Patient Safety, 2010

Clarinda Regional Health Center

April 2010

In 2008, staff from Clarinda Regional Health Center, a 25-bed critical access hospital in Clarinda, Iowa, participated in training on Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS™) and have worked to integrate teamwork training for all hospital staff. The training was offered as part of AHRQ's Knowledge Transfer Program.

TeamSTEPPS, a program developed by AHRQ and the Department of Defense, is an evidence-based system aimed at optimizing patient outcomes and promoting a culture of team-driven care. The program establishes interdisciplinary team training systems to serve as the foundation for a facilitywide patient safety strategy. Through the TeamSTEPPS National Implementation Project, AHRQ has trained hundreds of TeamSTEPPS master trainers at Quality Improvement Organizations and hospitals around the country.

Two clinicians and one senior staff person from Clarinda Regional Health Center participated in the two-and-a-half day training that was tailored to meet the needs of critical access hospitals. Because these hospitals are relatively small, it is difficult for them to function with multiple providers gone for up to a week. To address this issue, training was shortened to two-and-a-half days. These three people became TeamSTEPPS master trainers who then led all-staff training sessions on TeamSTEPPS at Clarinda.

Mark Goodridge, RT, a radiological technologist and one of Clarinda's TeamSTEPPS master trainers, reports that the hospital staff are using TeamSTEPPS techniques and learning from both mistakes and tasks that were well done through the use of debriefings that are conducted after every drill and code that takes place in the hospital. Goodridge observes that "clinical departments, which in the past had barriers, are communicating more efficiently through the use of tools such as SBAR and handoffs."

TeamSTEPPS was also integrated into the hospital's Leadership Fundamentals training for department managers, senior staff, and the Board of Trustees. By April 2009, 87 percent of Clarinda's staff had participated in training on some or all of the TeamSTEPPS modules, and nearly half of Clarinda staff could correctly answer at least 75 percent of the TeamSTEPPS knowledge questions.

Clarinda Regional Health Center is monitoring the impact of TeamSTEPPS through the AHRQ Hospital Survey on Patient Safety Culture. Between 2007 and 2009, the survey scores improved in one key area; the scores on the "mistakes have led to positive changes at the hospital" dimension of the survey improved from 67 percent to 76 percent.

However, Clarinda's scores decreased slightly on two other survey dimensions: "hospital departments work well together to provide the best care for patients" and "shift changes are problematic for patients in this hospital." Between 2007 and 2009, the hospital's scores on these dimensions declined by 5 percent and 10 percent, respectively.

Katherine Jones, PT, PhD, of the University of Nebraska Medical Center, led the TeamSTEPPS training at Clarinda. She speculates that there was not greater improvement in the hospital's pre- and post-training Hospital Survey on Patient Safety Culture scores because the training increased staff awareness of the elements of a safety culture; therefore, after the training, they were inclined to be more critical of their own performance.

Knowledge Transfer Case Study Identifier: KT-CQuIPS-36
AHRQ Products: TeamSTEPPS™, Hospital Survey on Patient Safety Culture
Topic(s): Patient Safety
Scope: Iowa

Hospital Survey on Patient Safety Culture. Contract No. 290-96-0004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/patientsafetyculture/hospsurvindex.htm

TeamSTEPPS™: Strategies and Tools to Enhance Performance and Patient Safety, November 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://teamstepps.ahrq.gov/abouttoolsmaterials.htm

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