VHA member teams use training techniques developed for military aviators to help healthcare organizations find ways to reduce medical errors.
In an effort to reduce medical errors, VHA has launched a program to improve the way hospital employees in the emergency and obstetrics departments work together.
VHA has licensed a team-training program called MedTeams from Dynamics Research Corp., an Andover, Mass., research, training and consulting firm. DRC is known for a training program it developed to help the U.S. Army reduce the number of errors aviation crews make. To develop MedTeams, the company applied to hospital emergency departments the theories it developed from its work with the military. DRC plans to expand its program this year to cover obstetrics.
Though VHA officials wouldn't say how much the organization spent on the program, they say the investment is minimal. MedTeams charges for training materials and consulting time but doesn't charge a licensing fee, says Mary Salisbury, director of the MedTeams program and principal MedTeams investigator at DRC.
VHA has sent three physician-nurse teams to be trained by DRC. VHA teams, in turn, will help roll out the program to member hospitals as VHA's Patient Safety Team Training. Following the DRC approach, VHA teams conduct an initial assessment at each hospital department and provide three days of instruction to physician-nurse leadership pairs from the hospitals, who will, in turn, teach the program to all members of their departments.
The initiative teaches employees some 41 behaviors involved in planning, communicating, training, resolving conflicts and balancing workloads. The idea is to hold every member of the team, from physician to orderly, accountable for patient safety. The program teaches physicians to explain each patient's care plan to other team members so everyone has enough information to help ensure patient safety. The approach then encourages every member of the team to speak up if they see a mistake about to happen.
Another key idea: Team members must talk to each other constantly about everything that is happening regarding the care of patients. Teams also are trained to spend a few minutes at the end of each shift discussing what went well and what didn't.
"This is a course that formalizes behaviors, rather than leaving them up to chance," Salisbury says. "Historically, we have trained people along discipline lines, but we haven't trained them how to work on a team."
Sutter Delta Medical Center in Antioch, Calif., implemented the program in its emergency department in 2000 and is pleased with the results. The department reduced the number of errors involving patient care by 50% from December 2000 to July 2001, says Ellen Leng, M.D., medical director of the emergency department.
Leng also credits the program with improving the efficiency of the staff. Even though patient volume in the emergency department rose 15% this flu season, compared with last year, staff levels remained the same.
Sutter Delta, a VHA member, got involved in team training through the California Emergency Physicians Medical Group, Oakland, which also has licensed MedTeams from DRC.
Leng says she and the emergency-department nurse manager attended a three-day training session at DRC in August 2000. When they returned to the hospital, they taught 12 eight-hour classes. The 65 employees of the emergency department as well as 20 physicians and some managers from other hospital departments each attended one of the classes.
But one eight-hour class isn't enough to institutionalize the program, Leng says. Leng and Lynn Fox, who replaced the emergency-department nursing manager involved in the initial MedTeams rollout, recently taught a one-hour refresher course. They plan to teach other courses periodically. They also plan to teach an eight-hour class for employees who have joined Sutter Delta since the program was instituted.
In addition, each team sets a goal to reach each day based on the concepts. During end-of-shift reviews, they talk about how well the team met the goal.
Leng and Fox monitor the staff's attention to the program and make changes as necessary. One example: Because teams have been skipping the end-of-shift reviews, Leng and Fox decided to make the reviews a formal goal for all shifts.
"This requires continued care and attention to keep it going," Leng says. "I suspect that there are some places where this is just a part of what they do. It is a part of the orientation, a part of the behavior. We are not there yet."