workers. In training of executives, he brings a servant leadership model to all of his engagements and has a deep understanding that culture eats strategy for lunch every time I love that lines up and Dr Kelly. Welcome to today's presentation. We appreciate and we are honored that you've joined us today. Victor, we appreciate it. We're so glad to collaborate with you and have you on our team, Victor you make this uh, so, uh, enjoyable and easy for us. So, let's get it, uh, kicked off. Uh. So, what comes to mind when, when you hear these words, teamwork and collaboration. Maybe things like working together, uh, sharing, uh, building on the strengths of of each other um, I would say, yes, yes. And yes. Uh, but these are outcomes, uh. So, what are the building blocks that must be in place to get there? Mutual respect, trust, shared purpose. These are some of the building blocks that we're going to discuss today. Look at the next slide. The goal of any high reliability organization is to have, it's it's, it's humans, it's people and its systems to interact in a manner. That's that's failure free and it's stable over time. Look for this goal to be realized and its clinical space. It's operational space and it's cultural space. This is achieved through being mindful, not in having your mind full. So we want our leaders in our front line to have a state of mindfulness around the bullet points that you see on the screen. Uh. When we achieve this, it manifests itself in this way. Uh, we are preoccupied with failure. We have a reluctance to simplify. We have a sensitivity to operations and what's happening around us. We're committed to resiliency and in all things we give deference to the expertise around us. Next slide here, you're going to see the 4 domains of the framework for high reliability. Uh, today we're centered around the cultural domain, specifically teamwork and collaboration. Excellent. So, as we dig deeper, and we have a clearer understanding that, uh, culture is manifesting the behaviors, the relationships, and the interactions of its people culture is very complex. It's adaptive and inherently human, continuously invest in providing the elements of HR, culture and conditions necessary for it to thrive. Being a supportive teammate and actively participating in reporting defects and sharing ideas are also key elements of an HR culture. On the next slide, we'll see. This is a very high level view of the areas that we will draw out in this discussion today. Uh. You you heard me go pretty quickly through the 1st 6 slides is because, uh, the depth of what don's about to bring us with shared purpose is worthy of taken a little more time on those sections done. You know, mute Don. Okay, thank you. Um, Jeff, and thank you for that. Nice introduction. And I want to echo Jeff’s view that this is really a great opportunity for us. You folks are at the cutting edge, uh, doing the work to take care of patients and we're hoping to give you some valuable tools to help you to be able to do that as effectively as as you can. And so, uh, we just really appreciate all that. You're doing so, uh, next slide victor. One of the great sources of motivation and reward is having 2 or more people doing work. They both feel is important. And we call this having a shared purpose even falling short is okay when 2 or more people have done their, their best together. Next slide so, let's kind of go back over what we mean by when we say, what's it? What does a team really? Well, it's a group with a specific task that requires everyone to work together. We call it an interdependent collaborative effort, and it's for the members to be able to accomplish. They can't do this alone. They have to do this together. So, success depends on having a shared purpose that unites the team, and the team cultivate a clear mental model, and we'll talk about ways we do that of who will do what, when so keep this notion in mind the mental model that we're always trying to make sure, everyone shares with this model in mind that is the mental model of what they're going to do practicing reveals where the team is functioning. Well, and where it's not and examples that football teams commit to improve by watching and discussing the videos of each play of their last game to identify what worked and didn't now near perfect execution is at least as important for patient care as it is for football. So, designing and practicing improvements is really an essential part of providing the reliable care patients deserve. Healthcare is finally focusing more and more on learning and practicing improvements in teamwork that is getting better at being teams that lead to better outcomes. You and your organization by participating in this series are part of that improved and important movement. Next slide now, here we have sort of, some different looking videos 1 of a a cowboy. I think that's probably Clint Eastwood and pit crew. So, let's talk about why we've got these both on the same slide. My wife's grandfather started to practice pediatrics in 919 more than a 100 years ago, and like, the cowboy shown here. He had to be able to handle everything without help care was simple, marginally effective, but free from mistakes. When I finished my training 55 years later, it had become much more effective. The result of giant leaps forward and science of medicine, but became more error, prone often due to gaps in teamwork. Very little was said about this issue then, and 30 years later after this trend has only worsened the tool go on day wrote something that I think is my worth reading for, you. He said half of major surgical complications are avoidable with existing knowledge. It's like, no one's in charge. Because, no, 1 is the public's experiences that we have amazing clinicians and technologies, but little consistent sense that they come together to provide an actual system of care from start to finish. We train higher and pay doctors be like cowboys. But it's pit Cruz that people need. For those of you are less familiar with racing time is critical when they come into the Pittsburgh replay to get gas and replace tires in a pit crew, every 2nd is important and everyone knows exactly what their job is when to do it. And it has all that they need to get the car back on the track. Really fast. Excellent okay, 1 of the things that's really key is is this concept of teamwork? Mindfulness. It's clear that situational awareness and mindfulness at the team level is very important. Let's review the steps that groups go through to get to this goal in doing this. Let's think about the unit or work group that you're a part of, or that you're coaching. The lowest level shown here represents a team that we call and mindful essentially no teamwork. The typical attitude is, hey, just do your job and everything will be fine.Not many units are actually this dysfunctional, but there are some, the next level up is much more common and it's better. It is. What we call reactive and we call it this because team training and improvement happened mostly right after something goes wrong. So, they react to the problem work on it, and then sort of stop focusing as much as they should on teamwork. If we move up 1 more level groups that often use teamwork skills, training and improvement methods or term systematic, they're fair number of units that achieve this over time. And and and it's really a good thing because things are working pretty well there. The next to the top is in strong organizations, effective team work is a high priority. So training and clinical use of good team behaviors is expected, recognized and reinforced these units aren't common, except in organizations that are really working on when, visiting a unit like this. You'll quickly recognize that it's reliable and exceptional in many dimensions a place where we all would like to get our care the highest level. We turn generative. It's pretty uncommon, but it has very strong systems that ensure continuous learning and targeted team behaviors. And to move up the scale of mindfulness depends on having an essential key leader who is effective at local leadership, who has high expectations, generates psychological safety reviews, performance, data, and strongly supports briefings, checklist, debriefs, huddles and open dialogue. Those things that Jeff went over briefly in the framework. So, let's go to the next slide.In this illustration, we see a photographer setting up to take a picture of of infant gorillas is he situationally aware? Well, let's review what's needed to be situationally aware they're listed on the left. He knows the goal. He has a plan, he probably knows that there's a risk of getting too close to an infant gorilla, especially if adults are close by but I suspect he isn't adequately monitoring the situation because adult gorillas are very close. So the photographer seems to have possibly lost situational awareness. And which is critical for his or her safety to be sure next slide. Now, 1 of the things that's important is that even if we have situational awareness, we have to be aware of some of our own mental biases, we tend to be primed to see what we expect. The these images illustrate how our brains try to work hard to simplify the deluge of visual information that may result in seeing what we expect, but something that's incorrect. On the left, most people see at 1st glance, only 1 vehicle, but they're actually are 2 vehicles, a truck and a car next to it. On the right is sort of encourage you to take a look at this on your own more carefully, but that's really made up of a series of components. The goal is not to show you an older man, and you can take a look at this sort of brain teaser when you have a little more time. It's not easy, but we can get more accurate information. If we make sure we take time to try to avoid drawing premature in correct conclusions. Especially if they don't make sense. Next slide now, let's we've talked about individual situational awareness let's talk about collective situational awareness collective mindfulness. We've all probably heard this teaching story of 6 blindfolded people who are asked to touch different parts of an elephant and say what the object is. Their guesses are all reasonable ones, given their limited information, but getting to an accurate collective situational awareness that creates a mental model for them, all requires 3 key processes. Communication of what they see dialogue about what they see in negotiation, because they clearly are seeing some different things, these 3 processes communication dialogue and negotiation are core aspects of teamwork and communication for success. The team members need to use 3 more elements of team behaviors, or attitudes respect for everyone no matter what they describe, they are experiencing deference to expertise and in examples like this, a commitment to resolve disagreements using dialogue and feedback in an environment that's sufficiently structured to reach a negotiated shared outcome. Without being able to have or develop a shared mental model teams are due to get off track and failed to achieve the success that they're trying to to, to reach. Next slide well, let's talk a little bit about what gets people off track what's listed on the on the left or commonly termed human factor threats. They are things that interfere with communication and teamwork. And they kind of fall into 2 groups. The 1st, is that a person can receive the wrong information due to ambiguity or noise that's distracting. The intended message was missed. The intended message was not understood, or that the individual that may have inadequate training to understand what his, what he or she is hearing. The 2nd, general category are things that interfere with the listeners attention and can generate misunderstandings of key information. Time pressures and production pressures there's a lot of that going around having too much to do generates a fair amount of distraction. But also, having too little to do, could be a problem. Boredom of a highly repetitive activity may lead someone to lose attention. Or, perhaps even a message that reminds a person of the past stressful experience, and undermines their attention confidence, or feeling psychologically safe. And then if they don't feel psychologically safe, that may prevent them from asking for needed clarification. So, Jeff, let's ask you to take it away from here. Thanks, Don, as we go to the next slide. Um, I want to make sure everybody can can see the chat. I've asked a couple of questions in the chat. Uh, this is an interactive session. So we're looking for your feedback. Communication doesn't exist. If there's not a feedback loop, uh, sherry, thank you so much for sharing your thoughts about that but I want to encourage everyone else not to leave sherry out there by herself, uh, in the chat. So, communication is, is 1 of the most basic elements that exist in the world. Uh, but, as we see in this, quote, it often is the element is most overlooked and it's apt for failure. Oh. And and we cannot achieve shared purpose, trust or respect without good clear communication. Uh, the next few slides are, we're going to stick with with communication as a foundation for teamwork and collaboration. So let's go to the next slide. Here we see a standard definition of effective communication. We can see in the red half that there is not a feedback loop to assure understanding, uh, communication cannot be effective. So, from the bullet points, uh, we can see there there are many opportunities for failure and communication, uh, that we so often take for granted, um, communication, uh. If it depends on memory, it's, it's valuable. Um, if, if there's a hierarchical, uh, issues can often lead to miscommunication because we sometimes don't feel psychologically safe to to ask questions or to clarify. And then there's often, uh, selective listening that, that we hear what we're expecting to hear just like, don's slide where we see what we're expecting to see and we don't actually stop and and see what's really there. Let's look at the next slide communication also has a very rhythmic, uh, way form of listening and reflecting and responding. And this complex system can easily be taken off track, uh, with speed, um, with a certain agenda or even with the type of content that's attempted to be conveyed. Um. To get good, clear, effective communication is is a true art and it's a skill that that often, um, what we just simply don't get. Right? It's like the next slide. So, let's now move, move past the building block of communication and really into the team behaviors. Uh, again, we know that this is gonna build off of a foundation of communication. But what what would we like to see in our teams? Uh, we need to see respect we need to see deference to expertise. We need to see that the team is seeking to resolve conflicts and, and the giving and receiving of feedback is essential, uh, to the good team behaviors. On the next slide, we'll see a little bit more. Um, let's talk about respect. Um. And in what respect means 1 of our colleagues put it like this. The goal is to realize that. Uh, there is a hierarchy when it comes to responsibility, but there is no hierarchy when it comes to respect, uh, that's everyone's responsibility in this type of environment. We create an expectation of trust and respect and professionalism, regardless of role, or position in the hierarchy or professional background and we apply these rules to everyone all the time with no exception. And, yes, there is a cycle here that is easily supported and just as easily broken. It's easiest to give respect when we feel that we are being respected. Respected and of course, the converse is true around that as well. Let's look at the next slot with deference to expertise it applies at all levels of the organization. Uh, but it's best seen pointing out when a formal leader acknowledges that many below them in the hierarchy are closer to the problem, and have a much greater understanding of what's causing the problem and possible solutions to it. In in this case, the leader differs to the expertise, uh, of the people closest to the problem, and simply becomes someone who can eliminate barriers and provide resources to those in the better position to solve the problem. Uh. And I just love it when we can see that played out in real life. Excellent. Decisions should also be rooted in the organization's mission and vision and values. Engaging in an exercise to develop and refine these elements will will generate agreement around goals and insure all parties are are journeying in the same direction. Thereby decreasing the likelihood of conflict and making it easier to resolve disagreements when conflicts, uh, do arise, uh, teams agree to resolve them through collaboration. And in a way that maintains and even strengthens the team members, uh, relationship. This involves gaining insight into what's driving the other person's request and coming up with innovations and ideas for solving the disconnect by engaging in appreciative inquiry and open dialogue asking open ended questions to understand. The other person's point of view team members, distinguish positional statements from underlying inputs and interest gaining critical information that allows the team to reach consensus. And we know that that consensus is where, uh, everyone gets something, but no, 1 gets everything, uh, being able to resolve conflict in in healthy ways is essential to to teamwork and collaboration. Let's look at the next slide so. Giving or or receiving feedback. Well, it starts from the premise that that feedback is a gift and not a weapon and if it can be used as a weapon. Uh, keeping feedback objective, keeping it short and keeping it focused is essential. When receiving feedback, uh, to separate the message from the person giving it is also helpful, uh, reflect on the message, keep the good and leave behind the parts that are not useful and move ahead. This is my own personal simple philosophy on feedback that serve me very well. As we look at the, the next slide, don's going to take us through more team activities that builds off of the behaviors and communications that we've set so far. Okay, Jeff actually, Victor can you go back a slide? I just wanted to emphasize 1 thing about that. We don't have time to go through it, but this engaged feedback checklist is really a nice tool and I wouldn't encourage each of you in your work to. I tried to go through something this self-evaluation exercise, maybe at least every month or 2 to just kind of ask, hey, you know, how am I doing? Am I really kind of following these rules? And because I think it's, it's really important for kind of self-development of being able to be a good participants in the kind of respectful feedback that Jeff is talking about. Okay, with the next slide, let's take this up a notch in practicality. How we're going to focus on specific. Behaviors that are important in creating teams next slide. So, uh, what your teams do the principles on the left are very important, but only take form in day to day real world activity is shown on the right that embody these principles. We don't have time to go deeply into several of them handoffs and checklist today. But a few words about them, before we cover some of the other ones in more detail again, our friend, the tool go on to popularize checklist and is checklist manifesto publication there, especially important before surgery and other procedures since forgetting, something could be catastrophic and a high risk activity. Secondly, hand offs are natural places for communication failures. The joint commission rightly advocates techniques, like, hand offs that improve communication and reduce error. A lot of focus has been on nursing shift, change hand offs. But the absence of physician to physician handoffs is as common and dangerous and often not talked about source of poor care as a patient safety officer in peer review of an event following involving a physician. I can't tell you how often I heard them. Say, I just assumed. And and again, this is it's just so easy to presume that you have the full mental model of what's going on and, and failure to achieve situational awareness is incredibly important for everyone especially physicians. Next slide, let's move on to huddles a key team activity that's commonly under used or not done very well. I'd encourage you to observe huddles in your organization and to see some of the good practices that are there and think about recognizing them and harvesting them to spread things really move quickly when you visit a unit and say, hey, you know, you might stop by and see, what's going on for South, because they've got really a great Huddle, because you can talk about the concepts with them, but when they see it, they really get the center box describes the main questions. The huddle tries to answer. Uh, how are we doing? What are our goals today? How are we going to achieve these goals? What risks do we face? What do we do? What we do if we get off track how can we voice concerns? Is everybody clear on the plan any questions? Those are the kinds of things that must be in huddles and when they are, um, they create 1st, uh, essential situational awareness about the teams work. Today they give individuals voice, which promotes team member connection and loyalty to the team. They celebrate what goes well, and recognize people for their contributions, which creates important relationships and connection when people want to come to work because this is a supportive group and these difficult times recognition is especially important finally by raising, discussing and resolving today's concerns and issues trust and psychological safety are built every day. So the next slide shows again, kind of repeat some of these next slide please. Repeat some of these concepts. Can we get to that? Okay. Perfect. Thank you. And I'm not going to go through all of them, but I will say about a couple of them the 2nd, around productive transparency supports teams to mature by having the information. The team needs to understand where it stands. Is it doing? Well, what does it need to work on the 4th and 5th formalize that? We should balance workload and point out risks that need significant significant risks that need attention an example might be. For example, everyone needs to know that a shared piece of equipment isn't working. Finally day to day insights and improvements help everyone deliver better care. An example might be hey, there's a new pharmacy number 2 calls for stat meds. That haven't been delivered. I've posted this on the huddle board. Those are key pieces of information that everybody needs to know about next slide. But huddles also, uh, we've just said what they should be. Let's talk a little bit about what they shouldn't be. It's very easy for huddles to get off track and lose much of their value. When they do. Each of those things listed on the left. Here is a time waster for a huddle when these happened, the huddle leader, which cannon should be rotated every week or so should take control and politely redirect the huddle discussion. So that it continues to share only what's most important? It is important. That team members have there have other times to do these things. Venting is normal and needed but not in the huddle fixing problems. That are complicated is important but not here. Unless it's just a quick occasionally patient level information may be relevant to everyone. But not very often. Next slide using tiered huddles is a great practice and 1 that perhaps you're not familiar with and it's not done very often, but it isn't too hard to design and implement. So what are they on the top? We illustrate that most leaders in, sort of the conventional mode lead from the top down, they develop priorities and approve departmental programs to address them. These programs are executed by directing those who report to these execs. Uh, and then who in turn deploy the execs goals and priorities to those further down the organization that is the middle managers who then are in touch with the front line staff. And organizations, like this safety is also reviewed at the top, and then risk awareness and fixes are communicated and deployed from the top down. However, in a tiered huddle system is shown on the bottom. And here, we see that the arrows point up. Because what happens here is that we have safety issues briefly reviewed each day in the unit titles, then selected findings are communicated up to middle leaders, who may do a little bit of exploration of of the issue. And then, in turn, they report identify problems to their executive leaders and again, they do this every day. This is not just a weekly thing. This is an everyday thing. The role of executives then in this model is to disseminate newly identified specific risk to all middle level leaders who can then discuss them with their teams. The leaders endorse and support improvement teams who more thoroughly evaluate the event and develop and distribute both findings and fixes broadly. Finally exist. Exactly. Should monitor the timeliness and impact of the deployed fixes and keep people accountable. Organizations that do this mount inner mountain is 1 that does this extremely well and their growing number of organizations that are doing this kind of thing. Next slide, let's talk. We, we are probably more familiar with the term repeat back when someone repeats what they've heard to make sure that they heard and understand it correctly. An example might be when I'm coming home from work and my wife asked me to stop at the store. Uh, I might say, okay, 1, head of lettuce and 2 tomatoes when we need something for a salad that way. I'm sure that um, I've heard her correctly. And 1, other thing I do just between us is that I write it down on a post it, because if I don't put that on my steering wheel on the way home, I'm going to forget it. So, um, so what kind of information warrants repeating back. Drug names and amounts numbers of all kinds phone numbers, room numbers times dates. How long something he was supposed to happen in locations now teach backs. Let's go to that topic, which is really they're different and are most commonly used with patients and families, especially after sharing a lot of information with a patient, or family a patient example would be to have the discharging nurse ask a patient to tell them what she or he will tell their spouse about when they about what self care they're going to do at home written instructions are helpful, but a teach back helps us to know if patients really get it and understand the more important things that they need to do. A professional example might be an infection prevention nurse may meet with a unit manager to go over a list of things to do with an unusual infection in the unit. They can then ask the unit leader to teach back what they're going to focus on in their next unit Huddle. So that way the infection control person knows that the unit leader really understands what's important. To do next slide. Okay. Let's let's move on to briefings. The components that are listed in the middle are really guiding principles for a briefing, and they describe what's important to set the right expectations. So, what are the practical aspects of good briefing? Because today, we're trying to focus more on, uh, on practical aspects of things. 1st, the leader of the brief and not necessarily the person who is at the highest rank, starts by saying something upbeat and then sets expectations by saying things like something like the following. We're going to discuss doing whatever and need to make sure everyone agrees with the plan. Then they would say it's essential that each of you speak up if you have any questions or concerns about what you hear this is a safe discussion. So, then the leader briefly describes who will be doing what and when especially focusing on what is different than usual, the leader then ask each person to raise any questions they have and describe what they see as the more difficult parts of the work and what they're looking out for. Finally, the leader then asked each person for a head nod. If they're good, we're starting to work. This plan describes. It's kind of like, when you fly and sit in the exit row, and then the flight attendant ask you to have a head nod that, you know, and will do what's asked. It turns out that people pay much more attention when they know that somebody is going to be coming back to them at the end for their commitment. Okay, next slide debriefings debriefing is a structured process typically done at the end of the shift or procedure. It renews the voice of the participants and builds genus by capturing what's been learned for a procedure. It's unlikely that there was a major problem, but even so the team should formally gather at least briefly to have the leader do a number of things. Thank the team to start with and then briefly to say, hey, what went well, today and lead and the leader should be liberal, but honest with praise don't just make up nice things to say. What did we learn a way to gently surface things that didn't go very well? It's key to have psychological safety and engage all team members. In this process, any problem individual behaviors or performance should not be part of the debrief. Those should be handled separately. What will we, the next question that the leader would ask you? This group is, hey, what did we do? Uh, will we do differently next time this converts what was learned into a commitment for future action. That's better care. And finally, is there anything that others should know about things that might be relevant to doing the same task? Like, perhaps malfunctioning equipment or instruments refilling supplies if stock was depleted and at. So, when this is used at the end of the shift, it might be kind of tough to gather the whole team for a debrief. But the chargers can check with several small groups to provide appreciation, gather learnings and to DOS, and then pass these along to the oncoming charge nurse. And administrative debrief about a project can also be a very good thing. And it's very, practically useful and build relationships, shared values and loyalty. Next slide Jeff. Let's let's take a Paul's right here and talk a little bit more about Huddles. We've got a little time left. Uh, so, donna's kind of got a little, uh, thread going in the chat. Um. The difference between, let's say, a shift change huddle and a true safety Huddle. We know that there can be components of safety in any Huddle. But then there are certain huddles that are specifically about about safety. Um, do you have any thoughts about about that? You'd like to explore. Now. It'd be glad to there are a lot of ways in which this is done. Um, I think that, um. It can be done as part of, uh, the, uh, morning, uh, sort of oncoming shift huddle to just say, you know, something brief about something that went wrong. So, everybody is aware of it. Um, it can also be done by a more of a group meeting, which is a pretty common practice where all of the, uh, units and departments get together with the leadership to talk about the safety events, uh, that happened in the last day to make sure that the executives know about it. Um, but I, I think I would favor or encourage that. There's some mention of safety, even in the operational huddle in the beginning to just say, is there anything that I need to take to the, uh, to the manager safety huddle? Um, about anything that went wrong. An example of of a safety huddle could be and this is probably pretty widely known the time out before a surgical event or some type of procedural event. Yeah and 1 of the key aspects of that is, everybody has a voice. Everybody has a has a part that they play during that Huddle right? Dawn. Yeah, absolutely. Now, and I think as part of that Huddle or the briefing, everyone should be there and everybody should, uh, participate to some degree. Yeah, so so as you try to take these huddles and these safety huddles and and make them your own, um. I would encourage you to to explore, um, you know, what works for for you and, and for for your organization and your, um, you know. For instance, um. A mid afternoon huddle on a 12 hour shift can be very, um, value added just to pull people together and say, you know, who has had lunch who hasn't had a chance to have lunch who is gonna get out of here on time. Who's not gonna get out of here on time who is behind on their medications? Um, you know. Maybe 1 person in their assignment, everything's going well, and they've got capacity to help somebody that is struggling a little bit, but it's only when you, you have that quick safety huddle to see where everybody is. Um. So so you can and move forward and re, disperse your resources. And I think that's happening at many tiers within the organization with. Bad management, uh, you know, with capacity. Um, so, so I would just take the, the, the, the framework of high reliability and, and the components and characteristics of the safety huddle and and find new opportunities to use those, uh, to produce value and and to hear what your front line has to say. And I think Jessica, I think that's well said, and I think the another thing that happens sometimes in mid afternoon, um, discussions, or huddles is to be thinking about what is tomorrow look like. Um, so that, it's, uh, it also is an opportunity to do the plan forward that you've been talking about. So, that, uh, organizations can be saying well, tomorrow's gonna be a really busy day if you're in a procedural area. And so people have some heads up about what to expect. Um, and is there anything we need to do today to be ready for tomorrow? And so, uh, it's, uh, both what's gonna happen in the next shift. But also, potentially, in, in organizations that are, uh, really forward looking are thinking about tomorrow. And when they do that kind of thing, I can think of 1 hospital in particular. It just ran things ran so much better because they had the Pre discussions of what's gonna be different tomorrow that we all need to think about today. Thanks, Don, for just John. Joining in with me and in that, and thank you all for, uh, for the thread and in the chat. Um, and the engagement. So, let's, uh, start to get into the home stretch of this presentation structured communication. Uh, s, bar is a widely known and use structured communication tool that helps the receiver to quickly come up to speed, uh, with the situation. It's especially useful when I know as an asset you nurse I would call, uh, a doctor so I'm calling Don in the middle of the night to escalate a situation. Well, well, I just woke Don up. He, he doesn't have the same, uh, viewpoint that I have at that time. Uh, s, bar, uh, is also very. Uh, under utilized in day to day communication and so I challenge you to see where you can incorporate this tool into your daily work to promote better and clearer, uh, communication. Uh, all right, thanks, Victor. Uh, so. Critical moments in health care arise daily and and there isn't always time to pull out a manual and thumb to the chapter on conflict management. Uh, sometimes something bad is about to happen and providers need to speak up. Right now uh, for example, a circulating nurse notices. The consent assigned for a left foot procedure. Um. She looks over at the table and the right foot is prepped and raped and and framed and the bright lights and the surgical lights, and the surgeon calls out scalpel. Please this will be a very bad time to try to ease into the conversation. You've got to be able to speak up quickly insights, such situations organizations needed and Don core phrase, uh, that, and on court, and in healthcare is a word or phrase understood throughout the organization to main stop everything. Now, it's also referred to as effective assertion or critical language, regardless of what we call it when the words are used everyone knows, it's meaning please stop and talk to me and let's take a minute to ensure we're doing the right thing for the patient. You know. Uh. These could be words, like, time out that's pretty universal. It gets everyone's attention very quickly. Uh, there are more subtle words, or phrases and techniques that that would not alarm patients and family members as much they can also be used. Um, as we see them on the screen here, um, phrases, like, I need a little clarity, or I'm concerned also helps the person. Um. That that's potentially about to make the error to save face as this starts to center the concern around the speaker and not the person. If I say Don about to do something that I don't say, Don, you're about to make a mistake. I say. I need some clarity. I need to understand this a little bit better. So it takes the emphasis off Don, but it allows time for Don to stop and and really, really think, um. Don, please feel free to jump in if you cause. I know you've got tons of experience in this space. Yeah. More experience than I I wish I had, but it was a, you know, again, it's, um, it's really essential and 1 of the most effective things. We did in, in, uh, when I was working in the bailer system was put in line, uh, put in place what we call to stop the line policy, which was that it was everyone's duty. Not just a good idea, but duty to speak up whenever they were concerned, that something might happen. That would hurt a patient. And there was no retribution allowed period. Uh, the only people who got in trouble with the people who yelled at someone for stopping the line, and once a month, we got all the people who stopped the line together, and we celebrated their courage and, uh, and it was incredibly powerful in the organization. So, uh, there's nothing better than, uh, you know, moving slowly up with the need some clarity. But when it really gets ugly, uh, I knew 1 nurse who just decided that she was gonna lay right across the surgical field when the, uh, they were doing the wrong thing. And, uh, you know, that was, uh, took a lot of courage to do that. But that stopped the line for sure. And they re, establish situational awareness and safety. So, uh, so it's the responsibility of everyone no matter what the rank is. Thanks Don, appreciate it. Let's look at the next slide as we, as we start to to wrap up most organizations track, the quantity of teamwork activities that occur uh, how many patients receive surgical safety checklists or such as that uh, but effectively, uh, tracking the quality of the interactions may not take place team, teamwork activities. Are only effective when they include a foundation or or great, uh, situational awareness, effective by directional communication and where team behaviors support the goals of the activities. Um. Let's look to the next slide. This is an example that we see here of quality of teamwork activities, uh, that can be tracked. Um, you know, to say that you have a huddle, every shift or or your huddle averages 15 minutes. Um. You know, is 1 measure, but to really understand that the quality of that huddle and and the ability of people to speak up and and say, what's on their mind or stop the line and really start to understand the psychological safety that exists in the unit or in an organization is really where we start to see, um, safety outcomes being affected. And on our last slide. This is a very simple sentence with very profound meaning that we should all be striving for in our workspaces. We all want to be able to say when we go to work this place makes me feel better about myself than anywhere else because of what I do and who I do it with. We leave you with that, uh, open it up for any questions. I think we've covered everything in the chat. Um. Vanessa Victor, we, thank you all for for letting us come today and and and bring this, uh, important topic, uh, in this presentation. Absolutely, thank you. And thank you. Dr, currently for that presentation and sharing that information, we did have a lot of activity in chat and thank you also for addressing that Jeff and. And doctor can only, I do want to remind the audience that there is an opportunity to ask questions. Would you have a couple of minutes you can certainly do that in chat, or you can just click to the right of your name. There's a little hand icon. There we can bring you into the conversation and you can participate verbally if you'd like, and while we give the audience a little time to contemplate that I do want to encourage everybody to head over to team of network's dot org. If you haven't done that, that is where you will find, um. Information on all of the initiatives that we have, including hospital quality improvement initiative and I know that most most of you have probably made your way over there or your consultant. Uh, if you're connected with 1 of our quality improvement specialists has helped, you. Uh, in that process. I'll just add 11 more thing while we're waiting for people to perhaps put some, uh, any other questions in the chat is just that, uh, you know, 1 of the items that's on the score survey that, uh, that again, your organizations have taken is, uh, I would feel safe being treated here as a patient and that is sort of what I would call the most foundational and important question, which is really is the care that me and my team are delivering good enough for me and my family and if it's anything less than the top box that's something that not that a unit should feel bad about, but the unit should feel is something to work on that lets them know that. The kinds of things that we're talking about today are the ways that you move the organization from having a, a majority say it's a good place to everyone saying. Well, thank you for that. Dr, Kelly. Do you appreciate that? And I do also want to let, you know that your feedback on how we did today is is important to us. We're going to. Provide you a redirect after this call when you disconnect, you can, uh, take a quick survey in fact, uh, on my colleague, B, young has placed that link, uh, into chat if you want to click on it. Now, you can certainly do that. If not, you'll be redirected to to take the survey, and just a couple of quick questions that provide us, uh, real and critical feedback in improving these conversations. So we do appreciate that tremendously. You can also follow us over on Twitter. You see, it's TMF networks. Uh, at TMF networks, we certainly, I encourage you to do that if you're into social media, which most of us are these days, but we just have a couple of minutes here. I don't want to, uh, extended. I know. Time is, uh, a critical. A component of everybody's day, and certainly a rare commodity these days. So with that if we don't have any additional questions or if you gentlemen don't have any additional comments, I would like to thank everyone for attending today. And we hope to see you on the next call last and final thoughts Dr. or Jeff. Now, just again, thanks everybody for, uh, both attending, but especially for those who participated in the chat and help to make this a richer conversation, we really enjoy doing that and think it's important. So, thank you. Thanks Thank you very much. Yes, that concludes our call for today. Um, we encourage you to visit with us next time. I have not nothing else. Please have a fantastic day. You may now all disconnect.