Implementation Guide, 4

TeamSTEPPS® Long-Term Care Version

Keys to success at each phase include involvement of the right people, use of information-driven decision making, and careful planning before acting. The following paragraphs provide an overview of each of the phases including goals and objectives, key actions, and recommended tools and resources.

The Quick Reference Guide to TeamSTEPPS Action Planning

Step 1: Create a Change Team

Objective: To create a team of leaders and staff members with the authority, expertise, credibility, and motivation necessary to drive a successful TeamSTEPPS Initiative.

  • Ensure key leadership representation: senior leadership, frontline leadership.
  • Identify an executive sponsor.
  • Ensure key expertise representation: clinical/technical, medical teamwork, process improvement and trending techniques.

Step 2: Define the Problem, Challenge, or Opportunity for Improvement

Objective: To specifically state the problem, challenge, or opportunity for improvement that will be targeted by your TeamSTEPPS intervention and to identify the involved process.

  • Identify a problem, challenge, or opportunity that you feel could be improved with enhanced resident care teamwork.
  • Identify the process during which the target problem, challenge, or opportunity occurs by stating what the process is, who is involved, and when and where it occurs.

Step 3: Define the Aims of Your TeamSTEPPS Intervention

Objective: To succinctly state in measurable terms exactly what you hope to achieve with the TeamSTEPPS Intervention.

  • For each aim, state in one sentence in measurable terms what you hope will be achieved, who will be involved (whose behavior will change), and when and where the change will occur.
  • Ideally, define a team process aim, a team outcome aim, and a clinical outcome aim.

Step 4: Design a TeamSTEPPS Intervention

Objective: To design a TeamSTEPPS Intervention that will address your target problem, challenge, or opportunity and achieve your stated aims.

  • Flowchart or map the process during which the problem, challenge or opportunity occurs. Write the process steps as they currently occur, identifying who is doing what, when, with what tools.
  • Study the process to identify risk points where things could go wrong and lead to a recurrence of the target problem.
  • Identify team strategies and tools (e.g., brief, huddle, debrief, STEP, SBAR, and I PASS the BATON) that would eliminate the risk points and prevent the problem from recurring.
  • Review the evidence base, brainstorm, and elicit input from key personnel to design your TeamSTEPPS Intervention. State what team tools and strategies will be implemented and who will use them, when, and where.
  • Flowchart the redesigned process as it will look with the intervention in place to identify potential benefits and negative effects.
  • Evaluate your intervention using the TeamSTEPPS Intervention Checklist, and then modify it if needed.

Step 5: Develop a Plan for Testing the Effectiveness of Your TeamSTEPPS Intervention

Objective: To develop a method to determine if your TeamSTEPPS Intervention achieved your aims. Did it work?

For each aim, create a testing plan, including:

  • Change Team member responsible for data collection, analysis, and presentation.
  • A measure and target ranges for the measure.
  • Study design (usually pre- and post-intervention study).
  • Sample (study group) or data source with comparison group.
  • Methods for data collection, analysis, interpretation, and presentation.
  • Timelines for baseline and for postintervention data collection and analysis.
  • Resources required.

Step 6: Develop an Implementation Plan

Objective:
Part A: To develop a plan for training your staff in the resident care teamwork knowledge, attitudes, and skills necessary to successfully implement your TeamSTEPPS Intervention.

Part B: To develop a plan for putting your TeamSTEPPS Intervention into place.

Part A: Develop a Plan for Resident Care Team Training

  • Identify your instructors, trainee audience(s), and specific training requirements. Determine who needs to be trained on what team knowledge/skills and by when in order to achieve your aims.
  • Develop a training plan for each trainee audience, including who will attend, what will be taught, when and where sessions will occur, and how training will be conducted (e.g., method of presentation, tools, supplies).
  • Use TeamSTEPPS training materials that will best meet your audiences' training needs.

Part B: Develop an Implementation Plan for the TeamSTEPPS Intervention

  • Ensure that you have collected all baseline data before implementing the intervention.
  • Identify the person(s) responsible for implementation.
  • Determine how you will implement your intervention in order to achieve your aims. Identify who will use what team strategies and tools, when, and where.
  • Create an implementation timeline.

Step 7: Develop a Plan for Sustained Continuous Improvement

Objective: To develop a plan for continuous process improvement with your TeamSTEPPS Intervention, including plans for ongoing assessment of the effectiveness of the intervention, sustainment of positive changes, and identification of opportunities for further improvements.

  • Develop a monitoring plan for ongoing assessment of intervention effectiveness, including measures and target ranges; data source; methods for data collection, analysis, and use for continuous improvement; and person(s) responsible.
  • Develop a plan for sustaining and spreading positive changes, including rewards, feedback, integration, ongoing teamwork coaching, and sharing of lessons learned.

Step 8: Develop a Communication Plan

Objective: To create a communication plan targeting major stakeholders that will generate initial and ongoing support for your TeamSTEPPS Initiative and promote the maintenance and spread of positive changes.

  • Identify persons or groups whose support will be important for achieving your intervention aims and for maintaining positive changes. Consider nursing home and frontline leaders, staff directly involved in the intervention, residents, and other units affected by the intervention.
  • Develop a communication plan for each identified group, including your goals for communication, who will get the information, what information you will communicate, and when and how you will communicate it (e.g., reports, presentations, e-mails).
  • Identify Change Team member(s) responsible for implementation and oversight.

Step 9: Putting it All Together: Write the TeamSTEPPS Action Plan

Objective: To generate a written action plan, based on steps 1 through 8, that will function as your "How-To Guide" for every component of your TeamSTEPPS Initiative.

If you have completed each of the worksheets for steps 1 through 8, you have already written your TeamSTEPPS Action Plan. Ensure that your final action plan includes all the following:

  • Identification of the Change Team.
  • Identification of the problem, challenge, or opportunity that will be targeted by the TeamSTEPPS Initiative.
  • Stated aims of your TeamSTEPPS Intervention.
  • Detailed description of your intervention.
  • A plan for testing the effectiveness of your intervention.
  • An implementation plan for both resident care team training and your intervention.
  • A monitoring plan for on-going assessment of the effectiveness of your intervention.
  • A communication plan to generate support for the TeamSTEPPS Initiative and to promote maintenance and spread of positive changes.
  • Timelines.
  • Resources required.

Step 10: Review Your TeamSTEPPS Action Plan With Key Personnel

Objective: To generate support and elicit ideas from major stakeholders and to identify barriers to program implementation.

  • Ask key stakeholders to review your action plan and to provide input. Request that they identify any potential problem areas and offer solutions.
  • Modify your action plan based on their input, as appropriate.

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TeamSTEPPS Action Planning At a Glance

Flowchart. Step 1: Create a Change Team. Step 2: Define the Problem, Challenge or Opportunity for Improvement. Step 3: Define the Aim(s) of your TeamSTEPPS Intervention. Step 4: Design a TeamSTEPPS Intervention: Identify Priority Problem, Challenge or Opportunity from Step 2. Step 5: Develop a Plan for Testing the Effectiveness of Your TeamSTEPPS Intervention. Step 6: Develop an Implementation Plan. Step 7: Develop a Plan for Sustained Continuous Improvement. Step 8: Develop a Communication Plan. Step 9: Putting it All Together: Write the TeamSTEPPS Action Plan. Step 10: Review your TeamSTEPPS Action Plan with Key Personnel. Step 10 leads through Incorporate Feedback from Key Personnel back to Step 2.

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Checklist for Completing Root Cause Analysis

Root Causes:
  Summary of each root cause identified during the root cause analysis.

Risk Reduction Strategies (Corrective Actions):
  A detailed (step-by-step) risk reduction strategy for each root cause.
  An explanation for each root cause determined to NOT warrant risk reduction intervention.

Person(s) Responsible for Implementation

For each risk reduction strategy:
  Identification by title of person(s) responsible for each step of the risk reduction strategy.

Dates of Implementation & Completion

For each risk reduction strategy:

  Anticipated date of completion for each step of the risk reduction strategy.
  Actual date of completion for any steps already completed.

Plan for Measuring Effectiveness

For each risk reduction strategy, a specific plan to measure effectiveness, including:

  An objective, quantifiable indicator (measure).
  Description of sampling method, including:
       Identification of population from which sample will be taken.
       Sample size.
       Method for sample collection or recruitment.
       If random, definition of "random".

   Explanation of study design (e.g., direct observation, pretest/posttest, audit tool).
   Description of data collection methods.
   For each indicator, a target range for desired performance.

Source:

The Joint Commission. Tool To Assist Organizations in the Completion of the Framework for Conducting a Root Cause Analysis. Oakbrook Terrace, IL: Joint Commission International Center for Patient Safety.

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TeamSTEPPS Intervention Checklist

   Targets a specific defined problem/challenge/opportunity and process.

   Consistent with resident safety requirements

  • Accreditation (if applicable)

   Consistent with current mission and system operating procedures.

   Benefits outweigh risks.

   Evidence based.

   Measurable

  • Desired result can be measured with objective quantifiable data.
  • Data are accessible, complete, and accurate.
  • Effectiveness can be monitored over time for continuous improvements.

   Feasible

  • Costs.
  • Staffing.
  • Equipment and other resources.

   Acceptable

  • Staff.
  • Leadership.
  • Residents/family members.

   Resident focused.

   Can be integrated into current operations.

   Sustainable.

   Includes a training plan.

  • Initial.
  • Refresher.
  • Turnover.
  • Emergency procedures (rapid identification of and recovery from errors and process failures).

   Incorporates redundancy and backup systems to minimize risk of resident harm in event of error or process failure.
   Addresses human factors.

For example:

  • Simplifies procedures and protocols.
  • Standardizes equipment, procedures, and protocols.
  • Minimizes reliance on memory.
  • Clarifies responsibilities and details task descriptions.
  • Ensures that most qualified person performs each task.
  • Improves communication and information transfer between staff and between residents and staff.
  • Avoids excessive workloads.
  • Reduces handoffs.

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Internet Citation:

TeamSTEPPS Implementation Guide for Long-Term Care.. November 2012, Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/teamsteppstools/instructor/implguide.htm


Page last reviewed October 2008
Internet Citation: Implementation Guide, 4: TeamSTEPPS® Long-Term Care Version. October 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/longtermcare/implement/implguide3.html