Course Management Guide

TeamSTEPPS® Long-Term Care Version

This guide provides an overview of the TeamSTEPPS initiative. A description of the course material, how to use it, and links to reference material on how to conduct the course, including training techniques and sample course planning tools, are provided.
 

Contents

Introduction
Course Overview
   Purpose
   Key Terms
   Key Elements and Available Tools
   TeamSTEPPS Overview
   TeamSTEPPS Course Options
   Course Versions
Course Preparation and Execution
   Selecting Instructors
   Selecting Coaches
   Course Materials
   Preparing for Instruction: Prior to the Course
   Preparing for Instruction: On the Day of the Course
   Delivering the Course
   After the Course
Appendices
   Appendix A: Sample Course Agenda
   Appendix B: Sample Course Evaluation Form
   Appendix C: Team Performance Observation Tool
   Appendix D: Team Assessment Questionnaire
   Appendix E: Training Techniques
   Appendix F: Learning Benchmarks
   Appendix G: Video Matrix

Visit the following Web site to obtain needed updates to the TeamSTEPPS curriculum: http://www.health.mil/dodpatientsafety/.

Attribution

Knowledge base for Culture Change derives from the work of John Kotter, PhD. Graphic design is inspired by the John Kotter (2006) book Our Iceberg Is Melting, Changing and Succeeding Under Adverse Conditions. This book illustrates Kotter's Eight Stages of Change, a proposed set of steps to initiate and sustain change in an organization, through the story of a penguin colony faced with a melting iceberg. User experience and feedback on this book sparked the graphic design concept for the Instructor Guide.

Course Management Guide

Introduction

This guide provides an overview of the TeamSTEPPS initiative. A description of the course material, how to use it, and links to reference material on how to conduct the course, including training techniques and sample course planning tools, are provided.

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Course Overview

Purpose

Upon review of the TeamSTEPPS Course Management Guide, the user will be prepared to:

  • Establish a systematic approach to all aspects of team training—assessment and readiness, planning, training and implementation, coaching, and sustainment of teamwork behaviors.
  • Possess the knowledge, tools, and strategies necessary to develop a customized pretraining, training, implementation, coaching, and sustainment and team improvement intervention and supporting Team Improvement Action Plan.
  • Understand the use and linkages between the training designs and all associated curriculum and media.

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Key Terms

To ensure understanding, a list of frequently used terms is provided and further defined.

  • Train-the-Trainer—In most cases, Master Trainers provide training to a group of participants, who then conduct training of staff at the unit, department, or facility level. These participants are also trained in skills to coach and role-model the behaviors.
  • Train-the-Participant—TeamSTEPPS trainers train participants of a particular workspace.
  • Master Trainer—A trainer knowledgeable of resident safety and regulatory standards of performance who is able to: perform site assessments and determine performance gaps; coordinate implementing TeamSTEPPS initiatives across a number of organizations; and prepare, train, and provide process consultation to the unit, department, or organization implementing teamwork.

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Key Elements and Available Tools

Assessment

  • Initial Site Assessment.
  • Leadership Support.
  • Observations.
  • Culture Survey.
  • Create a Change Team.
  • Select Instructor Cadre.
  • Select Executive Sponsor.
  • Establishment of Goals/Metrics.
  • SWOT Analysis.
  • Plan Training.
  • Grand Rounds(multidisciplinary).
  • Communication Campaign.
  • Pretraining (baseline) Survey.
  • Set Aims.

Planning, Training, & Implementation

  • Train-the-Trainer:
    • Fundamentals Course.
    • Change Management.
    • Coaching Workshop.
    • Implementation Workshop.
    • Practice Teaching Session.
    • Train-the-Participant.
  • Essentials Course.
  • Onsite Support of Initial Training.
  • Development of Team Improvement Action Plan.
  • Test Intervention.
  • Track Aims.
  • Communicate Updates.

Sustainment

  • Monitor Plan.
  • Ongoing Leadership Involvement
    • Executive Sponsor Updates.
  • Continued Training:
    • New Staff.
    • Refresher.
    • Inservice.
  • Newcomers' Orientation.
  • Coach.
  • Integration of Team Tools.
  • Team Performance Observations.
  • Posttraining Assessment.
  • Metric Results (reporting, analysis/reinforce).
  • Web-Based Updates.
  • Continuous Improvement.

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TeamSTEPPS Overview

The TeamSTEPPS initiative was developed by the Department of Defense Patient Safety Program, in collaboration with the Agency for Healthcare Research and Quality (AHRQ). TeamSTEPPS is an evidence-based comprehensive teamwork training system designed to improve quality and safety in health care, and is rooted in over three decades of research in high-stress, high-risk industries, such as military aviation.

TeamSTEPPS with specific team-related knowledge, skills, and outcomes is delivered to an organization by way of a customizable course. The course is delivered to individuals using a Train-the-Trainer model, resulting in instructors who in turn train and coach staff in targeted work units.

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TeamSTEPPS Course Options

Course Version & Description: Train-the-Trainer: TeamSTEPPS Fundamentals

Target Audience Class Size/
Composition
Course Materials Scheduling Frequency
TEAMSTEPPS Train-the-Trainer is designed for the health care team training coaches and instructors who will deliver the TeamSTEPPS curriculum. Ideal class size, to maximize learning and teaching effectiveness, is 25 participants per physician-nurse instructor pair. All classes should be interdisciplinary and cross-functional. Instructors' Guide Associated Media and Pocket Guide. The Instructor Guide is composed of TeamSTEPPS Fundamentals, Change Management, Coaching, and Implementation Workshops. Supplemental materials include practical exercises, video vignettes, specialty scenarios, evidence base, bibliography, and glossary Classroom instruction for TeamSTEPPS is designed to be conducted in 2.5 consecutive days. However, the course should be scheduled in a way that meets your facility's needs. To preclude disruptions and scheduling problems, participants should be excused from all duties during class attendance. An initial training is essential to create the instructor/coach cadre. Thereafter, the course is held as necessary to replace instructors. The TeamSTEPPS Train-the-Trainer Course is mandatory for the initial instructor and coaching team. Concessions can be and are made for individuals joining the team thereafter. Concessions are dependent upon the individual's experience with the material and with the process of coaching.
Course Version & Description: Train-the-Participant: TeamSTEPPS Fundamentals
Target Audience Class Size/ Composition Course Materials Scheduling Frequency
TEAMSTEPPS Fundamentals is designed for direct resident caregivers. Ideal class size is 25 participants to maximize interaction, learning and teaching effectiveness. All classes should be interdisciplinary and crossfunctional to include physicians, nurses, nursing, assistants, etc. Facility members determine the course materials necessary to train staff on site. If handouts are used, a common choice is to bind a set of course slides, printed three to a page, notes view. Supplemental materials can include the Pocket Guide, evidencebase references and tools such as I-Pass-the-Baton badge cards. Classroom instruction for TeamSTEPPS Fundamentals is designed as a 4-6 hour block for all physician and nonphysician unit or department members. The time block variability is dependent upon the time allocated to practice and interact. It is strongly recommended that TeamSTEPPS Fundamentals be mandatory for all direct resident caregivers. All new employees, to include residents, should receive this training as part of orientation. Coaching and reinforcement should be provided to all staff on a daily basis to maximize team functioning. Formal refresher training should be provided annually with ad hoc refresher training provided during inservices, etc.
Course Version & Description: Train-the-Participant: TeamSTEPPS Essentials
Target Audience Class Size /Composition Course Materials Scheduling Frequency
TeamSTEPPS Essentials is designed for nonclinical staff who provide a supporting role in the planning and/or execution of resident care. Class size should remain at a manageable number that allows for interaction and discussion. The Pocket Guide is used to reinforce learning and support discussions. Classroom instruction for TeamSTEPPS Essentials should be conducted in one 1.5-2 hour block for staff. It is strongly recommended that TeamSTEPPS Essentials be mandatory for department staff who do not provide direct care but are vital to care planning or execution (e.g., housekeeping, laundry, dietary).

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Course Versions

The customizable TeamSTEPPS curriculum is comprised of three major training products. Which product to use is determined by the training requirements:

  • Train-the-Trainer: A 2.5-day course designed to educate trainers in the fundamentals content and the associated knowledge and training required to implement and coach the desired behaviors necessary to achieve positive results.
  • Train-the-Participant: Is dependent on whether the participant is a direct provider of care or not.(The course version is not dependent on whether the workspace is trained by your own trainers or whether you choose to bring in outside trainers to train.)
    • If participant is a direct provider of care, then TeamSTEPPS Fundamentals is used. Fundamentals is the 4-6 hour TeamSTEPPS core platform, adaptable to any service or aspect of health care.
    • If the participant is not a provider of direct, hands-on care, then TeamSTEPPS Essentials is used. Essentials is a 2-hour course providing an abbreviated version of the Fundamentals content. This version is useful for staff who do not engage in the direct delivery of care, but who contribute essential information with an impact on the ongoing delivery of safe care. Important to note: TeamSTEPPS Essentials is not interchangeable with Fundamentals nor is Essentials a substitute for the basic education and skill practice offered through Fundamentals.

Customizing Content

The TeamSTEPPS framework has been extensively researched, piloted, and validated; therefore, it is recommended that the model remain intact. However, all courses are customizable in order to target the focus of your audience. The materials provided can be:

  • Used as is.
  • Customized with supplemental and interchangeable TeamSTEPPS content and examples (provided).
  • Customized with your own content and examples.

Important to note: It is incumbent upon those customizing presentations to scrub each example or case of its identifying details (e.g., without changing the impact of a case, a male can become a female, a child an adult, an adult a child). If those details are not able to be altered without an impact on the case, consider its use versus choosing another case. Consider the impact of open discussions on the caregivers involved in the case. If the decision is to keep the case, confidentiality and compliance with HIPAA regulations and protocol rule all discussions. All cases discussed should be closed cases. When in doubt regarding whether to use a case, discuss with facility management.

The customizable content icon is used in the Instructor Guide to assist you in identifying which sections of the modules have additional content (e.g., video vignettes or specialty scenarios) that can be used to customize the content. In all cases, the kit provides Word or PowerPoint documents that you can revise as needed. In all modifications or customization, please take the steps necessary to retain the TeamSTEPPS logo and the proper attributes or citations to all TeamSTEPPS contributors.

Information Detailing Course Versions

  • TeamSTEPPS Train-the-Trainer

    Using a Train-the-Trainer model, the Instructor Course is a 2.5 day composition of interactive classroom workshops designed to create a group of instructors for a department or facility. The Course provides instructor candidates with the skills needed to teach content, coach staff, and manage the Team Improvement Action Plan.

  • Day 1—is designed to deliver TeamSTEPPS Fundamentals and the Course Management Guide.
  • Day 2—is designed to provide the tools, strategies, and skill practice that address organizational change, change and resistance management; implementation planning, instructor and coaching skill development, and a 10-Step Team Improvement Action Plan. The Action Plan is designed to identify problems, establish goals and specific aims, determine team sensitive metrics, and monitor and analyze data to determine the impact of behaviors on process and outcomes. Day 2 topics include: Change Management: Achieving a Culture of Safety, Coaching Workshop and Implementation Workshop.
  • Day 3—is designed to provide instructor candidates the opportunity to practice teach preassigned modules from TeamSTEPPS Fundamentals. Day 3 is monitored by an Instructor who provides coaching and consultation to each participant. The length of Day 3 is dependent upon the number of participants teaching. Candidates teach for 20 minutes and then receive 2 minutes of peer feedback and coaching and 2 minutes of coaching/consultation from the Instructor. Ideal class size for the practice teaching sessions is eight participants per assigned master trainer.
  • TeamSTEPPS Train-the-Participant

    The Train-the-Participant course is a 4-6 hour interactive workshop that introduces the participant to the Fundamentals content that includes tools and strategies specifically designed to improve communication and team-driven outcomes. Module topics include: Course Introduction, Team Structure, Leadership, Situation Monitoring, Mutual Support, Communication, and Summary.

    Although little is known with regard to team training and alternate schedules or "dosing," the concept is popular specifically where blocking large segments of time for education is a challenge or threat to the safe delivery of care. Below are two alternatives to one-time training:

    .

  • Delivering the seven modules in two separate sessions:
    • Session 1 provides course introduction, team structure, leadership and communication.
    • Session 2 provides situation monitoring, mutual support, course summary and skill practicum.
  • Delivering one module a week for 7 consecutive weeks.

    While not much is known about training and dosing, what is known is that the full effect of the team behaviors will not be appreciated until the team is trained on the full suite of team skills and behaviors and engaged in their day-to-day use. It is suspected, however, that improved teamwork as an end is more important than the means. The intent of this Guide is to provide a flexible curriculum package that can be adapted to fit the needs of your facility and caregivers.

    Important to note: To preclude disruptions and scheduling problems and to maximize learning, participants should be excused from all duties during class attendance.

  • TeamSTEPPS Essentials Course

    The Essentials course is a condensed, modified version of TeamSTEPPS Fundamentals. Essentials delivers, in a 1-2 hour interactive workshop, the core teamwork concepts and specific tools and strategies known to improve communication and teamwork and reduce the chance of medical error. To achieve the full safety effect of teamwork, TeamSTEPPS Essentials s not interchangeable with Fundamentals nor is it designed to serve as a substitute for the basic education and skill practice offered through Fundamentals.

    Important to note: To preclude disruptions and scheduling problems and to maximize learning, participants should be excused from all duties during class attendance.

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Course Preparation and Execution

Selecting Instructors

The role of selected instructors is not restricted to classroom teaching. Teamwork success cannot be guaranteed through classroom training alone. As is the case with any change effort, the introduction of a teamwork system requires champions in everyday practice to reinforce, monitor, and role-model teamwork principles; Instructors serve as the change agents for the teamwork initiative.

Due to the complexity of the instructor role, it is imperative that selected candidates are:

  • Viewed as advocates of teamwork. Instructors are the champions of teamwork within the department and the facility. They must believe in the principles of teamwork and be the model for implementing teamwork actions during day-to-day operations, setting the example.
  • Dynamic presenters; individuals with a desire and talent to teach and make a point. (When choosing candidates, envision yourself in their classroom for 4 hours; what is your reaction?) Candidates should possess strong oral communication skills. Seek volunteers if your process allows. The act of volunteering carries with it an internal commitment to succeed.
  • Members of an interdisciplinary training team. To reinforce the team focus and interdisciplinary nature of this program, the teamwork curriculum should always be taught by a two-person team representing nursing and one other discipline and augmented by additional interdisciplinary team members when possible, or as appropriate.
  • Viewed as leaders among their peers and administrators. Instructors do not have to hold a position of legitimate authority in the department, but should be highly respected members of the department who are able to influence a systemwide change.
  • In positions that allow flexibility in scheduling. Instructors must be able to assume an active teaching role during periods of course delivery. In addition, they must be highly visible, accessible, and available for teamwork coaching throughout the change effort.

An effective training session does not just happen. There is a lot of work involved in preparing for class, delivering the material, and reviewing results of the presentation. Instructor responsibilities leading up to, including, and following course delivery are discussed below.

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Selecting Coaches

Learning does not stop after the completion of the course. Instructor/coaching candidates, as an aspect of their change team responsibilities, work to adopt and adapt the coaching plan to fit the unit or department. The number of coaches per staff member is higher than that for instruction. For coaching to be effective, one coach is required for every 10 staff members. To that end, the change team may decide to identify additional staff members to serve as coaches. New coaches require education on the coaching techniques discussed during the TeamSTEPPS Fundamentals Course, and a brief orientation to the coaching role. Additional tips and techniques on coaching can be found in the Instructor Guide—Module 9—Coaching Workshop.

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Course Materials

The TeamSTEPPS curriculum is rooted in research in military aviation and a robust evidence base of behavioral methods, human factors, and cultural change in health care. Additionally, inspiration for the TeamSTEPPS curriculum was derived from John Kotter's book Our Iceberg is Melting, Changing and Succeeding Under Adverse Conditions. This book provides a proposed set of steps to initiate and sustain change in an organization through the story of a penguin colony faced with a melting iceberg. This book provided the design concept for the Instructor Guide and presentation slides.

Instructor Guide

The Instructor Guide should be used as: (a) a course planning tool, and (b) a reference guide for teaching the course. It is very important to use the Instructor Guide as a course preparation tool since advance planning (such as identification of customizable content and practical exercises) is required for course delivery.

The Instructor Guide includes icons throughout the modules to notify the instructor or identify different actions that should be taken by the instructor and/or participant. The icons and their corresponding actions are shown below.

Time
Materials
Key Points
Discussion
Exercise
Play Video
Video Time
Customizable Content
Instructor Note

Supplemental Materials

  • Practical Exercise Hand-Outs.
  • Video Vignettes.
  • Specialty Scenarios.
  • Evidence Base for Each Module.
  • Measurement Tools.
  • Bibliography.
  • Glossary.
  • Sample Fundamentals Course Agenda (go to Appendix A).
  • Sample Evaluation Forms (go to Appendix B).

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Preparing for Instruction: Prior to the Course

Several actions should be taken prior to class to ensure an effective training session. Review the goals of each learning module and practical exercise. Know and practice teaching the material to be presented. A multidisciplinary training team should teach the course and, to the degree possible, scheduled instructors should be present for the entire session. (Instructors informally educate participants as to the value of the training when they themselves jump in and out of the sessions.)

There are a number of operational activities that must be completed prior to the day of the course. Completion of these tasks is essential for a smooth start.

  • Select and coordinate dates with the appropriate decisionmakers.
  • Schedule classrooms (as far in advance as possible).
  • Develop and publish the class schedule.
  • Coordinate meal and refreshment support as appropriate.
  • Schedule participants.
  • Submit for and coordinate the process to obtain continuing education credits through your local provider.
  • Distribute advance information—Make sure students have enough time to review information prior to the course (e.g., course agenda).
  • Obtain or print participant materials (e.g., pocket guides or presentation note pages).
  • Review all course materials:
    • Objectives.
    • Multimedia.
    • Handouts.
  • Meet with your training partner(s) in advance (training teams should be interdisciplinary)
    • Assign modules.
    • Assign or delegate roles and responsibilities for the class (e.g., a secretary or scheduling professional may be much more effective at obtaining classrooms and scheduling personnel than a physician or nurse). In short, identify the required training tasks, and take on the actions best matched to your skill base; share the tasks, share the training, celebrate the outcomes.
  • Practice:
    • Review the material.
    • Use the equipment.
    • Present a practice class. After a training session, many change teams determine the need for additional coaches. An excellent opportunity for a "first" or "practice" class is the opportunity to teach to early adopters, off-shift leaders, and new coaches. The new instructors benefit from growth in confidence and core capabilities and the unit or department benefits by the addition of enthusiastic champions who will serve as coaches and problem solvers.
    • Involve your training partner(s) and determine how best to support the course, the participant, and each other. Keep the course fun.

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Preparing for Instruction: On the Day of the Course

Several actions should be taken to ensure training sessions go smoothly:

  • Arrive early. Ensure that everything is available and operational.
  • Ensure all necessary support:
    • Classroom setup.
    • Availability of training aids and handouts.
    • Availability and operation of multimedia equipment.
    • Availability of training partner(s).
  • Check setup for refreshments if appropriate.
  • If continuing education credits are being granted:
    • Bring certificates for distribution.
    • Make sure information is complete on the attendance roster.
  • Distribute an attendance roster for signatures.
  • Provide participant materials.
  • Conduct last minute review.

A classroom that is set up poorly can adversely affect the presentation, while a room that is conducive to the adult learner will enhance the presentation. Two room setups are suggested. They are both designed to focus the students' attention on the instructor while providing an environment for interaction and discussion.

  • Horseshoe—This configuration works well when each participant will be seated at a desk or small table. Attention is focused to the front, but interaction with others is not impaired. Instructors are able to move freely about the room.
  • Table layout—This configuration is effective around a solid conference table or tables arranged in a "U" with an open center. The layout somewhat restricts the instructors' ability to move about the room and maintain eye contact. However, participant interactions are maximized.

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Delivering the Course

The following operational activities should be completed in the order presented:

  • While they are being greeted at the door, ask participants to sign an attendance roster.
    • Consider using first name only nametags (stick on). This aids to flatten the hierarchy among participants.
    • If continuing education units (CEUs) are being granted, read the disclosure statement informing students that the class will be conducted in an environment of nonattribution.
  • Deliver instruction using all of the available training aids and multimedia equipment to enhance the presentation.
  • Gather baseline data: distribute and collect Teamwork Assessment Questionnaires, AHRQ Patient Safety Culture Surveys, and Patient and Staff Satisfaction Surveys (If done prior to course, results can be incorporated into the presentation).
  • Distribute and collect course evaluations at the completion of the course. Student feedback is important for assessing the effectiveness of the training session. It is also essential for gathering data used to modify the course.
  • Distribute CEU certificates.

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After the Course

Final actions that need to be completed include:

  • Maintain an accurate and complete file of course information.
  • Participants (i.e., attendance rosters).
  • Course evaluations.

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Page last reviewed November 2012
Internet Citation: Course Management Guide: TeamSTEPPS® Long-Term Care Version. November 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/longtermcare/ltccrsmgmt.html