TeamSTEPPS® 2.0 Leadership Briefing
Slide 1: Title
Slide 2: What Is TeamSTEPPS®?
Slide 3: Why Use TeamSTEPPS?
Slide 4: Why Invest in TeamSTEPPS?
Slide 5: What Can TeamSTEPPS Do for Us?
Slide 6: What Can TeamSTEPPS Do for Us?
Slide 7: What Can TeamSTEPPS Do for Us?
Slide 8: What Can TeamSTEPPS Do for Us?
Slide 9: What Makes TeamSTEPPS Different?
Slide 10: What Will Our Teams Learn?
Slide 11: How Does TeamSTEPPS Work?
Slide 12: What Do We Need To Make This Work?
Slide 13: What Does Training Cost?
Slide 14: What Does Training Cost?
Slide 15: How Do We Start?
Slide 16: Training for the Guiding Team
Slide 17: Backup Slides
Slide 18: National Teamwork Initiatives
Slide 19: Importance of Communication
Slide 20: What Does it Cost?
Slide 21: Resources Available
TeamSTEPPS® 2.0 Leadership Briefing
- An evidence-based teamwork system.
- Designed to improve:
- Efficiency of health care.
- Practical and adaptable.
- Provides ready-to-use materials for training and ongoing teamwork.
Evidence-Based Teamwork System
- TeamSTEPPS is a teamwork system based on 20 years of experience and lessons learned from high-reliability organizations (for example, military operations, aviation, community emergency response services, nuclear power). These types of organizations have been conducting extensive research on how teams work, what makes them effective, and how to enhance their performance. This research is directly relevant to health care, because delivering effective care requires teamwork.
Designed To Improve Team Effectiveness
- TeamSTEPPS has incorporated the best practices from this research into a program to improve the quality, safety, and efficiency of health care by improving communication and other teamwork skills. These skills lead to important team outcomes, such as enabling the teams to:
- Adapt to changing situations.
- Have a shared understanding of the care plan.
- Develop positive attitudes toward and appreciate the benefits of teamwork.
- Provide more safe, reliable, and efficient care.
Practical and Adaptable
- Designed with input from the medical community, it is an initiative that will work within the daily functioning of our organization (it is practical) and can be customized (adapted) to meet our organization’s needs. For example, we could identify an appropriate teamwork tool/process to help address a known problem (from a variety of options) that will best work within a specific department and focus time on training the team to use that tool.
[Note: If you have a specific "problem" that a department or the organization is struggling with, use it as the example here; it will have more impact and focus the discussion/presentation on specific issues that are relevant to your senior leadership.]
- The TeamSTEPPS program provides materials to integrate teamwork principles into all areas of our health care system (for example, medical and support areas) so that everyone focuses on teamwork and the ongoing support needed to keep teamwork as the focus during daily work. The success of this program depends on enhancing the culture of our organization to focus on teamwork.
- Goal: Produce highly effective medical teams who optimize the use of information, people, and resources to achieve the best clinical outcomes.
- Teams of individuals who communicate effectively and back each other up dramatically reduce the consequences of human error.
- Team skills are not innate; they must be trained.
Review the goal statement.
- Health care systems, like many high-reliability organizations, depend on the coordinated interactions of care providers working in an environment that is:
- High risk.
- TeamSTEPPS provides the resources to optimize team performance across our organization.
- Human factors research has shown that even highly skilled, motivated professionals are vulnerable to error due to human limitations.
- But research has also shown that:
- Teams that communicate effectively and back each other up reduce the potential for error, which results in enhanced safety and improved performance.
- For example, the Joint Commission analyzed the sentinel events that were reported to them over the last 10 years and identified communication failure as the leading root cause of sentinel events.
- TeamSTEPPS improves communication and other teamwork skills (e.g., backup behaviors) that help an organization move toward attaining this goal. This is important because teamwork is not innate; it must be learned.
- Cost of TeamSTEPPS is minimal compared with savings.
- Annual cost is approximately 98,000 lives and $17-29 billion.
- Errors can be reduced by changes to the health care system, specifically by providing interdisciplinary team training.
- In 1999, the Institute of Medicine (IOM) estimated the annual cost of preventable medical errors in U.S. hospitals to be 98,000 lives and $17-29 billion every year.
[Note: Add cost information, if available, from your organization to make this slide more powerful. Consider: Cost of one lawsuit vs. implementation of TeamSTEPPS; recent data on the cost or number of medical errors within your organization. Consider reviewing a variety of sources, including adverse event and near-miss reports, root cause analyses or failure modes and effects analyses, and unit- or site-specific process and outcome measures (patient flow, hospital -acquired infection rates, preventable deaths, etc.).]
- The cost required to implement TeamSTEPPS is minimal compared with the cost of medical errors.
- The IOM concluded that medical errors could be significantly reduced through fundamental changes in our national health care system. One key recommendation was that health care organizations establish "interdisciplinary team training programs for providers that incorporate proven methods of team training."
Kohn LT, Corrigan, JM, Donaldson, MS, eds. To err is human: building a safer health system. Washington, DC: Committee on Quality of Health Care in America, Institute of Medicine, National Academy Press; 2000.
- After implementation of multiple medical team training programs:
- Improved observed team behaviors.
- Enhanced staff attitudes toward teamwork.
- Reduced observed clinical errors.
Clinical Units in a Medical Center2
- After implementation of SBAR to improve communication among clinical caregivers:
- Reduced rate of adverse drug events (from 30 to 18 per 1,000 patient days).
- Improved medication reconciliation at patient admission from 72% to 88% and at discharge from 53% to 89%.
- These are real examples that provide evidence of significant improvements in patient safety, clinical outcomes, and cost after implementing team training or specific elements within TeamSTEPPS.
- One of the anecdotal benefits of the initiative is that it "re-energizes" medical professionals to be interested in and proud of their profession.
- Morey JC, Simon, R, Jay GD, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MEdTeams project. Health Serv Res 2002;37:1553-81.
- Haig K, Sutton S, Whittington J. SBAR: a shared mental model for improving communication between clinicians. Jt Comm J Qual Patient Saf 2006;32(3):167-75.
Labor and Delivery Units1
- After implementation of multiple teamwork strategies and tools:
- A 50% reduction in the Weighted Adverse Outcome Score, which describes the adverse event score per delivery.
- A 50% decrease in the Severity Index, which measures the average severity of each delivery with an adverse event.
Intensive Care Units2
- After implementation of a "Patient Daily Goals" form to facilitate staff communication:
- A 50% decrease in mean ICU length of stay from 2.2 days to 1.1 days.
- Mann S, Marcus R, Sachs B. Grand Rounds). Lessons from the cockpit: how team training can reduce errors on L&D. Contemp OB Gyn 2006 Jan;51(1):34-45.
- Pronovost P, Berenholtz S, Dorman T, et al. Improving communication in the ICU using daily goals. J Crit Care 2003 Jun;18(2):71-5.
- After participating in an interprofessional TeamSTEPPS training during neonatal resuscitation in a simulated environment:
- Nurses who challenged a scripted medication order error increased from 38% before the training to 77% after training.
- The team’s ability to detect and correct inadequate chest compressions increased from 61.5% to 84.6% after the training.
- Sawyer T, Laubach V A, Hudak J, et al. Improvements in teamwork during neonatal resuscitation after interprofessional TeamSTEPPS training. Neonatal Netw 2013;32(1):26-33.
- After implementation of a "pre-op" brief:
- Increased OR communication.1,2
- Increased administration of properly timed prophylactic antibiotics prior to incision from 84% to 95%.1
- Increased pre-op deep vein thrombosis prophylaxis prior to induction from 92% to 100%.1
- Better error avoidance: Pre-op brief revealed seven patients (3.3%) with previously unidentified severe surgical risks—surgery cancelled.1
- A 16% reduction in nursing turnover rate.2
- A 19% increase in OR employee satisfaction.2
- Awad SS, Fagan SP, Bellows C, et al. Bridging the communication gap in the operating room with medical team training. Am J Surg 2005 Nov;190(5):770-4.
- Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004 Oct;13 Suppl 1:i85-90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765783/
- Evidence based and field tested.
- Easy to use.
- Publicly available.
TeamSTEPPS is different than some other teamwork and performance improvement programs. Rigorous scientific methods were used to develop TeamSTEPPS.
- Scientifically rooted in team performance and teamwork research and well-tested theoretical models for system-based error prevention (for high-risk industries).
- This research yielded a solid evidence base for a set of teamwork core competencies with identified knowledge, skills, and attitudes.
Field tested by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense TriCARE Management Activity
- Implemented within AHRQ high-reliability organization hospitals and ACTION partners and disseminated to AHRQ’s Patient Safety Improvement Corps.
- TeamSTEPPS is unique from other products in that it:
- Describes what to do.
- Guides users through how to do it (e.g., guidelines on establishing and implementing the program).
- Provides the needed resources (e.g., training content, exercise materials, tools).
- Fully customizable to meet our organization’s needs.
- Applies to all medical settings of any size or clinical specialty, either throughout the facility or within one work unit.
- May be implemented in full or in part.
- Mini case studies are available to be customized to our specialty area.
- Training includes standalone modules so our unique teamwork needs and resource availability can be considered when selecting what elements of the program we want to use.
Easy to use
- Provides simple, ready-to-use, structured communication tools and teamwork strategies that apply to our health care setting.
- TeamSTEPPS is in the public domain. Materials can be ordered from the AHRQ.
Image: The TeamSTEPPS logo.
Teamwork principles and training techniques apply to our organization as well as every other health organization.
If we implement TeamSTEPPS, our teams will learn about the four competency areas that lead to improved team performance, safer practices, and change in culture:
- Leadership—how to direct and coordinate, assign tasks, motivate team members, facilitate optimal performance.
- Situation monitoring—how to develop common understanding of team environment, apply strategies to monitor teammate performance ,and maintain a shared mental model.
- Mutual support—how to anticipate other team members’ needs through accurate knowledge and shift workload to achieve balance during periods of high workload or stress.
- Communication—how to effectively exchange information among team members, regardless of how it is communicated.
They will also learn about specific tools and strategies that can be implemented in our units that support these competencies. Some of these tools and strategies include:
- Team huddles.
- Two-Challenge Rule.
The end result will be a higher-performing team, where members:
- Share a clear vision of the plan.
- Use concise, structured communication techniques.
- Adapt readily to changing situations.
- Maximize the use of information, skills, and resources for optimal outcomes.
TeamSTEPPS reflects the dynamics that can occur when teams consist of physicians, nurses, and technicians. The initiative focuses on gaining the support of both physicians and nurses to enhance teamwork. To support this goal, one of the two trainers for the program should be a physician or nonphysician medical provider.
- Clearly define the need.
- Planning, Training, and Implementation
- Plan to sustain the effort.
- Train individuals.
- Implement and test the strategies.
- Integrate into daily practice.
- Monitor and measure programs.
A TeamSTEPPS Initiative occurs in three continuous phases.
Phase I—Assessment (Set the Stage)
This phase determines our organizational readiness for the initiative.
- Create a change team (the leaders and key staff who will drive the initiative).
- Identify a specific opportunity for improvement that could be accomplished through better teamwork.
- Formulate a vision for the initiative.
- Use site assessment tools to determine if the necessary leadership support, information base, and resources are in place.
[Note: It is important to identify a specific opportunity for implementing TeamSTEPPS (i.e., a problem to fix).]
Phase II—Planning, Training, and Implementation (Decide What To Do and Make It Happen)
This phase is where planning and execution take place.
- Develop an Action Plan specifying what will be done during the initiative (based on guidance from the TeamSTEPPS Implementation Guide).
- Conduct training, implement the tools and strategies selected, and test the intervention.
Phase III—Sustainment (Make It Stick)
This phase is designed to sustain and spread the improvements in teamwork performance, clinical processes, and outcomes throughout the organization.
- Help users integrate teamwork skills and tools into their daily practice.
- Monitor and measure the program’s ongoing effectiveness.
- Develop an approach for continuous improvement and spread the imitative throughout the unit or organization.
TeamSTEPPS is an initiative designed to change how our teams work together on an ongoing basis. It’s not just about the training but about providing sufficient time for teams to continue to practice the teamwork tools and strategies in their daily work. For example, its important to have a change agent who leads periodic meetings for a few months after the training to discuss how the team is performing and using the tools.
- Clearly define the need.
- Focus on enhancing teamwork and establishing a teamwork and safety culture.
- Get support from senior leadership.
- Allocate sufficient resources:
- Measure success.
- Reward and reinforce teamwork.
Clearly define the need: We need to identify a specific opportunity or issue we want to work on so that we can communicate why this initiative is important throughout the organization; we need to identify "what’s in it for me" for the staff. This need should be something we think a teamwork solution will work for (e.g., improving communication between nurses and physicians, ensuring everyone on the care team knows the plan). We need to align this initiative with other ongoing initiatives that we have (e.g., safety initiatives) so that it is not another "new program" but an integral part of achieving our vision.
Focus on enhancing teamwork and establishing a teamwork and safety culture: For this initiative to succeed, we need to establish a culture of teamwork and safety so that it’s not just a training program that staff go to, but a new way of working together. One of the powerful effects of this program is that it can reinvigorate our staff’s sense of pride in their profession and love of their work by providing them with tools to enhance their performance and increase patient safety. Staff (e.g., physicians and nurses) need to be willing to work together to communicate, question each other when appropriate, and back each other up.
Get senior leadership support: We need senior leaders to be involved, visible, and active in their support of teamwork. Senior leaders need to model the teamwork behaviors and skills we want the staff to adopt. We should identify a champion for this effort, someone with high credibility in the organization to lead and support the effort daily. We also need support of the leadership within the department that’s selected as the starting point for the initiative.
Allocate sufficient resources: We need appropriate time, personnel, and funding to establish the program, conduct the training, and then follow through on emphasizing the importance of teamwork in our daily work. For example, we need to:
- Identify trainers and coaches.
- Provide an infrastructure to support training.
- Allow time for staff to attend training (nurses, physicians, key personnel).
- Provide time for coaches to meet with staff members on an ongoing basis.
This may require some creative thinking, for example:
- How do we provide the opportunity for the team to attend training and still meet our target numbers/hours?
- How do we ensure that we have time to spend in team meetings in the future?
Measure success: We’ll need to continually evaluate whether the process is achieving the outcomes we anticipated. If we measure success, we can then publicize it to celebrate as well as further spread the buy-in for the process. We’ll also be able to modify the process based on lessons learned along the way.
Reward and reinforce teamwork: Since we need to create a teamwork and safety culture for this to be a success, it’s important that we reward and reinforce teams for engaging in the teamwork behaviors and learning teamwork skills. Leaders, champions, trainers, and coaches should be willing to provide ongoing feedback to others within the institution. Successes need to be formally recognized and showcased throughout the organization.
Key to Table Figures
- $A = Trainer preparation costs: Trainers’ time x trainers’ hourly rate.
- $B = Travel costs related to any of the train the trainer sessions.
- $C = Trainer costs to conduct training: Trainers’ time x trainer hourly rate.
- $D = Trainee costs: Number of staff to be trained x (number of training hours) x staff hourly rate.
- $E = Other training expenses: Food, senior leadership time for kickoff, etc.
- $F = Trainer costs for ongoing support: Number of “areas” participating x (hours of support) x trainer/coach hourly rate.
- $G = Optional cost for staff time discussions: As normal course of business.
- $H = Other ongoing support costs.
- $I, $J, $K = Total: Estimated costs at bottom of each column.
|Providing Ongoing Support||$F||$G||$H|
You can estimate the costs of implementing TeamSTEPPS based on the information below. You will need to make a few assumptions and then insert the estimated costs into the chart above. Based on the recommended approach for rolling out TeamSTEPPS, these numbers show the estimated cost for implementing the process, including training and post-training resource commitments.
- Estimate the number of people you will train.
- You may choose to implement TeamSTEPPS in phases. If so, estimate the total number of trainees accordingly. (You may want to report total costs and/or costs in phases.)
- Estimate the number of training sessions you will conduct and the number of trainers you will need.
- The average class size is typically around 20.
- Number of Staff To Be Trained/20 (Average Class Size) = Number of Training Sessions.
- Two trainers are required for each session. One will be a physician or nonphysician medical provider. Estimate how many trainers you will want to be prepared to deliver the TeamSTEPPS training (Number of Trainers).
- Estimate costs to prepare trainers (You may have your trainers train themselves. If so, reduce the Trainers’ Time as necessary).
- Number of Trainers x 3.5 (2.5 days of training plus 1 day travel) = Trainers’ Time.
- Trainers’ Time x Trainers’ Hourly Rate = Trainer Preparation Costs (Insert into Cell $A).
- Estimate any travel costs related to any of the train-the-trainer sessions and enter this into the other costs column (Insert into Cell $B). If train-the-trainer sessions will occur onsite, you will not incur travel expenses.
- Estimate costs to deliver training.
- Average staff time in training is 4 hours. If you will provide shorter or longer training, adjust your estimates accordingly.
- 2 Trainers x Number of Training Sessions x 5 (4 hours training + 1 hour trainer preparation) = Trainers’ Time.
- Trainers’ Time x Trainers’ Hourly Rate = Trainer Costs to Conduct Training (Insert into Cell $C).
- Number of Staff To Be Trained x 4 (number of training hours) x Staff Hourly Rate = Trainee Costs (Insert into Cell $D).
- Estimate any other training-related expenses (e.g., food, senior leaders’ time if they will kick off sessions) (Insert into Cell $E).
- Estimate costs for ongoing support of TeamSTEPPS.
- For each "area" participating in TeamSTEPPS, you can estimate costs based on the following assumptions (modify these as needed).
- For the first 3 months, a trainer or coach will spend approximately 8 hours per week. For the next 2 months, the trainer or coach will spend about 4 hours per week. In total, for the 5 months after training, the trainer or coach will spend about 128 hours supporting the team.
- Number of "Areas" Participating x 128 (hours) x Trainer/Coach Hourly Rate = Trainer Costs for ongoing Support (Insert into Cell $F)
- You can decide whether to include any staff time as a cost or to assume that discussing their work is a normal cost of business. (If included, insert into Cell $G.)
- Estimate any other ongoing support costs (Insert into Cell $H).
- Total the estimated costs in each column (Insert into Cells $I, $J, and $K).
- Create a sense of urgency.
- Pull together the guiding team.
- Formulate a change vision and strategy.
- Communicate your vision for understanding and buy-in.
- Send trainers to one of the TeamSTEPPS National Implementation Regional Training Centers.
We’ll start the process by reviewing the Implementation Guide and materials provided in getting started. The process recommended is based on Dr. John Kotter’s nationally acclaimed organizational change theory:
- Create a sense of urgency. It’s important that we identify a need for improved teamwork and the importance of acting now. We need to tie the program to an existing potential problem. We can use organizational data to identify and support the selection of this problem.
- Pull together the guiding team. We need to select a powerful group to lead this effort by identifying individuals with leadership authority, credibility, communication ability, analytical skills, and relevant clinical expertise.
- Formulate a change vision and strategy. We will identify how fixing this "problem" will change the future such as improved clinical outcomes, staff and patient satisfaction; and safer, more efficient patient care. We need to ensure that our vision is feasible and we have the necessary resources, information infrastructure, commitment to improvement, and leadership support. We’ll start with a small unit using one teamwork tool then expand beyond that using lessons learned.
- Communicate your vision for understanding and buy-in. We’ll then showcase a successful effort to interest other units in participating and create some buy-in. We’ll focus on the leadership and staff members who are critical to our success.
- Send trainers to the National Implementation Regional Training Centers. Use these resources while they’re available to help reduce costs. Information is available at https://www.ahrq.gov/teamstepps/instructor/in-person.html.
- Training is available on a "first come – first served" basis.
- Visit AHRQ’s TeamSTEPPS Web site for more information and available courses.
- The following slides (18–21) can support the briefing and may be integrated into slides 1–14 as appropriate.
- The Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges include aspects of communication, coordination, and collaboration in physician competencies.
- The National Quality Forum included teamwork training, skill building, and teamwork interventions in Safe Practices for Better Health Care: A Consensus Report (2006 update).
- The Joint Commission has increasingly included elements of teamwork in their National Patient Safety Goals and accreditation standards.
- The Centers for Medicare & Medicaid Services included TeamSTEPPS in the 9th Scope of Work.
The evidence base was convincing enough to prompt national teamwork improvement initiatives.
ACGME is looking at core competencies for medical graduates and identifying standards of performance.
- Communication failure has been identified as the leading root cause of sentinel events over the past 10 years (Joint Commission).
- Communication failure is a primary contributing factor in almost 80% of more than 6,000 root cause analyses of adverse events and close calls (VA Center for Patient Safety).
The Joint Commission analyzed the sentinel events that were reported to them over the last 10 years and identified communication failure as the leading root cause of sentinel events.
The Department of Veterans Affairs National Center for Patient Safety database shows similar results, with communication failure cited as a primary contributing factor to adverse events and close calls.
- Costs can be modified by obtaining materials and having trainers teach themselves.
- Based on the National Implementation of TeamSTEPPS Project, we estimate that a Change Team member will spend 10% FTE (200 hours) on this effort.
The costs presented in the previous slide can be modified or reduced by:
- Obtaining materials and having trainers teach themselves (less preparation of trainer costs).
- Attending master training.
- Using change team members. Based on the National Impact Program, we estimate that a change team member will spend 10% FTE (approximately 200 hours) on this effort during the implementation year.
- TeamSTEPPS resources include:
- Three teamwork training curricula.
- Course Management Guide.
- Multimedia course materials.
- TeamSTEPPS Implementation Guide.
- Measurement tools.
- Web site for updated resources and information:
TeamSTEPPS provides everything we need to build and sustain highly effective medical teams for today’s complex health care environment.
Three Teamwork Training Curricula
- Train-the-Trainer—to train individuals within our organization to be trainers; highly interactive (2 days).
- TeamSTEPPS Fundamentals—to train direct care providers on the teamwork concepts and skills; highly interactive (4-6 hours).
- TeamSTEPPS Essentials—to provide an overview of teamwork to nonclinical staff; provides basic tools for communication (2 hours).
Course Management Guide
- Provides a reference for team training instructors on how to prepare, execute, assess, and sustain the initiative.
- Includes complete course descriptions and an explanation of how to use resources.
Multimedia Course Materials
- Includes a set of educational media on CD and DVD that accommodates multiple learning styles.
- Illustrates concepts using slide presentations, discussions, video vignettes, case studies, testimonials, demonstrations, practice exercises, role play, and simulation.
- Includes a Pocket Guide, extensive evidence-based summaries, bibliography, and sample agendas and evaluations.
TeamSTEPPS Implementation Guide
- Includes a comprehensive "how-to" guide that details the necessary steps to design, implement, monitor, and sustain the initiative. Includes the Guide to Developing a TeamSTEPPS Action Plan and Implementation-At-A-Glance.
- Includes a battery of validated, ready-to-use tools to assess the effectiveness of the initiative.
- Provides instructions for selecting tools, developing measures , and analyzing data.