#on/nameclaimaim | #on/podcasts | #note/private ## Introduction ### Start with a story _Rebecca, do you have a particularly poignant story of teams coming together? I might tell a brief one about a code in CT for an ICU patient with angioedema post TNK who had a respiratory arrest. CT is next to the ED, but the ICU team was there, who's patient is it? Anesthesia showed up, who's airway is it? How do we take a group and turn them into a team? And how do I find my voice to be able to help organize this chaos? ### Guest Introduction - **Dr Rebecca Minehart, MD MSHPED** _Rebecca, this is what ChatGPT said about you, if you have a brief intro to send, happy to substitute, also send me all your bonafides_ Dr. Rebecca Minehart is an accomplished anesthesiologist and academic leader whose scholarship and presentations reflect a strong commitment to improving obstetric anesthetic care, fostering faculty development, and advancing team-based clinical safety. Holding the role of Associate Professor of Anesthesiology at Alpert Medical School of Brown University, she serves as Vice Chair for Faculty Development, and leads the Division of Obstetric Anesthesia at Women & Infants Hospital in Providence, Rhode Island.  Her clinical and scholarly focus centers on high-risk obstetric scenarios, implementing evidence-based care, promoting interdisciplinary communication, and reducing inequities in peripartum outcomes.  Among her many contributions, Dr. Minehart has delivered key presentations for professional societies and web-based continuing medical education, including topics such as obstetric anesthesiology resources in critical moments and leadership in physician‐scientist careers for women in anesthesiology.  Her leadership in faculty development, team-based safety culture, and obstetric anesthesia scholarship positions her as a distinguished contributor to both clinical practice and academic medicine. - **Dr. Lon Setnik, MD, FACEP, MSHPED** Dr. Lon Setnik is a board-certified emergency physician and simulation educator with over 20 years of experience in clinical care, leadership, and medical education. Currently, Dr. Setnik serves as the Director of Clinical Programs at the Center for Medical Simulation - the second oldest simulation program in the US. He holds appointments as a Part-time Lecturer in Anaesthesia at Harvard Medical School and Clinical Assistant Professor in Emergency Medicine at University of New England College of Osteopathic Medicine. His professional focus lies in advancing psychological safety, systems improvement, and experiential education to foster excellence in healthcare. Dr. Setnik is a sought-after speaker and educator, known for his innovative approaches to faculty development, team training, and critical event management and debriefing. ### Why is it so important to form a team quickly in high-stakes situations? - Anesthestic Emergencies require constant team formation – in a crisis, often a new team for every case. - **Great teamwork is critical** for **patient safety, clinician wellness, and community trust**. - **Poor teamwork increases stress & burnout**: worst cases aren’t just the hardest ones but the ones that “don’t feel right.” - **Our patients and families trust us more when they see great teamwork** → likely reduces **medical-legal risk**. - If we have a supportive framework like NCA, we can know what to say. Then we can start to pay attention to finding our unique voice. _How_ do we want to come across? ### What is Name-Claim-Aim (NCA) in one sentence? - **“NCA is the ABC's of teaming. - **NCA simple, flexible teamwork framework that helps rapidly form teams in high-stakes moments.”** - Name-Claim-Aim is a useful skin in English to a set of ideas about teaming - Teams need to identify that they are in a teaming situation - They need to create a shared mental model about what is happening and how they will work together - They need to have an identified and explicit structure matched to the needs of the situation - They need then prioritize and do the necessary tasks - In other languages or cultures, Name-Claim-Aim is not the ideal verbiage, it doesn't have to rhyme, but the framework should take us towards those 4 teaming concepts ## Understanding Crisis Situations ### Common Mistakes in High-Pressure Scenarios ### Key Mistakes That NCA Solves 1. **Assuming teamwork happens naturally** - **Solution:** Medicine needs to have and use a solid framework that helps us scaffold the learning of this highly complex process. - **Why it matters:** Teams must be actively formed, not assumed. We need a framework to learn, teach, and assess the process of teaming. 2. **Leaders are solely responsible for knowing what is happening and what to do** - **Solution:** **Name** what you know and don’t know in a way that includes team psychological ownership of the situation—this allows the team to contribute missing information, it shares the burden of thinking. - **Why it matters:** Leaders don’t need all the answers—they need to foster shared awareness, speaking up, shared mental models, and agreed to priorities 3. **Failing to adapt as the situation evolves** - **Solution:** **Claim** the leadership role clearly, then be ready to re-organize as the situation develops. **Aim** the team connecting people to tasks, roles are too confining for many of our dynamic situations. - **Why it matters:** A leader should focus on **orchestrating the team**, not splitting attention. Saying _“I will manage the team while you secure the airway”_ prevents cognitive overload. - Explicitly handing off leadership when teams come together or conditions change helps someone stay focused on the team, and gives them the role of managing the big picture. - Frequent check ins that involve not just what is happening, but how the team needs to evolve is key to keeping our operational structure aligned with the situational needs. - **Re-Name-Claim-Aim** at intervals to keep up with the situation. **Key Insight**: CRM provides principles, but **NCA helps execute them in real-time**. - **For educators**: NCA helps evaluate **team leaders’ performance**. - **For clinicians**: NCA provides a **trainable framework** for crisis response. ## The 'Name, Claim, Aim' Framework ### Step 1: Name #### What does “Naming” mean? - **Succinctly state the situation & provide just enough context**. - **Balance confidence & humility**: acknowledge uncertainty while aligning the team. #### Why does naming the problem help? - **Reduces cognitive load** (CRM research → explicit verbalization improves decision-making). - **Creates a shared mental model** → aligns team understanding. #### Example Story (1-liner) (Rebecca, happy if you have a better ICU example) - **Burn trauma med error** ICU nurse helping during multiple traumas accidentally gave **rocuronium instead of a normal saline flush** → patient stopped breathing and moving unexpectedly before being put on the monitor - **NCA moment:** _“Ok, we have a burn trauma patient with a head injury who got ketamine 20 mg and just stopped breathing and moving. I don’t know what happened, but he could have coded. I need everyone’s help, okay?”_ - **Nurse realized error immediately → rapid intubation, team function preserved.** ### Step 2: Claim #### What does “Claim” mean? - **Declare leadership & get team buy-in.** - **Claim role = reduce confusion & cognitive burden for team members.** - **Psychological safety grows here** – leader invites help, requires first closed-loop response, starts to build the cultural norms for the team #### Why is it important? - **Prevents leaderless chaos.** - **Keeps team focused & organized** → enables **role delegation & decision-making**. #### Do leaders always have to be the most senior person? - **No** – best leader is the one who **organizes the team effectively.** - **Great teams dynamically adjust leadership based on expertise.** #### Example Story (1-liner) - Rebecca here! ### Step 3: Aim #### What does “Aim” mean? - **Set a clear, actionable goal & invite input.** - **Clarifies both immediate priorities & big-picture direction.** #### How do teams balance quick action with making sure they’re on the right path? - **Actions provide diagnostic feedback** → reassess constantly. - **Final NCA step (“What am I missing?”) improves team thinking.** #### Example Story (1-liner) ## Practical Applications of Name-Claim-Aim ### How can someone start practicing NCA? 1. **Start with “Naming” in everyday interactions,** when you're in a moment of group confusion or conflict, see that as a likely mismatch of mental models. Try to get aligned on mental model sharing. 2. When observing resuscitations: ask yourself, does the group recognize it needs to be teaming? Does the team share a mental model for what's happening? Does the team understand their leadership structure? Does it fit the situation? Are people connected to a prioritized list of actions such that the right work is being done? 3. **Use NCA in non-crisis settings (e.g., daily rounds, meetings).** ### Does NCA apply outside of medicine? - **Yes** – applies in **team meetings, decision-making, & even personal situations.** - **Example:** _At CMS, we start staff meetings with:_ - _“We’re here to support each other, prevent things from slipping through cracks, and celebrate wins. I’ll get us organized, and I need all your help, okay? Next, lets get into our roles, timekeeper, recorder, capture action items. Before we get started, what else should we address?”_ ### How does Name-Claim-Aim help you find your voice as a resuscitationist? ### Final Takeaway - **See the world as a series of teaming moments.** - **When in a group, actively turn it into a team.** - **Use NCA to create shared mental models, organize your team, and maintain open communication.** ## Conclusion ### Where can people learn more? - **Website:** [harvardmedsim.org/name-claim-aim](https://harvardmedsim.org/resources/name-claim-aim/) - **Google:** Name-Claim-Aim - **LinkedIn:** @LonSetnik / @RebeccaMinehart? - **Email:** [email protected] / ### Final Thoughts on Leading in High-Stakes Situations - **To improve team skills, train Name-Claim-Aim separately before integrating it into complex simulations.** - **Like any procedure, teamwork needs structured practice.** - **Highlight NCA explicitly in training sessions—don’t bury it in medical discussions.**