Connect
MJA
MJA

Teams communicating through STEPPS

Karen Stead, Saravana Kumar, Timothy J Schultz, Sue Tiver, Christy J Pirone, Robert J Adams and Conrad A Wareham
Med J Aust 2009; 190 (11): 128.

Summary

Objective: To evaluate the effectiveness of the implementation of a TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) program at an Australian mental health facility.

Design, setting and participants: TeamSTEPPS is an evidence-based teamwork training system developed in the United States. Five health care sites in South Australia implemented TeamSTEPPS using a train-the-trainer model over an 8-month intervention period commencing January 2008 and concluding September 2008. A team of senior clinical staff was formed at each site to drive the improvement process. Independent researchers used direct observation and questionnaire surveys to evaluate the effectiveness of the implementation in three outcome areas: observed team behaviours; staff attitudes and opinions; and clinical performance and outcome. The results reported here focus on one site, an inpatient mental health facility.

Main outcome measures: Team knowledge, skills and attitudes; patient safety culture; incident reporting rates; seclusion rates; observation for the frequency of use of TeamSTEPPS tools.

Results: Outcomes included restructuring of multidisciplinary meetings and the introduction of structured communication tools. The evaluation of patient safety culture and of staff knowledge, skills and attitudes (KSA) to teamwork and communication indicated a significant improvement in two dimensions of patient safety culture (frequency of event reporting, and organisational learning) and a 6.8% increase in the total KSA score. Clinical outcomes included reduced rates of seclusion.

Conclusion: TeamSTEPPS implementation had a substantial impact on patient safety culture, teamwork and communication at an Australian mental health facility. It encouraged a culture of learning from patient safety incidents and making continuous improvements.

  • Karen Stead1
  • Saravana Kumar2
  • Timothy J Schultz3
  • Sue Tiver4
  • Christy J Pirone1
  • Robert J Adams5
  • Conrad A Wareham6

  • 1 South Australian Department of Health, Adelaide, SA.
  • 2 Centre for Allied Health Evidence, University of South Australia, Adelaide, SA.
  • 3 Australian Patient Safety Foundation, Adelaide, SA.
  • 4 Cramond Clinic, Queen Elizabeth Hospital, Adelaide, SA.
  • 5 Health Observatory, University of Adelaide and Queen Elizabeth Hospital, Adelaide, SA.
  • 6 Intensive Care Unit, Lyell McEwin Hospital, Adelaide, SA.


Acknowledgements: 

We acknowledge the contribution of the following organisations and committees: Australian Commission on Safety and Quality in Healthcare, SA Department of Health, SA Council for Safety and Quality in Health Care, SA Safety and Quality in Health Care Consumer and Community Advisory Committee, Australian Patient Safety Foundation, University of South Australia, Women’s and Children’s Hospital, Queen Elizabeth Hospital, Port Augusta Hospital, and Repatriation General Hospital. We acknowledge the generosity of the US Department of Defense and the Agency for Healthcare Research and Quality in permitting the use of their TeamSTEPPS materials and in their guidance during program implementation. We also thank Ms Mary Salisbury for her support.

Competing interests:

None identified.

  • 1. Wong MC, Yee KC, Turner P. A structured evidence-based literature review regarding the effectiveness of improvement interventions in clinical handover. eHealth Services Research Group, University of Tasmania, 2008. http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/PriorityProgram-05 (accessed Sep 2008).
  • 2. Australian Council for Safety and Quality in Health Care. Clinical handover and patient safety: literature review report. Canberra: ACSQHC, 2005. http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/F3D3F3274D393DFCCA257483000D8461/$File/clinhovrlitrev.pdf (accessed Sep 2008).
  • 3. Mann S, Marcus R, Sachs B. Lessons from the cockpit: how team training can reduce errors on L&D. Contemp Ob Gyn 2006; 51: 34-45.
  • 4. Morey J, Simon R, Jay G, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation of results of the MedTeams project. Health Serv Res 2002; 37: 1553-1581.
  • 5. Morey JC, Simon R, Jay GD, Rice MM. A transition from aviation crew resource management to hospital emergency departments: the MedTeams story. In: Jensen R, editor. Proceedings of the 12th International Symposium on Aviation Psychology. 2003 Apr 14–17; Dayton, Ohio, USA. Dayton, Ohio: Wright State University Press, 2003: 826-832.
  • 6. Simon R, Langford V, Locke A, et al. A successful transfer of lessons learned in aviation psychology and flight safety to health care: the MedTeams system. Proceedings of Patient Safety Initiative 2000: spotlighting strategies, sharing solutions; 2000 Oct 4–6; Chicago, USA. Chicago: National Patient Safety Foundation, 2000: 45-49.
  • 7. Simon R, Morey JC, Rice MM, et al. Reducing errors in emergency medicine through team performance: the MedTeams project. In: Scheffler AL, Zipperer L, editors. Enhancing patient safety and reducing errors in health care. Chicago: National Patient Safety Foundation, 1998: 142-146.
  • 8. Salas E, Sims DE, Burke CS. Is there “big five” in teamwork? Small Group Res 2005; 36: 555-599.
  • 9. Salas E, Burke CS, Stagl KC. Developing teams and team leaders: strategies and principles. In: Day DV, Zaccaro SJ, Halpin SM, editors. Leader development for transforming organizations: growing leaders for tomorrow. Mahwah, NJ: Lawrence Erlbaum Associates, 2004: 325-355.
  • 10. Risser DT, Rice MM, Salisbury ML, et al. The potential for improved teamwork to reduce medical errors in the emergency department. The MedTeams Research Consortium. Ann Emerg Med 1999; 34: 373-383.
  • 11. Salas E, Nichols DR, Driskell JE. Testing three team training strategies in intact teams: a meta-analysis. Small Group Res 2007; 38: 471-488.
  • 12. Salas E, Diaz Granados D, Weaver SJ, King H. Does team training work? Principles for health care. Acad Emerg Med 2008; 15: 1002-1009.
  • 13. Leedom D, Simon R. Improving team coordination: a case for behavior-based training. Mil Psychol 1995; 7: 109-122.
  • 14. Agency for Healthcare Research and Quality. TeamSTEPPS instructor guide. Rockville, Md: AHRQ, 2006. (AHRQ Publication No. 06-0020-0.)
  • 15. Alonso A, Baker DP, Holtzman A, et al. Reducing medical error in the military health system: how can team training help? Hum Resour Manage Rev 2006; 16: 396-415.
  • 16. Sorra JS, Nieva VF. Hospital survey on patient safety culture. Rockville, Md: Agency for Healthcare Research and Quality, 2004. (AHRQ Publication No. 04-0041.)
  • 17. QV Research. Total team assessment. http://www.qvresearch.com/organizational_assessments/total_team_assessment.htm (accessed Apr 2009).
  • 18. Singla A, Kitch BT, Weissman JS, Campbell EG. Assessing patient safety culture: a review and synthesis. J Patient Saf 2006; 2: 105-116.
  • 19. Taylor-Powell E, Steele S. Collecting evaluation data: direct observation. University of Wisconsin, 1996. http://learningstore.uwex.edu/pdf/G3658-5.PDF (accessed Apr 2009).
  • 20. Leonard KL, Masatu MC. The use of direct clinical observation and vignettes for health service quality evaluation in developing countries. Soc Sci Med 2005; 61: 1944-1951.
  • 21. Clancy C, Tornberg D. TeamSTEPPS: assuring optimal teamwork in clinical settings. Am J Med Qual 2007; 22: 214-217.
  • 22. Australian Government National Mental Health Seclusion and Restraint Project. NMHSRP background. http://www.nmhsrp.gov.au/c/mh?a=da&did=1006037&pid=1197368795 (accessed Mar 2009).
  • 23. Cockburn J. Adoption of evidence into practice: can change be sustainable? Med J Aust 2004; 180 (6 Suppl): S66-S67. <MJA full text>

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.