Two Singapore Hospitals Train Staff in TeamSTEPPS

Patient Safety
December 2007

An evidence-based team training and implementation toolkit ? Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) ? has been used to train over 1,000 hospital staff in two hospitals in Singapore: Singapore General and Changi General Hospital. The toolkit was developed by AHRQ and the Department of Defense.

The training sessions were launched during Changi General Hospital?s annual Patient Safety Day event, and in the Singapore General Hospital as part of the Quality Week program. Rather than planning an entire new program, the organizers borrowed expertise from the TeamSTEPPS trainers.

The Singapore clinicians (physicians, nurses, and support staff) were trained in less than four days by TeamSTEPPS trainers. The trainers include Sue Hohenhaus, registered nurse and clinical human factors nurse researcher at Duke University Health System; Jay Hohenhaus, certified registered nurse anesthetist at Soldiers and Sailors Memorial Hospital in Wellsboro, Pennsylvania; and Stephen Powell, managing principal of Healthcare Team Training and a captain for a major airline.

The three were invited to conduct training at the Singapore hospitals following publication of an article they wrote that was published in August 2006 in the American Journal of Nursing. The article, ?Enhancing Patient Safety During Hand-Offs,÷ advocated that health care facilities adopt a communication technique when patient care changes from one person to another, whether it is between shifts, between departments, or between facilities.

TeamSTEPPS stresses teamwork and communication among doctors, nurses, and other health care providers in order to improve quality, safety, and efficiency. The system builds on four competency areas ? leadership, situation monitoring, mutual support, and communication ? and provides tools to use in a multitude of situations. To avoid the miscommunications that are clearly associated with medical errors, TeamSTEPPS helps establish a culture of patient-centered care through the use of teamwork and enhanced communication.

In Singapore, the team addressed the training in three parts, as follows:

  • Background information about why techniques were developed to enhance safety for the airline industry and how those techniques are being transferred to health care settings
  • Communication and the SBAR (Situation-Background-Assessment-Recommendation) technique
  • Patient advocacy and assertion

In addition, the training team conducted a ?Train the Trainer÷ session in Singapore. CEOs and other executives attended this session, in addition to nurses and physicians. This additional training is then augmented by a coaching component to transform the training into habits. Says Powell, ?You can teach these techniques, but unless you go into the setting and coach them, it is not as effective.÷

According to T.W. Lim, MD, Chairman of the Patient Safety Committee at Changi General, ?We found, while cultural differences do exist, the [TeamSTEPPS] concepts can be applied to our local situation. The training provided the foundation for us to shape our own training program for the staff.÷

One cultural difficulty, particularly for the women being trained at the Singapore hospitals, was overcoming the belief that questioning a physician is disrespectful. Though not all the nurses were women, nursing is a female gender-based profession, which ? regardless of whether the nurse is male or female tends to have a more subservient role.

?A lot of the training that I do is teaching them that it is not disrespectful to question physicians. The nurses are often the voice of the patient,÷ says Sue Hohenhaus.

She adds, ?The culture is so different in Singapore. It is much more difficult for a nurse to speak. But it was clear how much they wanted to learn when they would seek you out between sessions and in the hallways.÷

The TeamSTEPPS program is based on more than 20 years of experience in the aviation, military, nuclear power, health care, business, and other safety-conscious industries. It is intended to create an environment where people broadly communicate and have a clear understanding of the goals and objectives of the team.

Singapore General Hospital is the public sector's flagship hospital. Established in 1821, it is Singapore's oldest and largest acute care hospital with 1,515 beds. Changi General Hospital is a 797-bed hospital with a comprehensive range of medical services, caring for the health care needs of the community in the eastern part of Singapore.

Impact Case Study Identifier: 
AHRQ Product(s): TeamSTEPPS®
Topics(s): Patient Safety
Geographic Location: Singapore
Implementer: Singapore General Hospital/Changi General Hospital
Date: 12/01/2007
Page last reviewed December 2007