TeamSTEPPS 2.0: Module 11. Implementation Workshop

Instructor Overview: Implementation Workshop

 Instructor Note: In this module, you will describe the three phases of the TeamSTEPPS model for change and walk participants through the 10-step TeamSTEPPS implementation process.

The key activity within this module is the Implementation Planning Exercise, which allows participants time to work with their colleagues to develop their own Implementation Plan.

It is recommended that the information on pages 4-7 be used to introduce the Implementation Planning Exercise. If time permits, use the information provided on pages 8-21 to further describe each of the 10 steps. Importantly, allow time for the participants to work on their Implementation Plan and report back to the group at the end of the allotted time.

The Implementation module includes the content provided in the outline below.

 

#	Content	Page #	Approx. Time
1.	Introduction, Overview, and Key Principles	4—6	5 mins
2.	The 10 Steps of TeamSTEPPS Implementation	7-21	20 mins
3.	Implementation Planning Exercise	22—23	125 mins

 

	Subsections: Implementation Overview Key Principles The 10 Steps of TeamSTEPPS Implementation Implementation Planning Exercise
	Module Time: 150 Minutes
	Materials: TeamSTEPPS Implementation Guide

Contents

• Objectives
• Implementation Overview
• Key Principles
• Implementation Planning: 10 Steps
• Describe the Targeted Unit/Work Area
• Step 1. Create a Change Team
• Step 2. Define the Problem or the Opportunity for Improvement
• Step 2. Define the Problem or the Opportunity for Improvement (continued)
• Step 3. Define the Aims of Your TeamSTEPPS Intervention
• Step 4. Design a TeamSTEPPS Intervention
• Step 5. Develop a Plan for Testing Your TeamSTEPPS Interventions
• Step 6. Develop an Implementation Plan
• Step 7. Develop a Sustainment Plan
• Step 8. Develop a Communication Plan
• Step 9. Develop a TeamSTEPPS Implementation Plan Timeline
• Step 10. Review Your Plan With Key Stakeholders
• Exercise: Implementation Planning

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 Objectives

Say:

Upon completion of this module, you will be able to:

• Describe the steps involved in implementing TeamSTEPPS.
• Develop a TeamSTEPPS implementation plan.

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 Implementation Overview

Say:

A TeamSTEPPS initiative involves three continuous phases: Phase I—Assessment; Phase II—Planning, Training, & Implementation; and Phase III—Sustainment. TeamSTEPPS provides guidelines, tools, and resources for completing each phase and for gathering data needed to progress to the next phase. Keys to success at each phase include involvement of the right people, use of information-driven decision making, and careful planning before acting.

Let's review each phase.

Phase I: Assessment

• The goal of Phase I is for an organization (or work unit) to determine if it is ready to undertake a TeamSTEPPS Initiative. An organization is ready if it has a climate conducive to change and objective information to support the need for a TeamSTEPPS intervention.

Phase II: Planning, Training, and Implementation

• The goal of Phase II is for the Change Team to develop a detailed plan for their entire TeamSTEPPS initiative. Then, the Change Team must follow that plan to train the staff needed to implement the TeamSTEPPS intervention.

Phase III: Sustainment

• The goal of Phase III is to sustain and spread improvements in teamwork and in associated clinical processes resulting from the TeamSTEPPS initiative. Specific objectives are to integrate teamwork behaviors and tools into daily practice; monitor the ongoing effectiveness of the TeamSTEPPS intervention; identify opportunities for continued improvement; and spread positive changes throughout the organization.

TeamSTEPPS implementation is a dynamic process. While the information in this module will help you and your fellow change team members begin to develop your implementation plans, you will need to review and revise your strategy throughout the course of your initiative.

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 Key Principles

Say:

The TeamSTEPPS Implementation Guide is based on the principle of improving patient safety and quality of care by improving health care team processes. A team process is a series of interdependent actions that lead toward a desired endpoint. Examples of processes include admitting a patient, administering a medication, and transferring a patient from one unit to another.

Improving a team process includes the following steps:

• Identify a recurring problem or opportunity for Improvement that, if addressed, could lead to better patient safety or quality of care. What is it specifically that you want to "fix" or improve?
• Flowchart or map the process during which the targeted problem or opportunity for Improvement occurs. Write down the process steps as they currently occur and identify who is doing what, when, and with which tools.
• Study the process to identify weak points where things could go wrong and lead to a recurrence of the target problem or opportunity. These weak points are called risk points.
• Design and implement interventions aimed at eliminating or reducing the impact of the risk points. This in turn will prevent the targeted problem from recurring or will lead to your targeted improvements.
• Test the intervention to ensure that it did in fact eliminate or reduce the target problem or resulted in your targeted improvement.
• If the test shows that the intervention was successful, monitor intervention effectiveness, sustain positive process changes, and identify opportunities for further improvement.

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 Implementation Planning: 10 Steps

 Instructor Note: The remainder of this module walks participants through 10 steps of TeamSTEPPS implementation planning. The slides for each step contain the template the participants can use to record their plans. These templates are also provided in the TeamSTEPPS Implementation Guide, which can be found in Tab E after this Instructor Manual.

Do:

Provide participants with the TeamSTEPPS Implementation Guide.

Say:

Implementing TeamSTEPPS involves 10 steps. The 10 steps, which are included in the TeamSTEPPS Implementation Guide, are:

1. Create a Change Team.
2. Define the problem, challenge, or opportunity for Improvement.
3. Define the aims of your TeamSTEPPS intervention.
4. Design a TeamSTEPPS intervention.
5. Develop a plan for testing the effectiveness of your TeamSTEPPS intervention.
6. Develop an implementation plan.
7. Develop a plan for sustained continuous improvement.
8. Develop a communications plan.
9. Putting it all together—Develop an implementation plan timeline.
10. Review your TeamSTEPPS Implementation Plan with key personnel, and modify according to input.

 Instructor Note. If time permits, review each of the steps with the participants. Then, facilitate the Implementation Planning Exercise described on page 22. Allow participants to work on their plans with their colleagues. A total of 2.5 hours has been recommended for this module, including the planning exercise and report-outs by participants.

If time is limited, you may advise participants that the content on the following pages may be useful reference materials as they work through the implementation exercise. Provide participants with the exercise instructions found on page 22.

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 Describe the Targeted Unit/Work Area

Say:

Before you begin the first step of implementation planning, think about and describe the unit or work area in which you plan to implement TeamSTEPPS. Identify what that unit or work area looks like in terms of size and staff composition. This information will be important in identifying an Action Plan that is feasible within the targeted unit or work area. This information may also be useful in providing your organizational leadership with an overview of your plan.

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 Step 1. Create a Change Team

Say:

The objective of Step 1 is:

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

Key actions for Step 1 include:

1. Select a multidisciplinary Change Team.
2. Ensure representation from different leadership levels, including senior leadership, clinical/technical experts, and frontline leadership.
3. Ensure that at least one or more members have completed the TeamSTEPPS Master Trainer course.
4. If possible, ensure that at least one member has experience in performance improvement. Relevant skills include data collection, analysis, and presentation.

Tips for success in Step 1 include:

• The Change Team will focus on improving processes within its own unit. Choose members with relevant clinical expertise, workplace location, credibility, and direct involvement in the processes that will be affected by the TeamSTEPPS intervention.
• Ideally, all Change Team members will attend TeamSTEPPS Master Training.
• The optimal Change Team size is five or six individuals.
• Where relevant, involvement of both physicians and nurses from the clinical workspace is essential.

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 Step 2. Define the Problem or the Opportunity for Improvement

Say:

The objective of Step 2 is:

• To state the problem, challenge, or opportunity for Improvement that will be targeted by your TeamSTEPPS intervention.

Key actions for Step 2 include:

1. Identify a problem, challenge, or opportunity that could be improved with enhanced teamwork. Strategies include:
   • Reviewing unit performance and safety data, such as incident reports, the AHRQ Hospital Survey on Patient Safety Culture, the TeamSTEPPS Teamwork Perceptions Questionnaire and site-specific process and outcome measures.
   • Reviewing reports of root cause analyses and failure modes and effects analyses.
   • Asking frontline staff, "What bad outcomes are waiting to happen because of breakdowns in the transfer of critical information?" "What things keep you up at night?"
2. Identify the process during which the problem, challenge, or opportunity occurs by stating what the process is, who is involved, and when and where it occurs.
3. If you completed the TeamSTEPPS Implementation Worksheet as part of the Fundamentals Course, refer to the teamwork issue you identified in that exercise as a starting point (see responses to Module 7: Summary questions).

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 Step 2. Define the Problem or the Opportunity for Improvement (continued)

Say:

This slide provides an example of defining the problem or opportunity for Improvement. Here, we see that the Change Team would like to address suboptimal communication among surgical team members. They have further identified the what, who, when, and where as it relates to the team process.

Tips for success in Step 2:

Change Teams may want to define three or four problems or opportunities and then select the highest priority issue for the TeamSTEPPS intervention.

Look for problems or opportunities that meet the following criteria:

• The associated process occurs frequently.
• Breakdowns in team performance could result in harm to patients.
• Process change is feasible and likely within the short term.

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 Step 3. Define the Aims of Your TeamSTEPPS Intervention

Say:

The objective of Step 3 is:

• To state in measurable terms what you hope to achieve with the TeamSTEPPS intervention: what will be achieved, who will be involved, and when and where the change will occur.

Key actions for Step 3 include:

1. Develop one to three measurable aims for your TeamSTEPPS intervention, and state in one or two sentences what you hope will be achieved, who will be involved, and when and where the improvements will occur. Aims should align with your defined teamwork problem or opportunity for Improvement. Aims can be based on the process of the TeamSTEPPS intervention itself or on the outcomes of that intervention.
   • Team process aims focus on how well or often your staff carries out your TeamSTEPPS intervention. For example, you may state, "Increase the use of presurgical briefs in the OR by 40% within 3 months of implementing TeamSTEPPS. These will include the entire OR team for the given case and be conducted using a briefing checklist."
   • Outcome aims focus on changes that occur because your staff carries out the intervention. These aims can be directed changes in team performance (team outcome aims) or in clinical results (clinical outcome aims). An example of a team outcome aim is "Increase the perception of teamwork behaviors among OR staff within 6 months of implementing TeamSTEPPS. We will use the TeamSTEPPS Teamwork Perceptions Questionnaire immediately after training and 6 months post-training." An example of a clinical outcome aim is "Increase the percentage of OR patients who receive prophylactic antibiotics appropriately timed prior to incision from 85% to 100% within 4 months of the TeamSTEPPS implementation."
2. It is ideal (but not necessary) to have a team process aim, a team outcome aim, and a clinical outcome aim. This becomes particularly important when testing the effectiveness of your TeamSTEPPS intervention.
3. Review the information you recorded on the TeamSTEPPS Implementation Worksheet to help you identify your aims.

Say:

Tips for success in Step 3 include:

• Develop aims that specifically address the target problem identified during Step 2.
• Put time and thought into defining the problem and defining the aims of your TeamSTEPPS intervention, since they are the most important steps in Implementation Plan development. The target problem and stated aims drive the development of all remaining components of the Implementation Plan.

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 Step 4. Design a TeamSTEPPS Intervention

Say:

The objective of Step 4 is:

• To design a TeamSTEPPS intervention that will address your targeted problem or challenge and achieve your stated aims.

Key actions for Step 4 include:

1. Flowchart or map the process during which the target problem, challenge, or opportunity occurs. Write down the process steps as they currently occur and identify who is doing what, when, with what tools, and where teamwork is required.
2. Identify risk points where things could or do go wrong and lead to a recurrence of the problem, challenge, or opportunity.
3. Determine which TeamSTEPPS tools or strategies would work best to eliminate the process risk points.
4. Draft your TeamSTEPPS intervention. State what tools and strategies will be implemented; who will use them, when and where.
   • If you completed the TeamSTEPPS Implementation Worksheet during the Fundamentals Course, refer to the tools and strategies you identified, as well as the multi-team system to which the intervention will be targeted.
5. Evaluate your TeamSTEPPS intervention for potential benefits and negative effects:
   • Flowchart the redesigned process as you imagine it would look with your TeamSTEPPS intervention in place.
   • Identify potential failure points in the redesigned process. How will you reduce the probability or severity of these failures?
   • Identify potential benefits and negative effects of the redesigned process on units outside your workspace. How will you control potential negative effects?

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 Step 5. Develop a Plan for Testing Your TeamSTEPPS Interventions

Say:

The objective of Step 5 is:

• To develop a method to determine if your TeamSTEPPS intervention achieved your aims.

Key actions for Step 5:

Ideally, you will test if your TeamSTEPPS intervention achieved each one of the aims you generated during Step 3. If time and resources are limited, select only one aim for testing. Base your selection on the importance of the aim and on the feasibility of testing it.

Testing does not need to be complicated. Basic performance improvement trending and tracking methods generally suffice. For each aim you select, create a testing method by performing the following key actions:

1. Identify who on your Change Team will be responsible for data collection, analysis, and presentation (generation of graphs and charts).
2. Identify a measure and define target ranges for that measure.
3. Measure before and after you implement TeamSTEPPS to see if the desired changes occurred.

Tips for success in Step 5 include:

• Keep it simple. Select one solid measure for each aim.
• If you use any patient data, ensure that your plan adheres to all patient rights and privacy laws and regulations. Check with your governing Institutional Review Board, Committee for the Protection of Human Subjects, or other resident subject matter expert if you are unsure.
• Use existing data sources whenever possible. Determine what data your facility or workspace already collects that you may be able to use.

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 Step 6. Develop an Implementation Plan

 

Say:

The objective of Step 6 is:

• To develop a plan for training your staff on the TeamSTEPPS tools and strategies you plan to implement and to develop a plan for putting your TeamSTEPPS intervention into place.

Key actions for Step 6 include:

1. Identify your audiences and their training requirements.
2. Determine who (staff members within a targeted unit or department) needs to be trained on what TeamSTEPPS skills and by when.
3. Identify the instructors for each audience.
4. Develop a training plan for each audience, including:
   • Who will attend the training sessions.
   • What skills you will teach.
   • When the training sessions will occur and for how long.
   • Where the sessions will occur.
   • How you will train (method of presentation, tools, supplies).
   • Logistics such as schedules, equipment, impact of training on other operations, additional resources required, and notification of trainees and other key stakeholders.
5. Determine if any of your audiences will require refresher training. If so, repeat the above actions for refresher training.
6. Create your training timelines.
7. Include time for developing your materials and managing logistics.
8. Include initial, newcomer, and refresher training, if needed.
9. Determine whether and how coaches will be used to sustain your implementation plan. If coaches will be used, consider:
   • How many are needed.
   • When and how they will be trained.
   • How they will be used, including expectations for the role.

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 Step 7. Develop a Sustainment Plan

Say:

The objective of Step 7 is:

• To develop a sustainment plan for your TeamSTEPPS intervention, including plans for ongoing assessment of the effectiveness of the intervention and for identification of opportunities for further improvements.

Key actions for Step 7:

The purpose of the sustainment plan is twofold: to determine if your intervention continues to achieve your aims and to identify opportunities for further process improvement. Designing a sustainment plan is similar to designing a testing plan (Step 5). The sustainment plan is often just a simplified version of the testing plan, with fewer and less frequent measurements.

1. For your monitoring plan, determine:
   • Measures and target outcomes.
   • Data source or sources (e.g., existing QI database).
   • Methods for data collection.
   • Methods for data analysis and interpretation.
   • Resources required (money, time, equipment, personnel, expertise).
   • Persons responsible for implementation and oversight.
2. Determine how data from your monitoring plan will be used to continually improve processes and performance.

Tips for success in Step 7 include:

• Integrate your TeamSTEPPS intervention into existing processes for long-term sustainment. Make it part of your unit's normal daily routines.
• Publicize your successes. Examples include visibly displaying large wall charts in your workspace showing positive performance trends; writing articles in local publications and medical journals; and giving presentations on your results at staff meetings.
• Develop standardized procedures for integrating newly acquired staff.

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 Step 8. Develop a Communication Plan

Say:

The objective of Step 8 is:

• To create a communications plan targeting major stakeholders that will generate initial and ongoing support for the TeamSTEPPS initiative and promote the maintenance and spread of positive changes.

Key actions for Step 8 include:

1. Identify your stakeholders:
   • Whose support will be important for achieving the aims of your intervention and for maintaining positive changes?
   • Consider organization leaders, frontline leaders, staff directly involved in the intervention, patients, support staff, and other units affected by the intervention.
2. For each of your identified stakeholder groups, develop a communications plan, including:
   • Goals for communication with this group. What do you want to achieve?
   • Who will receive the information?
   • What information will you communicate?
   • When and how often will you communicate?
   • How will you communicate (e.g., reports, presentations, Emails)?
3. Identify a person on the Change Team who will be responsible for implementation and oversight of the communications plan.

Tips for success in Step 8 include:

• Stay focused on your goals for communication with each stakeholder group. Keep asking, "What do I hope to accomplish for the initiative (e.g., buy-in, resources, participation) by communicating with this group?" The goals will drive the development of your communications plan.

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 Step 9. Develop a TeamSTEPPS Implementation Plan Timeline

 

 

Say:

The objective of Step 9 is:

• To generate a written Implementation Plan, based on Steps 1 through 8, that will function as your "How-To Guide" for every component of your TeamSTEPPS initiative.

Key actions for Step 9 :

If you completed each of the worksheets for Steps 1 through 8, you have already written your TeamSTEPPS Implementation Plan. Ensure that your final Implementation Plan includes all of the following elements:

1. Identification of the Change Team.
2. Identification of the problem, challenge, or opportunity for Improvement that will be the focus of the TeamSTEPPS initiative.
3. Stated aims of the TeamSTEPPS intervention.
4. Detailed description of the TeamSTEPPS intervention.
5. A plan for testing the effectiveness of the TeamSTEPPS intervention.
6. An implementation plan for both medical team training and for the TeamSTEPPS intervention.
7. A monitoring plan for ongoing assessment of the effectiveness of the TeamSTEPPS intervention.
8. A communications plan to generate support for the TeamSTEPPS initiative, to keep major stakeholders informed of progress, and to maintain and spread positive changes.
9. Timelines.
10. Resources required.

Tips for success in Step 9 include:

• Save your original 10-step worksheets. They may contain information and ideas you might want later.

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 Step 10. Review Your Plan With Key Stakeholders

Say:

The objective of Step 10 is:

• To generate support and elicit ideas from major stakeholders, and to identify barriers to program implementation.

Key actions for Step 10 include:

1. Identify stakeholders who could contribute significantly to the Implementation Plan. Consider organization leaders, frontline leaders, persons directly involved in the intervention, and personnel with special expertise such as facility data analysts.
2. Ask key stakeholders to review your Implementation Plan and to provide input. Specifically request that they identify any potential problem areas and offer solutions.
3. Modify your Implementation Plan based on their input, if needed.

Tips for success in Step 10 include:

• You may want to ask some stakeholders to review only certain sections of the Implementation Plan.

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 Exercise: Implementation Planning

 Instructor Note: If, due to time, you did not review each of the steps on the prior slides with the participants, you may wish to briefly orient them to the TeamSTEPPS Implementation Guide, which is provided in Tab E, after this Instructor Manual. As noted previously, you may want to advise participants to reference the information on the prior pages as they work through the exercise.

Note that the timing of this exercise is flexible. That is, you may wish to increase the time that participants have to work on planning and select a few teams to provide very brief report-outs on their progress when you reconvene the group.

Say:

Your TeamSTEPPS Implementation Guide will walk you through the 10 steps. For some of the steps, you may want to reference the TeamSTEPPS Implementation Worksheet you completed during the Fundamentals course, on which you began to think about the teams affected by your teamwork issue and specific TeamSTEPPS tools and strategies to implement to address the issue.

You will have 1½ hours to work with your colleagues on your own TeamSTEPPS Implementation Plan. This is your time to begin to think through your plan so that you have a starting framework when you return to your organization.

At the end of this exercise, we will reconvene as a group and you will be asked to present what you and your team have accomplished.

 Instructor Note: If space permits, allow teams to move to separate breakout rooms or other areas where they can talk through their problems and think together.

If any individual participants are not attending with a team, ask about their implementation plans and try to identify some characteristic (e.g., type of teamwork issue, unit targeted for implementation, intended systemwide implementation) that allows you to match each individual with an existing team of participants. The individual matched with a team will be able to gather thoughts from the exercise that can be generalized to their own plans, and the teams may benefit from the inclusion of a different perspective.

 Instructor Note: It is strongly recommended that individuals who are knowledgeable about implementation are available during this exercise to walk around and spend time with each team as they work. Participants appreciate any guidance and assistance received during this exercise.

Do:

• After the participants have gotten started, circulate among the groups. Spend some time listening to each group's discussion and ask questions that will help them think through their plan.
• Be mindful of the time so that you can reconvene the entire group and ask participants to report on their plans. Allow others to ask questions.

	Time: 2 hours
	Materials: TeamSTEPPS Implementation Guide

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