Sizing Up the Iceberg: Exercise Sheet

TeamSTEPPS® Long-Term Care Version, Module 8

The Long-Term Care version of TeamSTEPPS adapts the core concepts of the TeamSTEPPS program to reflect the environment of nursing homes and other other long-term care settings such as assisted living and continuing care retirement communities. The examples, discussions, and exercises below are tailored to the long-term care environment.


As you answer the questions below, consider the current state of your nursing home and the current safety climate. In your group, answer the following questions assigned to you by the instructor.

1. Do you have a "Fred" in your organization? If so, how is this person treated?

Step 1: A Sense of Urgency

2. What information do you have that may indicate a need for change in your nursing home?

3. Where else might you look for "hidden" information?

4. In the story, Fred took to Alice to see and experience the potential dangers for herself. How would you do that in your nursing home?

5. Have you ever known a "Nono"? What impact has that person had on change in your nursing home?

6. How is the need for change communicated in your facility? What do you think is the most appropriate way to communicate the need for change?

7. What can you do to create a sense of urgency for change in the nursing home?

Step 2: The Guiding Team

8. What characteristics would you look for in a team to guide change in your nursing home?

9. What do you think is the most crucial thing to enable this guiding team to truly function as a team?

Step 3: A Change Vision and Strategy

10. How might you best determine what your change strategy needs to be?

Step 4: Understanding and Buy-In

11. How could you best ensure understanding and buy-in of needed changes in your nursing home?

12. Identify ways to communicate and reinforce change that you believe would be most effective in your nursing home.

Step 5: Fewer Obstacles, More Empowerment

13. Where might you anticipate and eliminate barriers to change in the nursing home?

14. What do you believe might be behind people's resistance to change?

15. What are the norms of your "colony" that may interfere with change?

Step 6: Short-Term Wins

16. Identify examples of successes relative to the changes needed in your nursing home that you have already seen.

17. What could you do to reinforce success? (Remember the festival at the school?)

Step 7: Not Letting Up

18. Describe what you think it will take to really keep change going in your nursing home.

19. What resources and/or support will people need to implement the needed change?

Step 8: A New Culture

20. Describe the new culture that you see for your nursing home. What will be the benefits of such a culture?

Page last reviewed November 2012
Page originally created November 2012
Internet Citation: Sizing Up the Iceberg: Exercise Sheet. Content last reviewed November 2012. Agency for Healthcare Research and Quality, Rockville, MD.