Readiness Assessment

Is your practice or medical office ready for TeamSTEPPS^®?

Answering the questions below can help you determine the degree to which your practice (or the practice you support) is ready to initiate TeamSTEPPS. The questions are meant to help you to think through critical factors that can affect your success in implementing the program. In this spirit, we strongly encourage you to read the notes that accompany each question before you answer. You may also find it useful to involve a group (e.g., senior leaders) in assessing the practice’s readiness and determining steps you might take to realize the best outcome.

Instructions

Answer "Yes" or "No" to each question. Instructions for obtaining your readiness "score" are presented at the end of the questions.

Defined Need

1. Has your practice/the practice you support clearly defined the needs that are driving it to consider implementing TeamSTEPPS?

____ Yes   ____ No

A practice is more likely to implement TeamSTEPPS when it has objective information to support the need for improving specific areas. This "needs assessment" will ensure the practice has identified a challenge or issue for which more effective teamwork would enhance performance. Further, the assessment will help the practice select a specific challenge or issue for which the initial implementation would prove most fruitful.

Using a needs assessment to create a secure foundation for TeamSTEPPS may not be easy, because individuals have difficulty appraising their work environments in an unbiased way. The best way to proceed is to collect data that are as objective as possible. The most objective data are statistics gathered from practice-specific records: average length of patient wait times, number of followup appointments completed, compliance with preventive screenings, infection rates, number of misdiagnoses, percentage of lab results communicated to patient, etc. Such data provide a baseline of the practice’s current status. If appropriate, they can also be used to develop a business case or leader briefings.

Patient and staff satisfaction surveys, as well as other surveys completed by staff, can also provide useful information. Examples of the last category include the AHRQ Medical Office Survey on Patient Safety Culture, available at http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/index.html, and the TeamSTEPPS Teamwork Perception Questionnaire (T-TPQ), available at http://www.ahrq.gov/teamstepps/instructor/reference/teampercept.html.

2. Is building a stronger teamwork and safety culture an appropriate strategy to address the needs or quality improvement efforts of your practice/the practice you support?

____ Yes   ____ No

A substantial body of research and practice has shown that teamwork plays a key role in ensuring patient safety and high-quality patient care. A practice that is ready to focus on teamwork and safety is more likely to benefit from implementing TeamSTEPPS.

TeamSTEPPS focuses on developing five fundamental, interconnected skills: functioning as a unified team, communicating effectively, providing effective leadership, delivering mutual support, and monitoring an ongoing situation. As you define the practice's need for TeamSTEPPS, the results may reveal a challenge or issue for which TeamSTEPPS is obviously relevant (e.g., a lack of standardization in the way nurses and physicians communicate the same information).

On the other hand, the needs assessment may reveal a challenge or issue that, on the surface, does not appear to signal poor teamwork (e.g., patient wait times are significantly longer than desired). For the latter type of challenge, think about how this concern manifests itself in the behavior of office and clinical staff. You may discern patterns of interactions (or the lack of interactions) that seem to sustain the less than desirable functioning you have identified.

Finally, your practice/the practice you support may identify some challenges that exert a negative impact on efficiency but are not under your control and do not involve teamwork. For example, issues related to information technology, electronic health records, or other computer-driven functions affect the practice’s operations but cannot be resolved through strategies (such as a TeamSTEPPS implementation) focused on building stronger teamwork and safety culture.

Readiness for Change

3. Is now the right time to initiate a culture change (i.e., it will not compete with other quality improvement efforts or major changes currently being made in your practice/the practice you support, such as implementing an electronic health record system)?

____ Yes    ____ No

Appropriately implemented, TeamSTEPPS can exert a powerful effect on a practice's culture—markedly increasing staff engagement and fostering a sense of efficacy. Yet, because its implementation requires a solid commitment to organizational change, choosing an optimal time to initiate the program is critical. If your practice/the practice you support is currently experiencing other significant changes (e.g., instituting electronic health records)—or is undergoing a transition—a wise strategy might be to wait until these changes are completed before introducing TeamSTEPPS. Even if the changes are well coordinated, attempting to introduce multiple concurrent changes is likely to decrease the staff's ability and willingness to participate fully in TeamSTEPPS; they may view it as a distraction rather than an improvement.

A practical strategy for this aspect of readiness is to:

1. Identify the changes that are occurring or will occur during the timeframe within which TeamSTEPPS implementation is being considered.
2. Create a timeline for each change.
3. Determine which staff members are involved in each change.

This information can be used to decide an optimal (or at least more favorable) period for implementation. Sometimes delaying the effort for a few months can substantially enable staff capacity and willingness to change.

4. Have other factors, such as anticipated busy times of the year or known staffing fluctuations, been considered in the timing of TeamSTEPPS implementation?

____ Yes   ____ No

Routine staffing changes and the predictable ebb and flow in service demands can affect the appropriate timing of TeamSTEPPS implementation. Specifically, staff stability is important for the success of a TeamSTEPPS initiative. For example, if a small practice is facing staff retirements or extended leaves of absence, these temporary instabilities and staff shortages may influence timing decisions. Similarly, if a practice can anticipate busy times of the year, during which staff may feel overworked, consider allowing sufficient time to elapse before or after these potential distractions before introducing TeamSTEPPS.

As noted with regard to the general timing of implementation (see Question 3), a practical strategy for addressing the timing of implementation as it relates to factors such as staff stability and busy times of the year is to identify the anticipated timing of these factors and create a timeline of each. In addition, determine which staff members are affected by these factors. You can use this information to identify an optimal period for implementation. Recall that, sometimes, delaying the effort for a few months can substantially bolster staff capacity and willingness to change.

5. Does the leadership in your practice/the practice you support back the culture change and effort needed to implement and sustain TeamSTEPPS?

____ Yes   ____ No

TeamSTEPPS cannot succeed without the active support of the practice's leaders (e.g., practice owners or other administration). "Active support" means providing the personnel, time, and resources needed to implement and sustain trainer preparation, ongoing coaching, and periodic evaluation. In addition, leaders play a crucial role in sponsoring, evaluating, enabling, or modifying the behaviors needed to shape and maintain the targeted changes.

One way to gain the support of the practice's leaders is to assemble a business case that can be presented to support initiating TeamSTEPPS. Identify who will receive the business case presentation (e.g., senior leaders) and provide the type of information that will be most meaningful to them in making their decisions (e.g., evidence-based research, success stories).

Present a compelling rationale for why the change effort is necessary (e.g., the problems that TeamSTEPPS will solve) and the benefits it will potentially yield. A lack of urgency and a vague rationale are two of the most common derailers of change efforts. If you cannot develop a persuasive rationale for TeamSTEPPS, the best course of action is to postpone implementation.

Be sure that your presentation emphasizes the program’s purpose and goals, explains what is required from an organizational perspective, and defines the commitment you are seeking from the leaders (e.g., decisions, support for the program, resources). Emphasize that TeamSTEPPS is more than just a "training program"; it encompasses an ongoing effort to enhance teamwork. Leader support is necessary to ensure that, after training, new behaviors become incorporated into everyday actions.

Sometimes leaders fail to sponsor efforts effectively because they simply do not know how to sponsor a program. Thus, after your leaders understand and approve the implementation of TeamSTEPPS, ensure their continuing support by coaching and supporting their behavior. Ask them to help launch the effort, agree to follow up on progress, reinforce key behaviors, and model the desired behaviors themselves.

6. Do you have buy-in of the practice's office manager/administrator regarding TeamSTEPPS implementation?

____ Yes   ____ No

In the medical office setting, the full endorsement of the office manager/administrator is crucial to implementing TeamSTEPPS. In many cases, the office manager/administrator is in a prime position to act as a key advocate for, and enforcer of, any changes your practice/the practice you support undertakes. The stronger and more explicit his or her endorsement, the more likely the implementation of TeamSTEPPS is to succeed.

Time, Resources, Personnel

7. Have you identified the right individuals, including at least one physician or other influential clinician, who are willing and able to serve as champions of TeamSTEPPS in your practice/the practice you support?

____ Yes   ____ No

Having the right individuals to champion your TeamSTEPPS effort is a vital aspect of the effort's success. Champions support the effort, encourage others, and maintain energy. The champions you identify will be responsible for driving and sustaining the change your intervention targets; they will serve as your change agents. These individuals should have the practice leadership's support, be viewed as respected and influential, and, where possible, represent a cross-section of professions within the practice.

Ideally, you will involve individuals who tend to exert the greatest influence on other team members—those whom team members rely on when deciding if something is useful. If these individuals cannot assume the role of champion at the beginning of the effort, try to involve them in the initial decisions (e.g., which problems to address, which tools to use).

The importance of identifying and maintaining a physician or other clinician as a champion is critical. Without the commitment, support, and participation of at least one of the practice's physicians or other clinicians, change cannot successfully occur. For example, if staff members are trained in the use of a specific communication tool but physicians do not use it, the intervention will not be shown to be valued and reinforced, and it will not be sustained.

8. Will the clinicians and staff in your practice/the practice you support who are acting as the champions of the TeamSTEPPS intervention be able to commit time to the project?

____ Yes   ____ No

Successful implementation of TeamSTEPPS will require the champions identified for the effort to devote sufficient time to the project, including time spent on their own learning and time to train and coach other staff. Again, senior leader support is critical to ensuring that the champions can perform effectively.

9. Will your practice/the practice you support be able to identify and prepare appropriate staff to serve as TeamSTEPPS trainers/instructors?

____ Yes   ____ No

Identifying the right individuals to serve as trainers/instructors is another significant aspect of TeamSTEPPS implementation. Trainers/instructors should, first of all, be willing to participate and hold positions that allow them the needed flexibility. Furthermore, to optimize the program’s success, they should:

• Be viewed as advocates of teamwork and as models for implementing teamwork actions during day-to-day operations.
• Be viewed by peers and administrators as respected and influential leaders.
• Be dynamic and enthusiastic presenters.

10. Will your practice/the practice you support be able to identify and prepare appropriate staff to serve as TeamSTEPPS coaches?

____ Yes   ____ No

Implementing TeamSTEPPS signals a significant change in a practice's culture. To sustain the new culture beyond the initial training requires dedicated coaches who reinforce, monitor, and model teamwork principles in everyday practice. For larger practices, the recommendation is that one coach be selected for every 10 staff members. Coaches should:

• Be effective at developing the teamwork skills of others.
• Be able to effect changes in work patterns, behaviors, and environments.
• Be highly respected, with sufficient informal or formal power.
• Exhibit an interpersonal style conducive to coaching (e.g., demonstrate a supportive attitude and the ability to build confidence in others).
• Be able to provide effective feedback that is descriptive, problem oriented, empowering, probing, and considerate.
• Be highly visible, accessible, and available for coaching throughout the change effort.

11. Do the staff in your practice/the practice you support have enough flex time during the workday to commit to learning TeamSTEPPS?

____ Yes   ____ No

To ensure success, everyone in the practice should have enough time to learn and practice using TeamSTEPPS. The full training element of the program includes up to 6 hours of instruction; however, a given practice may decide to train only one skill, tool, or strategy that may require 1 hour or less of instruction. To prevent disruptions and scheduling issues and to maximize learning, the practice will need to design training schedules that deliver training during normal practice hours or after hours (e.g., hosting a continuing education lunch or dinner). Creative solutions may be needed. There might already be time in the practice’s normal operations, such as weekly staff meetings, to accommodate training.

Sustainment of Change

12. Will your practice/the practice you support be willing to measure and assess progress and continually improve processes?

____ Yes   ____ No

For continued success, your practice/the practice you support should view quality improvement initiatives, such as TeamSTEPPS, as a process rather than an event and document its effectiveness on an ongoing basis. Documented improvements in the targeted areas can be used to garner additional staff buy-in; documented concerns can guide thoughtful program revision.

One of the best ways to establish TeamSTEPPS as a continuous improvement process is to incorporate its behaviors into existing work processes by making better teamwork an integral part of doing the job. Identify any current safety and quality initiatives (e.g., Lean Six Sigma) that may already be occurring within the practice and determine how TeamSTEPPS can fit into and reinforce those efforts. (One caveat: avoid linking TeamSTEPPS with an unpopular or unsuccessful effort.)

13. Will your practice/the practice you support be able to reinforce and reward positive teamwork behaviors and improvements in processes?

____ Yes   ____ No

Positive teamwork behaviors and improvements in processes and outcomes that result from your TeamSTEPPS intervention need to be reinforced and rewarded. Leaders, champions, instructors, and coaches should provide ongoing feedback to others within the practice. Successes need to be formally recognized and showcased. The initial training may generate behavior change, but the reinforcement provided by positive feedback—and, ultimately, by the participants’ increased sense of self-efficacy and purpose—is the only way to sustain it.

Readiness Assessment Scoring

The following provides the scoring associated with the TeamSTEPPS for Office-Based Care Readiness Assessment. Score 1 point for each “Yes” response; a maximum of 13 points can be earned.

9–13 Points

Your practice/the practice you support is likely ready to implement TeamSTEPPS. As you begin the implementation process, make sure you continue to monitor whether the answers to these questions change, and keep a close eye on any items to which you answered "No."

6–8 Points

Your responses regarding approximately one-third to one-half of the questions indicate that your practice/the practice you support may not yet be ready to implement TeamSTEPPS. Review the notes accompanying each question and identify any steps the practice might take to improve its readiness.

0–5 Points

Based on your responses, significant work is likely needed to raise the readiness level of your practice/the practice you support. Implementing TeamSTEPPS at this time is not likely to produce the desired results. Consider postponing the implementation process for a few months and review the notes accompanying each question for ways to enhance the practice's readiness. Then answer the questions again to determine if any of the factors have changed.

Further Information

Listed below are resources with additional information.

1. Beaman KV, Guy GR. Effecting change in business enterprises. New York, NY: The Conference Board; August 2005. Report No. R-1371-05-RR.
2. Lines R. Influence of participation in strategic change: resistance, organizational commitment, and change goal achievement. J Change Manag 2004;4(3):193-215.
3. Sirkin HL, Keenan P, Jackson A. The hard side of change management. Harv Bus Rev 2005;83(10):109-18.
4. Tannenbaum SI. Enhancing continuous learning: diagnostic findings from multiple companies. Hum Resour Manage 1997;36(4):437-52.
5. Tracy JB, Tannenbaum SI, Kavanagh MJ. Applying trained skills on the job: the importance of the work environment. J Appl Psychol 1995;80(2):239-52.

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