Teams communicating through STEPPS

Abstract

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.

Outcomes of classroom-based team training interventions for multiprofessional hospital staff. A systematic review

“…All studies were published in English. One study was Swiss,24 one was Australian,37 and two were British 28 38. The rest were American.…”

“…All studies except two19 36 described a process of training needs assessment, the main method being a safety or teamwork attitude questionnaire (SAQ/TAQ), use of patient safety data and inputs from staff. The duration of the course varied from 4 h to 3 days (a few also described longer train-the-trainer courses) 26 31 37 39. All interventions focused on teamwork, coordination and communication.…”

“…A third found perceived benefit of briefings higher among nurses than among anaesthetists and surgeons 26. Two studies assessed knowledge: one found a significant increase from before to after 37. Another found high overall knowledge after 39…”

“…Nine studies evaluated the effect of the intervention at the individual observed behavioural level 18 20 26–29 35 37 39. Behavioural change was measured through the use of perioperative briefings and was mostly positive: in one study, compliance increased from 0% to 86% after training, but decreased to 66% after 6 months 26.…”

Effects of a team-based assessment and intervention on patient safety culture in general practice: an open randomised controlled trial

“…Generally, studies evaluating interventions that aim to improve safety culture have shown increases in safety climate scores,29–35 while one study also reported improved observed safety behaviour and performance 36. Unfortunately, these studies either had uncontrolled pre-post designs, small sample sizes of selected participants or were case reports from single healthcare organisations 37.…”