TeamSTEPPS Implementation At a Glance

TeamSTEPPS Long-Term Care Instructor Guide

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.

Implementation Overview

A TeamSTEPPS Initiative occurs in three continuous phases: Phase I - Assessment; Phase II - Planning, Training, & Implementation; and Phase III - Sustainment. A nursing home or work unit can shift toward a culture of safety using team tools and strategies by progressing through each of the three phases and completing the key actions within each phase. The TeamSTEPPS Initiative provides guidelines, tools, and resources for completing each phase and for gathering data necessary for progression to the next phase. Keys to success at each phase include involvement of the right people, use of information-driven decisionmaking, and careful planning before acting. The following paragraphs provide an overview of each of the phases, including goals and objectives, key actions, and recommended tools and resources.

Shift Toward A Culture of Safety

The shift process has three phases. Phase 1: Assessment. Pretraining assessment includes site assessment, culture survey and data/measures. Are these ready? If no, pass through climate improvement and return to pretraining assessment. If yes proceed to action plan and then move on to Phase 2. Phase 2: Planning, training and implementation. Training leads to intervention. Intervention includes testing and leads to Phase 3. Phase 3: Sustainment. This phase includes culture change: coach and integrate, monitor the plan, and continuous improvement. Continuous improvement includes going back to training to lead to more culture change. In short: Set the stage, decide what to do, make it happen and make it stick.

Phase I: Assessment

The goal of Phase I is for the nursing home (or work unit) to determine if it is ready to undertake a TeamSTEPPS Initiative. An organization is ready if it has (a) a climate conducive to change and (b) objective information to support the need for a TeamSTEPPS Intervention. A climate conducive to change is characterized by leadership and key staff members who are committed to making a change and who are willing and able to dedicate the necessary time, resources, and personnel. During Phase I, an initial Change Team (the group of individuals who will drive the TeamSTEPPS Initiative), is formed of leaders and key staff members, who determine organizational readiness for undertaking the TeamSTEPPS Initiative by conducting a site assessment and reviewing available organizational data.

At the completion of Phase I, an organization decides that it IS or IS NOT ready for a TeamSTEPPS Initiative. If the Change Team determines that the nursing home IS NOT ready but believes that a TeamSTEPPS Initiative would likely benefit safety and quality of care, they should make efforts to move the organizational climate toward readiness and to collect objective data that would support the need for the initiative. If the Change Team determines that the nursing home IS ready for a TeamSTEPPS Initiative, they will proceed through the three phases.

Phase II: Planning (Action Plan), Training, and Implementation

The goal of Phase II is for the Change Team to develop a detailed action plan for their entire TeamSTEPPS Initiative and then to follow that plan to conduct resident care team training and to implement the TeamSTEPPS Intervention. Three key actions occur during Phase II - writing a TeamSTEPPS Action Plan, conducting resident care team training, and implementing (and testing) the TeamSTEPPS Intervention.

Phase III: Sustainment - Monitor, Coach, and Integrate

The goal of Phase III is to sustain and spread improvements in teamwork behavior and in associated clinical processes and outcomes resulting from the TeamSTEPPS Initiative. Specific objectives are to integrate key elements of the TeamSTEPPS Initiative into normal daily routines, to monitor the ongoing effectiveness of resident care team training and the TeamSTEPPS Intervention, to identify opportunities for continued improvement, and to spread positive changes throughout the nursing home.

Tools and Resources:

  • Measurement Tools: AHRQ Patient Safety Culture Survey, Patient and Staff Satisfaction Surveys, Team Assessment Questionnaire, Team Performance Observation Tool, Learning Benchmarks, and site-specific process and outcome measures.
  • TeamSTEPPS Training Techniques, Sample Course Evaluation.
  • Guide to Developing a TeamSTEPPS Action Plan.
  • Massoud MR, Nielsen GA, Nolan K, et al. A Framework for Spread: From Local Improvements to System Wide Change. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2006. Available at .
  • 100,000 Lives Campaign. Running a Successful Campaign in Your Hospital, How-to Guide. Cambridge, MA: Institute for Healthcare Improvement; 2006. Available at .
  • 100,000 Lives Campaign. Getting Started Kit: Sustainability and Spread, How-to Guide. Cambridge, MA: Institute for Healthcare Improvement; 2006. Available at .

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Page last reviewed October 2014
Page originally created October 2012
Internet Citation: TeamSTEPPS Implementation At a Glance. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.