AHRQ Patient Safety Surveys, TeamSTEPPS Used in Georgia Nursing Homes and Hospitals
Alliant/GMCF, the Medicare Quality Improvement Organization (QIO) for Georgia, used AHRQ's patient safety culture surveys and team training tools in tandem to help nursing homes and hospitals identify areas in which they can improve patient safety.
Medicare contracts with QIOs to help providers improve the quality of care. It also requires them to use tools such as AHRQ's "Nursing Home Survey on Patient Safety Culture" and "Team Strategies and Tools to Enhance Performance and Patient Safety" (TeamSTEPPS®), a team training program developed by AHRQ and the Department of Defense. The requirement to use such tools was founded under Medicare's 9th Scope of Work.
Quality Advisors at Alliant/GMCF administered AHRQ's patient safety culture survey to 62 nursing homes before providing TeamSTEPPS training. The survey results were then used to identify the best strategies for improving care.
"We used TeamSTEPPS to set up a matrix that showed participants their issues from the survey, and then matched interventions with weaknesses," says Mari Lou Keberly, RN, who served as a Quality Advisor on the Care Transitions Team.
As a result of the TeamSTEPPS training, Alliant/GMCF incorporated the tools into its program design. The TeamSTEPPS system builds on four competency areas—leadership, situation monitoring, mutual support, and communication—and provides tools to avoid the miscommunications that have been demonstrated to be associated with medical errors.
During the 9th Scope of Work, five TeamSTEPPS master trainers and the organization's leadership supported the use of the communications tools. One of the trainers noted, "We are encouraged to work together as a team and to find ways to be more effective. We were able to use a common language and apply it to our organizational culture. This improved our internal processes, while helping us to improve our communication."
Alliant/GMCF offered elements of TeamSTEPPS training to every nursing home in Georgia through the State's biannual regional meetings for nursing homes. The training reached 118 nursing home administrators, 286 staff members, and invited guests, such as long-term care ombudsmen. Monthly statewide calls reinforced TeamSTEPPS concepts and highlighted a nursing home that had successfully used the tools. Session evaluations proved that building skills in communication and teamwork were highly valuable to both staff and leadership.
Alliant/GMCF TeamSTEPPS trainers have had an opportunity to use, share, and evaluate the tools. One corporate nursing home that worked with the organization on improving care transitions asked for additional training for the nursing home leadership. This team focused on improving handover management, while working toward reducing hospital readmissions.
Quality Advisors found that incorporating TeamSTEPPS strategies with other work that they are doing has helped to overcome communication barriers, while focusing on improving the quality of health care. "A real benefit of the AHRQ toolkit is that it promotes better communication to help keep everyone on the same page. Most everyone connects with that concept, so they support it," says Keberly.
TeamSTEPPS: Strategies and Tools to Enhance Performance and Patient Safety. November 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://teamstepps.ahrq.gov/abouttoolsmaterials.htm.
Nursing Home Survey on Patient Safety Culture: Items and Dimensions. AHRQ Publication No. 08-0060, September 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nhsurvey08/nhdimensions.htm.