QIO Implements TeamSTEPPS® in Two Iowa Hospitals
IFMC, the Medicare Quality Improvement Organization (QIO) for Iowa, uses "Team Strategies and Tools to Enhance Performance and Patient Safety" (TeamSTEPPS®), a program developed by AHRQ and the Department of Defense aimed at optimizing patient outcomes and promoting a culture of team-driven care. IFMC is using TeamSTEPPS with Covenant Medical Center and Sartori Memorial Hospital to improve patient safety by enhancing teamwork and communication.
QIOs are tasked by Medicare to work with nursing homes and hospitals to improve patient safety and quality of care. Because TeamSTEPPS emphasizes teamwork and communication, Medicare leaders saw the program's training as a natural element for the safety and quality objectives. Each QIO was required to send at least two staff members to receive the training. Iowa elected to send more than 20 staff members for training.
The TeamSTEPPS system builds on four competency areas—leadership, situation monitoring, mutual support, and communication—and provides tools to use in a multitude of situations. The program helps to avoid the miscommunications that are clearly associated with medical errors.
Kelli Vellinga, RN, BSN, is a Collaboration Specialist with IFMC and a TeamSTEPPS master team trainer. She uses the TeamSTEPPS tools to assist hospitals working on surgical care improvement to reduce surgical infections and complications.
Vellinga says that, when working with a hospital, it is important to conduct a comprehensive readiness assessment to determine whether an organization has the culture and leadership necessary to implement TeamSTEPPS. To reinforce the use of the tools and strategies, Vellinga joins surgical teams in the units and coaches them directly, sometimes following patients from admission to the operating room.
"TeamSTEPPS has a lot of tools, and we try to customize the approach based on the providers' needs. After conducting my assessment and on-site observation, I assist teams in developing a customized plan to improve the quality and safety of care. As an outsider, I can be a change catalyst," says Vellinga. "Sometimes a fresh perspective is just enough to create that discomfort or urgency that is necessary for change to occur."
Kathy Eisenman, RN, Surgical Services Manager at Sartori Memorial Hospital, works with Vellinga to implement TeamSTEPPS. She became a master trainer after IFMC introduced the program. "We learned the effect TeamSTEPPS can have on patient safety, and we talked about debriefs, huddles, and trying to communicate better," she says. "We took baby steps at first trying to get it going—we picked out a few tools from the program like CUS ('I'm concerned, uncomfortable, this is a safety issue'), handoffs, briefing, and debriefing. We also tried to stress the environment of collaboration, and that it's okay to speak up in order to change the culture of safety."
Covenant Medical Center and Sartori Memorial Hospital share a Director of Surgical Services, Marcia Dlouhy, RN, BS. Dlouhy says the hospitals' national surgical care infection prevention measures have significantly improved. "Our data show we are ranking much better now than before we introduced TeamSTEPPS. We're spreading this to the other departments now. It isn't just happening with the surgical teams."
Eisenman agrees that the results of the improved communications TeamSTEPPS creates are far-reaching. Improvements in the hospital's scores on national surgical care safety measures that reduce the incidence of surgical complications are being attributed directly to TeamSTEPPS tools. "Because we are smaller hospitals, it's easy to see the surgical care infection and complication prevention measures improving from unit to unit. Now, all team members are looking to make sure both the pre- and post-operative antibiotic is administered appropriately, which is an important measure used to determine surgical care infection prevention processes."
In addition, Eisenman says that her teams' attitudes about patient safety have changed because of the TeamSTEPPS program. "At first it was to meet the mark; now it is because we want zero complications and infections. All the units are committed to the TeamSTEPPS process."
Dlouhy says the goal is to reach 100 percent in all the surgical infection prevention measures. "Are we at 100 percent yet? No, but we are getting the doctors and the teams working together better. We will get there."
TeamSTEPPS®: Strategies and Tools to Enhance Performance and Patient Safety. November 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://teamstepps.ahrq.gov.