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.


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.


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.

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