About TeamSTEPPS

TeamSTEPPS is a teamwork system designed for health care professionals that is:

A powerful solution to improving patient safety within your organization.
An evidence-based teamwork system to improve communication and teamwork skills among health care professionals.
A source for ready-to-use materials and a training curriculum to successfully integrate teamwork principles into all areas of your health care system.
Scientifically rooted in more than 20 years of research and lessons from the application of teamwork principles.
Developed by Department of Defense's Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality.

TeamSTEPPS provides higher quality, safer patient care by:

Producing highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes for patients.
Increasing team awareness and clarifying team roles and responsibilities.
Resolving conflicts and improving information sharing.
Eliminating barriers to quality and safety.

TeamSTEPPS has a three-phased process aimed at creating and sustaining a culture of safety with:

A pretraining assessment for site readiness.
Training for onsite trainers and health care staff.
Implementation and sustainment.

The TeamSTEPPS curriculum is an easy-to-use comprehensive multimedia kit that contains:

Fundamentals modules in text and presentation format.
A pocket guide that corresponds with the essentials version of the course.
Video vignettes to illustrate key concepts.
Workshop materials, including a supporting CD and DVD, on change management, coaching, and implementation.

Three Phases of the TeamSTEPPS Delivery System

The three phases of TeamSTEPPS are based on lessons learned, existing master trainer or change agent experience, the literature of quality and patient safety, and culture change. A successful TeamSTEPPS initiative requires a thorough assessment of the organization and its processes and a carefully developed implementation and sustainment plan.

Phase 1 - Assess the Need

The goal of Phase 1 is to determine an organization's readiness for undertaking a TeamSTEPPS-based initiative. Such practice is typically referred to as a training needs analysis, which is a necessary first step to implementing a teamwork initiative. For more information about conducting a needs assessment, Select for more information.

Phase 2 - Planning, Training, and Implementation

Phase 2 is the planning and execution segment of the TeamSTEPPS initiative. Because TeamSTEPPS was designed to be tailored to the organization, options in this phase include implementation of all tools and strategies in the entire organization, a phased-in approach that targets specific units or departments, or selection of individual tools introduced at specific intervals (called a "dosing strategy" in TeamSTEPPS parlance). As long as the primary learning objectives are maintained, the TeamSTEPPS materials are extremely adaptable. For more information about planning, training, and implementing TeamSTEPPS, Select for more information.

Phase 3 - Sustainment

The goal of Phase 3 is to sustain and spread improvements in teamwork performance, clinical processes, and outcomes resulting from the TeamSTEPPS initiative. The key objective is to ensure opportunities exist to implement the tools and strategies taught, practice and receive feedback on skills, and provide continual reinforcement of the TeamSTEPPS principles on the unit or within the department. For more information on sustaining TeamSTEPPS initiatives, Select for more information.

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Details of a Site Assessment

A site assessment entails identifying opportunities for improvement; determining the readiness of the institution, such as leadership support; identifying potential barriers to implementing change; and deciding whether resources are in place to successfully support the initiative. Each part of the Phase 1 assessment is described below.

1. Establish an organizational-level change team

The organizational-level change team should consist of a multidisciplinary group that represents the breadth of health care professionals within the organization. Successful change teams are comprised of organizational leaders who are committed to changing the current culture.

2. Conduct a site assessment.

A site assessment, also called team training needs analysis, is a process for systematically identifying teamwork deficiencies so training programs can be developed to address those deficiencies. This information is then used to identify critical training and develop training objectives.

3. Define the problem, challenge, or opportunity for improvement.

The team must identify the recurring problem that threatens patient safety and then determine how this problem results from existing processes and procedures. The team should devise a flowchart or map of the process during which the problem occurs. With information and processes properly mapped, it becomes clear what interventions are needed, what the objective of these interventions should be, and how ready the organization is to engage in these interventions.

4. Define the goal of your intervention

List the goals that will reduce or eliminate the risk to safe patient care. For each goal, state in one sentence what will be achieved, who will be involved (whose behavior will change), and when and where the change will occur. Ideally, a team process goal, a team outcome goal, and a clinical outcome goal will be defined.

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Details for Planning, Training, and Implementation of TeamSTEPPS

The tools and strategies needed to address opportunities for improvement in an organization will be determined by the Phase 1 assessment. The next step is to develop a customized Implementation and Action Plan, followed by training and implementation. Below is a brief description of steps for planning, training, and implementation.

1. Define the TeamSTEPPS intervention.

Decide whether "whole training" (all the tools in one sitting) or "dosing" (specific tools targeted to specific interventions) is the best intervention tactic. Whole training optimizes teamwork but does not maximize learning. It can also lead to overload or uncertainty about which tools best fit improvement opportunities. Dosing is the recommended approach because it allows for direct linking of tools and strategies with specific opportunities for improvement to minimize training fatigue and overload.

2. Develop a plan for determining the intervention’s effectiveness.

There are a variety of ways to evaluate the impact of training. The plan should assess whether trainees have acquired new knowledge, skills, or attitudes at the end of training; if individuals are taking their learning back to the workplace and using it on the job; and organizational outcomes.

3. Develop an implementation plan.

Assess what groups will be trained, the order in which they will be trained (if not together and all at once), and what level of training they will receive. Include in the plan who will conduct training and where and when training will take place.

4. Gain leadership commitment to the plan.

Inform leaders of all facets of the plan, including how much time will be used for training and the desired resources to support it. Leadership commitment often yields plan refinement. The key is to know what elements of the plan cannot be altered.

5. Develop a communication plan.

Develop a plan for communicating what will be done and how the goal will be achieved. Leaders (both designated and situational) should provide information to all those in their departments or units about the initiative. It is crucial to tie together all activities that will take place with the overall goal for the initiative (i.e., improved patient safety).

6 Prepare the institution.

For any initiative to be fully successful, transfer of training must be achieved. Transfer is achieved by ensuring new knowledge or skills are learned and applied in the work environment. The change team must ensure the work environment is prepared to foster transfer of training so new tools and strategies are applied on the job.

7. Implement training.

The most effective strategy for delivering the training initiative is one that involves teams of trainers that include physicians, nursing staff, and support staff. A combination of the curricula is recommended when training different sets of staff independently. The TeamSTEPPS system includes three different medical team training curricula and a complete suite of multimedia course materials:
1.Train-the-Trainer. This 2-day training course is designed to create a cadre of teamwork instructors with the skills to train and coach other staff members.
2.TeamSTEPPS Fundamentals.This curriculum includes 4 to 6 hours of interactive workshops for direct patient care providers.
3.TeamSTEPPS Essentials. This curriculum is a 1- to 2-hour condensed version of the Fundamentals Course and is specifically designed for nonclinical support staff.

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Details for Sustaining a TeamSTEPPS Intervention

The designated change team manages sustaining interventions through coaching and observing team performance. An effective sustainment plan should account for ongoing assessment of the effectiveness of the intervention, sustainment of positive changes, and identification of opportunities for further improvements. Below is a brief description of the steps to include in a TeamSTEPPS sustainment plan.

1. Provide opportunities to practice.

Any TeamSTEPPS based initiative will be much more successful if the change team accounts for opportunities to practice these behaviors. It is important to embed opportunities for practice in day-to-day functions.

2. Ensure leaders emphasize new skills.

Leaders play a critical role in sustainment because they are responsible for emphasizing daily the skills learned in TeamSTEPPS training. The goal is for leaders to engage in activities that will ensure continuous involvement in teamwork.

3. Provide regular feedback and coaching.

Regular feedback and coaching are key to ensuring interventions are sustained. Change team members, champions from the unit, and leaders should develop and use a coaching and feedback plan that allows for sufficient observation and feedback opportunities.

4. Celebrate wins.

Celebrating wins bolsters further sustainment and engagement in teamwork. When using a TeamSTEPPS-based initiative, it is critical to celebrate successes for two reasons. First, it recognizes the efforts of those who were engaged from the beginning, and second, it provides detractors or laggards a tangible example of how teamwork has improved the current operations.

5. Measure success.

The change team should measure success by demonstrating satisfaction with training, learning, the effective use of tools and strategies on the job, and changes in processes and outcomes. It is useful to ensure that measurement of pretraining factors is parallel with post-training factors so changes can be assessed.

6. Update the plan.

The final stage in any TeamSTEPPS-based intervention is to revise the plan as the organization's needs change. The change team should determine when organizational needs have changed and ensure the sustainment plan continues to focus on the needs of the organization or unit where the intervention has been implemented.

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