Patient Safety, 2008

SSM Health Care

July 2008

SSM Health Care, one of the largest Catholic health care systems in the country, has been using Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS™), a program developed by the Department of Defense in collaboration with AHRQ, to help establish a culture of patient-centered care through the use of teamwork and enhanced communication.

Says Andy Kosseff, MD, Medical Director of System Clinical Improvement at SSM, "We are indebted to AHRQ for this wonderful program and are ready and willing to help in any way to promote TeamSTEPPS and share our experiences. We believe that this is one of the most important safety interventions we have implemented."

Since 2007, SSM has conducted 11 four-hour training sessions for 300 clinicians on obstetric units at two of SSM's hospitals, St. Mary's Hospital in Madison, WI and SSM St. Joseph Hospital West in Lake St. Louis, MO. About 100 attending doctors and residents and 200 nurses, obstetrical technicians, and other allied health professionals were trained.

SSM has a rigorous outcomes measurement program for its TeamSTEPPS™ pilot units. Kosseff says, "We want to carefully measure the effects of [Team]STEPPS training and make sure we are making a difference with this effort." Included in the outcomes measurement is the Adverse Outcomes Index; a measure of serious and sentinel events; nurse retention rates; and patient, physician, and employee satisfaction before and after Team STEPPS implementation.

TeamSTEPPS stresses teamwork and communication among doctors, nurses, and other health care providers in order to improve quality, safety, and efficiency. The system builds on four competency areas—leadership, situation monitoring, mutual support, and communication—and provides tools to use in a multitude of situations. TeamSTEPPS helps to avoid the miscommunications that are clearly associated with medical errors.

At SSM, coaches, the unit director, and an administrative council member form the TeamSTEPPS Steering Team. This group meets monthly to design implementation of TeamSTEPPS tools and concepts on the unit sequentially; to discuss their coaching interventions in terms of what did and did not work; and to review data as it becomes available.

"We are continually revising the curriculum based on the successes and lessons learned from our earlier training," Kosseff says, enumerating some of the important lessons the organization has learned, as follows:

1. It is essential to have a mixture of physicians and nurses at the trainings. The real value occurs in a setting of health care providers from various disciplines.
2. Strong administrative support helps convince physicians to be present at the training. Because of this, physicians have participated very actively in the sessions without having to be paid to attend.
3. The use of case histories from the units where clear team failures have occurred helps to reinforce the learning.
4. Coaches play a critical role and need to be trained simultaneously with the general unit in order to be available as soon as all are trained. They are now incorporated into the entire Team STEPPS program.

According to Kosseff, "Particularly remarkable in our work so far has been the universal support from administrative councils, doctors, and nurses to undertake the training and really participate in it. The vibrancy of each training session—no two sessions are alike—keeps trainers on their toes."

The positive results of the initial training in the pilot sites have encouraged SSM to modify the TeamSTEPPS training for use throughout all its hospitals. Future plans include expanding TeamSTEPPS for all types of units within its other hospitals—not just the high-risk units.

SSM is sponsored by the Franciscan Sisters of Mary and based in St. Louis, Missouri. The system owns, manages, and is affiliated with 20 hospitals and two nursing homes in four states.

Impact Case Study Identifier: CQuIPS 08-03
AHRQ Product: TeamSTEPPS™
Topic(s): Patient Safety
Scope: Illinois, Missouri, Oklahoma, Wisconsin

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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