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www.ahrq.gov/sites/default/files/publications/files/pocketguide.pdf
January 01, 2020 - 26
• Feedback ....................................27
• Advocacy and Assertion ........... 28
• Two-Challenge … (real or perceived)
• Offer a solution
• Reach agreement on next steps
29
Mutual Support
Two-Challenge … feedback to team members
Effectively advocates for the patient using the Assertive
Statement, Two-Challenge … Rule, or CUS
Uses the Two-Challenge Rule or DESC script to resolve conflict
33
B
A
R
R
IE
R
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www.ahrq.gov/teamstepps-program/resources/modules/index.html
February 01, 2024 - and Tools
Task Assistance
Formative Feedback
Advocacy and Assertion
Conflict in Teams
Two-Challenge
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/navigating-hierarchy-121013.pptx
January 01, 2006 - hierarchy and patient safety
Explain communication strategies that empower team members to speak up and challenge … Articulate clear goals
Make decisions through collective input of members
Empower members to speak up and challenge … of the meeting room and all safety team members should have equal authority to identify issues and challenge
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/patient-family-centered-care-040913.ppt
June 02, 2025 - Culture Change Model
Comparison Table
*
Objective Kotter: Leading Change Kouzes and Posner: Leadership Challenge … Challenge the process. … *
Principles of Safe Design Apply to Technical and Teamwork
*
Safe Teamwork :
Challenge of
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www.ahrq.gov/hai/cusp/modules/implement/teamwork.html
December 01, 2012 - Two-Challenge Rule 1
Slide 27. DESC Script 1
Slide 28. CUS 1
Slide 29. … Two-Challenge Rule.
DESC Script.
CUS.
Collaboration.
Communication:
SBAR. … Two-Challenge Rule 1
Used when there is an information conflict and an initial assertion is ignored … The Two-challenge Rule empowers any team member to stop the action if he or she senses, or discovers,
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www.ahrq.gov/patient-safety/quality-measures/21st-century/index.html
June 01, 2018 - The Challenge and Potential for Assuring Quality Health Care for the 21st Century
Next Page … Table of Contents
The Challenge and Potential for Assuring Quality Health Care for the 21st … health care, the Vice President released this Department of Health and Human Services report, The Challenge
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www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/dx-improvement/module6-presenters-notes.pdf
January 10, 2022 - Mutual Support, 2019)
(TeamSTEPPS for Office‐Based Care: Mutual Support, 2015)
Slide 15
Two-Challenge … The two‐challenge rule empowers all team members to “stop the line” if they sense
or discover an essential … The first challenge should be in the form of a question, and the second should
provide some support … This two‐challenge tactic ensures that an expressed
concern is heard, understood, acknowledged, and … [Self‐Paced Learner Tip: Reflect on a time when you could have used the two‐
challenge rule or when one
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/implement-fac-guide.html
July 01, 2023 - Slide 19: Two-Challenge Rule
Say:
You should voice your concerns using advocating and asserting … statements at least twice if your initial assertion is ignored, thus the name "Two-Challenge Rule." … The first challenge should be in the form of a question. … The second challenge should provide some support for your concern for the patient. … The two-challenge tactic ensures an expressed concern has been heard, understood, and acknowledged.
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www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/dx-improvement/dxsafety-selfpaced-roadmap.pdf
February 01, 2022 - Module 5: Situation Monitoring
Module 6: Mutual Support
■ Exercise: Two-Challenge Rule. … Reflect on a time
when you could have used the two-challenge rule
or when one of your patients and families
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www.ahrq.gov/patient-safety/reports/hotline/lessons5.html
May 01, 2016 - This challenge was compounded by the requirement to use specific informed-consent language and to include … The informed-consent issue may be an unavoidable challenge for any patient reporting system, but hotlines … A related challenge was that of communicating to patients and caregivers the options for sharing information … While technical, regulatory, and organizational issues appear to be tractable, the challenge of creating
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/leadership-3.html
June 01, 2021 - Table of Contents
Leadership To Improve Diagnosis: A Call to Action
Diagnostic Safety as a Challenge … Diagnostic Safety Improvement Leadership
References
To solve the problems posed by the new challenge
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-patients-source-understanding-dx-error-vol2-3.html
June 01, 2023 - The Challenge: When eliciting accounts from patients and families, one cannot simply ask respondents … The Challenge: Most studies eliciting patient experience with medical errors focus on the adverse event … The Challenge: To assess the longer term aftermath of perceived diagnostic mishaps, one must elicit … The second challenge to collecting accounts about diagnostic mishaps through existing patient experience … The challenge of collecting detailed, representative narrative data is thus twofold.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/educational-bundles/infection-prevention/hand-hygiene/hand-hygiene.pptx
March 01, 2017 - Challenge staff to practice the hand-rubbing motion for the correct amount of time without looking at … Although we all learned from a very young age how to wash our hands with soap and water, the biggest challenge … Another challenge can be finding a clean sink for hand washing. … Hand washing challenge. Challenge staff to compete to see who has the best hand-washing technique. … Challenge staff to practice hand washing for the correct amount of time without looking at a clock or
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www.ahrq.gov/hai/cauti-tools/archived-webinars/integrating-teamwork-tools-cusp-efforts-transcript.html
December 01, 2017 - The two-challenge rule is a tool that is really about advocacy and assertion. … It's a two-challenge rule. … Then, of course, the CUS and the two-challenge rules which help you advocate for your patients. … The CUS or two-challenge rule, there was a definite opportunity there for the nurse when she knew in … She should have questioned the need for that catheter and she could have used the CUS or the two-challenge
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/integrating-teamwork-tools-into-cusp-efforts-transcript.docx
April 07, 2015 - The two-challenge rule is a tool that is really about advocacy and assertion. … It's a two-challenge rule. … Then, of course, the CUS and the two-challenge rules which help you advocate for your patients. … The CUS or two-challenge rule, there was a definite opportunity there for the nurse when she knew in … She should have questioned the need for that catheter and she could have used the CUS or the two-challenge
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www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/implementation-guides/implementation-guide2/implguide2conc.html
September 01, 2014 - Some States may be well positioned to undertake the challenge.
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www.ahrq.gov/hai/cusp/modules/implement/alt-text.html
April 01, 2013 - STEP
I’M Safe
Mutual Support:
Task Assistance
Feedback
Advocacy and Assertion
Two-Challenge … the third column, Mutual Support tools include Task Assistance, Feedback, Advocacy and Assertion, Two-Challenge … - Offer a solution
- Obtain an agreement
TeamSTEPPS logo and penguin
Slide 26
Two-Challenge … observation at least twice to ensure that their interests and observations are being addressed
The Two-challenge
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/distributed-cognition-er-nurses5.html
August 01, 2022 - diagnostic error by understanding and optimizing the diagnostic process in this unique setting is a challenge
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www.ahrq.gov/professionals/systems/primary-care/pcp-costs/valko-costs.html
May 01, 2015 - Retrospective data collection from participating practices was a challenge because of administrative … To address this challenge, the study team allowed ample time for practices to estimate their costs and
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www.ahrq.gov/sites/default/files/2024-07/walker-report.pdf
January 01, 2024 - Three years ago,
Geisinger began to address this challenge by providing independent (non-Geisinger) … A sustainable business
case for information sharing was generally seen as a challenge in the current … information sharing at a
regional level, but many practical barriers exist, making implementation a challenge … Physician Interviews: Obtaining and sustaining physician participation is an
ongoing challenge. … Physician practices where information is
primarily paper based represent a particularly significant challenge