University of Florida Health Center Improves Teamwork Among Staff and Health Outcomes in Diabetes Patients Using TeamSTEPPS

The University of Florida used AHRQ’s TeamSTEPPS® to enhance communication and teamwork among the medical staff at Archer Family Health Care, its university-affiliated, nurse-led primary care practice located in Archer, Florida. The goal was to promote effective team care among clinicians treating a select group of patients with diabetes and depression.

Not only did teamwork and communication improve, but patient outcomes improved as well. In fact, 53 percent of patients with diabetes had reduced blood sugar levels, and 33 percent of patients reduced their severity of depression after the Archer team took the TeamSTEPPS training and began putting their knowledge to use.

“Using TeamSTEPPS training strategies such as closed-loop communication, situation monitoring, and mutual support enabled the Archer Family Health Care staff to improve coordination of care as well as identify barriers faced by patients in obtaining care,” said Karen Whalen, Pharm.D., assistant dean for clinical education and clinical professor at the University of Florida’s College of Pharmacy.

With the TeamSTEPPS strategy on closed-loop communication, the staff discussed each patient’s treatment plan during team meetings to ensure everyone was aware of the next steps in coordinating their care. The staff also used the TeamSTEPPS “check-back” method of repeating back the treatment plan to confirm that team members understood any urgent issues in the care of patients. The TeamSTEPPS strategy on situation monitoring taught the staff to actively scan and assess each patient’s situation to identify and help resolve barriers to care, such as a patient’s inability to pay for medicines or arrange transportation to medical appointments. Mutual support, another TeamSTEPPS strategy, enabled the staff to work more closely together by being willing to step in to assist one another to ensure safe and efficient patient care.

As a result of improved team collaboration from the TeamSTEPPS training, Dr. Whalen said 53 percent of patients with diabetes experienced a one point or more reduction in their HbA1c blood sugar levels. Of those, 54 percent were able to maintain that reduction over a 1-year period. The 33 percent reduction shown in depression was based on a self-reported health questionnaire among those patients.

“If you want to be a good medical team, you have to communicate effectively and understand a patient’s entire situation,” Dr. Whalen said. “By training our entire staff on TeamSTEPPS principles and strategies, each member of our team can see how much their observations and assistance have contributed to benefit our patients.”

She believes formal training in teamwork, such as with the TeamSTEPPS model, is “essential to ensure the success of an effective interpersonal health care team.”

TeamSTEPPS has also been used to train the university’s medical, nursing, and pharmacy students to prevent medication errors using simulated medical care scenarios, according to Carol Motycka, Pharm.D., assistant dean and Jacksonville campus director at the university’s College of Pharmacy.

Students were surveyed before and after participating in four simulated medication management scenarios, including a constantly crying baby with the wrong medical chart and a 60-year-old patient having an adverse reaction to an antibiotic just before surgery.

Following the training, survey data showed statistically significant improvements in students’ perceptions related to the TeamSTEPPS focus areas of leadership and teamwork, communication, situation monitoring, and mutual support.

“Nineteen of the survey’s 30 data categories showed significant improvement,” Dr. Motycka said, adding that plans are underway to expand the TeamSTEPPS training and medical error simulations at the university.

“Based on the positive results of the training at our Jacksonville campus, we are hoping to replicate this training for pharmacy students at our other two campuses,” she said. “Long-term, we’d also like to embed this training in the curricula of our medicine and nursing programs across all campuses.”

TeamSTEPPS was developed by AHRQ in collaboration with the Department of Defense.