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Action Planning Worksheets

TeamSTEPPS Implementation Guide

TeamSTEPPS is a teamwork system developed jointly by the Department of Defense (DoD)and the Agency for Healthcare Research and Quality (AHRQ) to improve institutional collaboration and communication relating to patient safety.

Action Planning Worksheets for each step are contained in the following pages. 

TeamSTEPPS Action Planning Worksheet — Step 1

Step 1. Create a Change Team

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

Essential Change Team Members

Change Team Member Name(Staff Position) Key Characteristics Primary Role(s)

Senior Leader

"Executive Sponsor"

  
  • Enough "clout" in the organization to implement new approaches to care.
  • Authority to allocate time and resources necessary to achieve team's aim(s.)
  • Authority over all areas that will be affected by the change.
  • Sponsors and visibly supports the Change Team.
  • Creates the vision of the new system for the organization as a whole.
  • Leads the spread of specific changes throughout the organization or system.
  • May choose to become a member of the Change Team

Clinical or Technical Expert

"The Champion"

Physician(s):

Nurse(s):
  • Expert knowledge of the relevant clinical subject matter.
  • Understands the processes of care within workspace where changes will occur.
  • Good working relationship with colleagues and front-line leaders.
  • Interest in driving/leading change

Essential to have at least one Physician Champion and one Nurse Champion.
  • Responsible for being members of the instructor cadre.
  • Responsible for coaching and role-modeling the team behaviors and skills.
  • Responsible for keeping the executive sponsor updated.
Front-Line Leader  
  • Understands details of the organization (unit/department.)
  • Understands effects of making changes in the institution.
  • Able to work effectively with the physician/nurse champions.
  • Is the critical driving force on the team.
  • Assures that changes are tested / measured.
  • Provides oversight for data collection.

 

Other Change Team Members

Name (Staff Position) Primary Role(s)
   
   
   
   
   

 

Identify team member(s) with medical teams expertise:

 

Identify team member(s) with process improvement experience, including performance trending techniques:
NOTES:

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TeamSTEPPS Action Planning Worksheet — Step 2

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 the TeamSTEPPS Intervention, and identify the involved process. *What specifically do you want to "fix" or improve? Note: When the word "problem" is used, it broadly refers to any challenges you choose to tackle or opportunities for improvement that would most likely be positively impacted by a TeamSTEPPS Initiative.

Briefly state the problem, challenge, or opportunity for improvement that will be improved through medical teamwork. What is it that you will fix or improve?


 

What is the evidence to support your problem selection?

 Adverse event due to a breakdown in team skills (e.g., communications, situation monitoring, mutual support/back-up.)

  Near miss(es) due to breakdowns in team skills.

  Staff members are concerned that we could have an adverse event due to breakdowns in team skills.

  Other data, evidence or supporting information: __________________________________________________________________

  Do you have any data?

  • Workspace performance data: __________________________________________
  • Incident reports.
  • Results from the AHRQ Patient Safety Culture Survey.
  • Results from the Team Assessment Questionnaire.
  • Results from the Team Performance Observation Tool.
  • Other:_________________________________________________

 

Identify the clinical process during which the target problem occurs:

What is the clinical process or communication process during which the problem occurs?

Who is involved in the "problem" process? (List by staff positions not individuals' names. Could also include patients.)

When does the "problem" occur? (e.g., day shift, night shift, shift changes, certain days or clinical circumstances)

Where does it occur? (e.g., clinical setting or site)


 
NOTES:

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TeamSTEPPS Action Planning Worksheet — Step 3

Step 3. Define the Aims of Your TeamSTEPPS Intervention

Objective: To succinctly state in measurable terms exactly what you hope to achieve with your TeamSTEPPS Intervention — what will be achieved, who will be involved, and when and where the change will occur.

State at least one team process aim:

A team process aim states your goal for how well your staff will carry out your TeamSTEPPS Intervention as you designed it. Examples include (a) a goal for how often your staff will use the intervention team tool (e.g., brief, SBAR, I PASS the BATON) or (b) a goal for how many staff members will receive medical team training.

What do we want to achieve? (e.g., number of staff who receive team training; increase in rate of use of a specific teamwork tool)

 

Who will be involved in the change? These are the persons who are involved in the "what you want to acheive" listed above - such as the staff members who receive medical team training or who use the teamwork tools (List by staff position or title, not individuals' names.)

 

When will the improvement occur? Within what timeframe?


 

State at least one team outcome aim.

A team outcome aim is directed at the changes that occur in team performance as a result of your staff carrying out your intervention. It states your goal for improvements in your staff's team performance.

What do we want to achieve? (e.g., increase staff perception of good team behavior; increased observed effective team communication among staff)

 

Who will be involved in the change? Whose team behavior will change? (List by staff position or title, not individuals' names.)



 

When will the improvement occur? Within what timeframe?





 

State at least one clinical outcome aim.

The clinical outcome aim is your goal for improvements in clinical results due to improved team performance.

What do we want to achieve? (e.g., increased patient satisfaction; improved performance on a relevant healthcare quality measure [e.g., increased rate of appropriate prophylactic use of beta-blockers to prevent intra-operative myocardial ischemia]; decreased rates of adverse events or near misses)

 

Who will be involved in the change? Whose behavior will change and/or which patient populations will be affected?

 

When will the improvement occur? Within what timeframe?


 
NOTES:

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TeamSTEPPS Action Planning Worksheet — Step 4

Step 4. Design a TeamSTEPPS Intervention

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

Identify opportunities for process improvement using team strategies/tools:
  1. In the space below, flowchart or map the process — where the target problem or opportunity for improvement occurs — write down the process steps as they currently occur and identify who is doing what, when, with what tools. Use extra sheets of paper if needed.
  2. Then mark with an "X" the risk points in the process where things could go wrong and lead to a recurrence of your target problem.
  3. Finally, identify with arrows where in the process team strategies and tools might eliminate or mitigate the risk points and prevent the problem from recurring.

 

Review the evidence-base and search for best practices.
Have other groups successfully used specific team tools to reduce similar process risk points? Are there any relevant patient safety requirements, expert recommendations, or best practices? If so, list below and cite source or reference.
Draft your TeamSTEPPS Intervention. State what team strategies and tools (e.g., brief, debrief, STEP, SBAR, I PASS the BATON) will be used, who will use them, when and where.

 

Evaluate your intervention for potential benefits and negative effects.
  1. In the space below, flow-chart or map your redesigned process as it would look with your intervention in place. Study the flowchart and then:
  2. Mark potential failure points in the redesigned processes. How will you reduce their probability or severity?
  3. Identify system-wide potential benefits and negative effects. How will you control potential negative effects?
  4. Evaluate your intervention using the TeamSTEPPS Intervention Checklist.
  5. If necessary, go back and modify your intervention based on your evaluation.

 

TeamSTEPPS Intervention Checklist

  Targets a specific defined problem and clinical process.

  Consistent with patient safety requirements.

  • DoD
  • Service
  • Accreditation

  Consistent with current mission and system operating procedures.

  Benefits outweigh risks

  Evidence-based

  Measurable

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

  Feasible

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

  Acceptable

  • Staff
  • Leadership
  • Patients

  Patient-focused.

  Can be integrated into current operations.

  Sustainable.

  Includes a training plan.

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

  Incorporates redundancy and back-up systems to minimize risk of patient harm in event of error or process failure.

  Addresses human factors.

For Example:

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

Return to Contents

 

TeamSTEPPS Action Planning Worksheet — Step 5

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?

Complete the following table for each one of your aims.
 
State Aim:
Individual (staff position) on Change Team responsible for data collection, analysis, and presentation:
Measures and target ranges for that measure:
Measure must answer if you achieved your aim.

Study design:

  Pre- and post-intervention study

  Other design. Describe:

 

"Test subjects" or data source and control group:
 Pre- and post-intervention study - baseline (pre-intervention) data from the study group serves as the control.
  Other control group. Describe:

Data collection methods:
For both baseline and pre-intervention data, identify who will collect the date, when, where, and how.

Baseline (pre-intervention data):



 

Post-intervention data:




 
Methods for data analysis and interpretation:
What calculations will you perform with your data to determine if you achieved your aims? Examples include event counts, rates (percentages), survey scores, and time-to-event occurrences.
Data presentation methods (e.g., line graphs, run charts, bar graphs, control charts):
 
Resources required (time, equipment, personnel, expertise):

Timelines:
Show on a timeline when you will collect data, analyze it, and present it.

Baseline (pre-implementation) data:



 

Post-implementation data:




 
NOTES:
 
 

Return to Contents

 

TeamSTEPPS Action Plan Worksheet — Step 6

Step 6. Develop an Implementation Plan

Objective:
Part A: To develop a plan for training your staff in the medical teamwork knowledge and skills required to successfully implement your TeamSTEPPS Intervention.
Part B: To develop a plan for putting your TeamSTEPPS Intervention into place.

PART A: MEDICAL TEAM TRAINING PLAN — INITIAL TRAINING

Trainee Group (Audience)* Trainer Training Site Date & Times Training Content (Knowledge & Skills) Training Methods & Tools
           
           
           
           
           

 

* List trainees by group. Complete a trainee roster on a separate sheet of paper.

PART A: MEDICAL TEAM TRAINING PLAN — NEWCOMERS' TRAINING

Trainee Group (Audience)* Trainer Training Site Date & Times Training Content (Knowledge & Skills) Training Methods & Tools
           
           
           
           
           
           

 

* List trainee by group. Complete a trainee roster on a separate sheet of paper.

PART A: MEDICAL TEAM TRAINING PLAN (continued)

Timeline for Initial Training:

  Ensure that all baseline data are collected prior to implementing medical team training.

Timeline for Newcomers' Training:




 

Timeline for Refresher Training:





 

NOTES:





 

PART A: MEDICAL TEAM TRAINING PLAN — REFRESHER TRAINING

Trainee Group (Audience)* Trainer Training Site Date & Times Training Content (Knowledge & Skills) Training Methods & Tools
           
           
           
           
           
           

 

* List trainee by group. Complete a trainee roster on a separate sheet of paper.

PART A: MEDICAL TEAM TRAINING PLAN (continued)

Timeline for Initial Training:

  Ensure that all baseline data are collected prior to implementing medical team training.

Timeline for Newcomers' Training:




 

Timeline for Refresher Training:





 

NOTES:





 

PART B: IMPLEMENTATION PLAN FOR TeamSTEPPS INTERVENTION

Baseline Data:

  Check that all baseline data are collected prior to implementing your TeamSTEPPS Intervention.
Identify person(s) responsible for implementation:
Describe the intervention implementation plan:
How will you assess if the TeamSTEPPS Intervention has been correctly implemented among your staff members?

Timeline for implementation of your TeamSTEPPS Intervention:

  Check that all baseline data are collected prior to implementing your intervention.





 

NOTES:

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TeamSTEPPS Action Planning Worksheet — Step 7

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 on-going assessment of the effectiveness of the intervention, for sustainment of positive changes, and for identification of opportunities for further improvements.

Monitoring Plan
The monitoring plan will measure over time if the intervention continues to be effective. The plan can be a continuation of your testing plan, although you may want to simplify it by reducing the frequency of measurements. Describe your monitoring plan:

Measures and target ranges:



 

Data source:



 

Data collection methods:



 

Methods for data analysis and presentation:



 

Person(s) (staff position) responsible:

 

Plan for sustaining and spreading positive changes:
Consider: (a) recognition and rewards program; (b) continuous feedback on performance and sharing of lessons learned; (c) continued teamwork coaching and refresher training; (d) integration into existing processes; (e) publicizing successes; (f) integration of newly acquired staff
Resources required (money, time, equipment, personnel, expertise):

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TeamSTEPPS Action Planning Worksheet — Step 8

Step 8. Develop a Communication Plan

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

Person(s) (by staff position) responsible for implementation and oversight of communication plan:
___________________________________________________________________________________

Stakeholder ("Who") Communication Goal(s) Information to Communicate ("What") Timing of Communications ("When") Communication Methods ("How")
         
         
         
         
         
         

Notes:

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Page last reviewed November 2018
Page originally created September 2012

Internet Citation: Action Planning Worksheets. Content last reviewed November 2018. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/teamstepps/instructor/essentials/implguide2.html

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