JONA
Volume 46, Number 4, pp 201-207
Copyright B 2016 Wolters Kluwer Health, Inc. All rights reserved.
THE JOURNAL OF NURSING ADMINISTRATION
Promoting Patient Safety
A
Results of a TeamSTEPPS Initiative
Teresa Gaston, DNP, RN
Nancy Short, DrPH, MBA, RN
Christina Ralyea, DNP, MS-NP, MBA, OCN, NE-BC
Gayle Casterline, PhD, RN
Teamwork is an essential component of communication in a safety-oriented culture. The Joint Commission has identified poor communication as one of
the leading causes of patient sentinel events. The aim
of this quality improvement project was to design,
implement, and evaluate a customized TeamSTEPPS
training program. After implementation, staff perception of teamwork and communication improved. The
data support that TeamSTEPPS is a practical, effective, and low-cost patient safety endeavor.
nication has been gaining momentum in healthcare.
In 2006, the Department of Defense and the Agency
for Healthcare Research and Quality (AHRQ) partnered to develop a teamwork program designed specifically for healthcare called Team Strategies and
Tools to Enhance Performance and Patient Safety
(TeamSTEPPS ). TeamSTEPPS promotes the use of
standardized communication tools and addresses
5 areas of teamwork including leadership, communication, situational monitoring, team structure,
and mutual support.8
Positive improvements have been reported in the
18 TeamSTEPPS research studies reviewed by the
authors. Staff perceptions regarding teamwork and/or
communication were the most common areas in which
measurable improvement occurred.9-22 TeamSTEPPS
implementation has demonstrated improved outcomes
in a variety of specialty areas and settings including
the operating room,22 pediatric and adult intensive
care units,15 emergency department,23 mental health,18
neonatal intensive care,24 a combat hospital,25 and
outpatient oncology.10 One study reported a 13% increase in positive staff perceptions of teamwork and a
20% increase in positive staff perceptions of communication measured by the Hospital Survey on Patient
Safety Culture (HSOPSC) 1 month after implementation.22 Several studies16-18 measured knowledge,
reporting anywhere from a 6% to 9% increase following the training program. In addition, decreased
patient incident events have been reported following
training.25,26
The aims of this quality improvement project
(QIP) were to improve staff perceptions of teamwork
and communication by customizing and implementing TeamSTEPPS training for the oncology service
line (OSL) in an academic health center and to evaluate
A
Following the momentous report To Err Is Human,1
the Institute of Medicine and The Joint Commission
(TJC) recommended teamwork and communication
training in healthcare to assist in decreasing medical
errors.2 Although teamwork is cited as an essential
component of both communication and a safetyoriented culture,3 effective teamwork is often absent
in healthcare settings4 and requires cultivation.5 According to TJC,6 communication is one of the leading causes of patient sentinel events.
For decades, the aviation industry and the US
military have enforced training in teamwork and communication as a means to decrease errors and increase
positive outcomes.7 The goal of improving patient safety
with highly effective teams and coordinated commuAuthor Affiliations: Nurse Informatics Educator (Dr Gaston),
Information Services, Carolinas HealthCare System, Charlotte;
Associate Professor (Dr Short), School of Nursing, Duke University, Durham; and Assistant Vice President (Dr Ralyea), Patient
Care Services Oncology Division, and Nursing Research & Evidence
Based Practice (Dr Casterline), Carolinas HealthCare System,
Charlotte, North Carolina.
The authors declare no conflicts of interest.
Correspondence: Dr Gaston, Carolinas HealthCare System, 5039
Airport Center Pkwy, Charlotte, NC 28208 (teresagaston2@gmail.com).
DOI: 10.1097/NNA.0000000000000333
A
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201
the overall effectiveness. Based on previously reported
2013 HSOPSC results, nursing leaders identified
teamwork and communication on the OSL as an improvement opportunity. Important stakeholders, including nursing leadership and the Quality and Patient
Safety (QPS) team, were highly supportive.
Targeted outcomes for implementation included
the following:
1. observe an improvement in staff perceptions
of team structure and communication as measured by the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ);27
2. observe an increase in positive staff perceptions of teamwork by 13% and communication openness by 20% as measured by the
HSOPSC28;
3. observe a 5% increase in staff knowledge as
measured by the TeamSTEPPS Learning Benchmark Test (LBT)29; and
4. discover and describe staff perceptions toward
the application of TeamSTEPPS tools and behaviors into clinical practice as measured by
the focus groups.
Methods
Design
This QIP incorporated a mixed-methods approach
including both quantitative and qualitative data collection. A preimplementation/postimplementation design measured perceptions of teamwork, perceptions
of communication, knowledge, and number of patient incident reports. In addition, the design measured course evaluations, focus groups, and exit surveys
after training only. Qualitative information was gathered from the focus groups.
The settings were 3 oncology acute patient care
units (total of 72 beds) within the OSL of an 874-bed
academic health center located in the southeast United
States. At project onset, 95 RNs, 35 clinical nurse
assistants (CNAs)/healthcare technicians (HCTs),
and 14 physicians were eligible to participate. Each
received an e-mail invitation to voluntarily sign up
for a TeamSTEPPS training session. RNs and CNAs/
HCTs received 2 hours_ pay outside their scheduled
shift work to attend 1 training session. Nurses who
completed the training course received 2.0 contact
hours, whereas physicians did not receive any continuing medical education. The convenience sample
of voluntary staff included full- and part-time staff
(n = 92 RNs, n = 12 CNAs/HCTs, n = 6 physicians)
who work within the OSL. Of the participating staff,
94% (n = 103) denied ever attending a formal TeamSTEPPS training prior to this QIP.
202
Project Implementation
Training
Because the TeamSTEPPS program was purposely
designed to be customizable by healthcare organizations,8 a few studies have successfully provided 2-hour
training sessions in lieu of the 6-hour session promoted
by the AHRQ.10,15,30 Therefore, in collaboration with
the QPS team, the content was customized to a 2-hour
training session. These training sessions included
didactic instruction along with an audiovisual slide
presentation containing videos, discussion questions,
scenarios, and oncology-specific examples. Seven staff
members volunteered to become TeamSTEPPS Master Trainers (MTs) and attended a 1-day course. The
project team scheduled 10 TeamSTEPPS sessions with
1 make-up session to implement during September 2014.
Coaching
Coaching is an essential element of sustainability,18
although not well studied. The MTs provided coaching on each of the patient care units after training for
3 months. The latest version of the TeamSTEPPS program has a new coaching guide, and this module was
reviewed by all MTs. The nurse managers or the MTs
either e-mailed staff or verbally reviewed with staff a
Tool of the Month for 3 months following training.
Focus Groups
During the training sessions, all participants (n = 110)
received a thank-you card, and of those participants, a
randomized 40% (n = 44) received a special thankyou card containing a focus group invitation. Three
focus groups met 1 month after the completion of all
training sessions to answer specific questions.
Data Collection and Measures
Data were obtained during 4 time periods: immediately prior to and immediately following each of the
11 training sessions, approximately 1 month after the
final training session was conducted, and at the conclusion of this project. Data collection included the
following: demographics, T-TPQ, HSOPSC, LBT, focus
group questions, exit survey, training course evaluation, and number of patient incident reports. The
T-TPQ, HSOPSC, and the LBT are open-access tools
and available on the AHRQ Web site, whereas the
demographic survey, focus group questions, exit survey, and training course evaluation were created for
this QIP (Table 1).
Demographic data included patient care unit(s)
to ensure employment by the OSL, professional
credentials, and a yes/no question to identify
JONA Vol. 46, No. 4 April 2016
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Table 1. Data Collection Detail
Types of Data Collected
Time Periods of Data Collection
Administered immediately prior to the start of each
training session (September 2014)
September 2014VIntervention
Administered immediately following each training
session (September 2014)
Focus groups (October 2014)
Paper surveys made available for a 2-wk period
1 mo following the completion of the last training
sessions (October 2014)
Patient incident report no. (January 2015)
Demographics
T-TPQ
¾
¾
HSOPSC LBT
¾
Course
Evaluation
Exit
Survey
¾
11 TeamSTEPPS training sessions
¾
¾
¾
3 Small group
sessions
¾
¾
¾
¾
Retrospective data collection upon completion of this project
including 3-mo pretraining (June, July, August 2014) then 3-mo
posttraining (October, November, December 2014) numbers
those who had previously completed TeamSTEPPS training. Individual participant responses
were not identifiable by demographic data.
AHRQ developed the T-TPQ tool to measure
the effectiveness of the TeamSTEPPS training
program. This tool can be administered in conjunction with the HSOPSC tool.27 For the purpose of this QIP, we selected only 2 subscales,
team structure and communication from the
T-TPQ (Likert scale 1-5). The reliability values
of team structure (Cronbach_s ! = .89) and
communication (Cronbach_s ! = .88) subscales
have been reported to be good and have construct validity.31
For the purpose of this QIP, we selected only
2 subscales from the HSOPSC tool (Likert scale
1-5) including staff perceptions of teamwork
within the units (Cronbach_s ! = .83) and communication openness (Cronbach_s ! = .73).
Given these values, the HSOPSC has acceptable reliability.32 The items and subscales are
psychometrically sound.33 The HSOPSC has
been administered across hundreds of healthcare organizations supporting its validity with
national benchmarking data that are also
available.28
AHRQ developed the LBT specific to the educational content of the training program to measure participant knowledge. This was modified
by decreasing the number of multiple-choice
questions from 23 to 10 and by selecting questions specific to the revised 2-hour course content.
Three focus groups were conducted to gather
staff_s perceptions regarding the application
of training to clinical practice. See Table 2 for
focus group questions. Resources regarding
how to plan and conduct focus groups, as well
as how to create questions, and analyze the
results were utilized.34,35 Gift cards were given
to those who participated. Only summative
information was reported to protect participants_ anonymity and confidentiality.
An exit survey was designed to gather more
information about the application to clinical
practice, and the questions were created specifically for this QIP, thereby lacking reliability and validity.
A training course evaluation tool assessed staff
satisfaction following each of the training sessions. This was based on the standard evaluation tool used for in-services by the academic
health center. In addition, 2 additional questions were created to illicit more information
from staff regarding future application of the
newly learned tools.
Patient incident report counts were obtained
to indirectly observe if the training impacted
staff behaviors and patient events in the clinical setting.
Data Analysis
Data were analyzed using SPSS version 22 software
(IBM, Armonk, New York). The quantitative data
were normally distributed. Descriptive statistics were
used for the demographics, T-TPQ, HSOPSC, LBT,
exit survey, and course evaluation data. An unpaired, 2-sample t test was conducted for the T-TPQ,
HSOPSC, and LBT. In addition, a comparison was
made from the previously reported 2013 HSOPSC
data for the entire health center and the 2013 AHRQ
75th percentile comparative database versus the
2014 HSOPSC data from this QIP. The qualitative
data from 3 focus groups were organized by major
themes and coded by 2 individuals separately. Patient
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203
Table 2. Focus Group Information
Questions Asked
Most Common Themes
1. What facilitators do you see in your work area that promote
or support the use of TeamSTEPPS?
2. Describe a time or an experience when you used a
TeamSTEPPS tool.
3. Tell me some ideas on how we can better integrate
TeamSTEPPS tools into everyday practice.
4. Describe how we can keep TeamSTEPPS going for newly
hired staff.
5. Tell me about some of the barriers that you may have experienced
when applying the TeamSTEPPS tools in your work area.
& Huddle time
& BI need clarity[ and CUSa tool used for medication
orders, communication between nurses and physicians,
and electronic chemotherapy orders
& Verbal reminders during huddle time and team meetings
& Visual reminders on the nursing unit bulletin boards
and in the break rooms
& Written reminders via e-mail and communication books
& More educational in-services
& Add to general hospital orientation program
& Add to nursing unit-specific orientation
& Personal attitudes of staff
& Nurse-physician communication
a
CUS: "I am Concerned! I am Uncomfortable! This is a Safety issue!" (TeamSTEPPS).
incident report numbers were compared 3 months
pre/post. Statistical significance was set at P < .05.
Results
TeamSTEPPS Teamwork Perceptions Questionnaire
The 2 selected subscales of the T-TPQ (n = 107 pre,
n = 73 post) were calculated using a 2-sample t test
based on the user manual.27 The mean for the team
structure subscale before training on a 1- to 5-point
Likert scale was 3.89 and at 1 month after training
was 4.43 (t178 = j5.62, P = .000). The mean for
the communication subscale from pretraining was
4.08 and at 1 month after training was 4.58 (t180 =
j 6.22, P = .000). Both subscales measured demonstrated an improvement in staff perceptions for
team structure and communication with statistical
significance (Figure 1).
tile and (b) communication openness at 67% for the
overall health center and 66% for the AHRQ comparative database 75th percentile benchmark. The
2 selected safety culture subscales of the HSOPSC
(n = 109 pre, n = 73 post) were calculated using a
2-sample t test based on the mean percent positive
responses utilizing the HSOPSC survey user_s guide.28
Staff perceptions for the teamwork within unit subscale
increased from 74% before training to 91% at 1 month
after training (t182 = j3.66, P = .000), and the communication openness subscale increased from 58%
before training to 79% at 1 month after training (t176 =
j4.43, P = .000); both demonstrated improved staff
perceptions with statistical significance (Figure 2).
Hospital Survey on Patient Safety Culture
Baseline 2013 retrospective data obtained from the
academic health center showed (a) teamwork within
units at 85% for the overall health center and 84%
for the AHRQ comparative database 75th percen-
Learning Benchmark Test
A 2-sample t test (n = 110 each sample) showed a
pretraining mean score of 92% (range, 40%-100%;
median, 100%) and an immediate posttraining mean
score of 94% (range, 30%-100%; median, 100%) on
a scale of 0% to 100%. Although staff knowledge
increased by 2%, this was not statistically significant (P = .207). The t test was selected based on a
Figure 1. T-TPQ results: mean scores for team structure
and communication. *Statistical significance at P < .05.
Figure 2. HSOPSC results: mean % positive responses.
*Statistical significance at P < .05.
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sufficient sample size and only slightly skewed data
for the immediate posttraining group.
Focus Groups
Another aim of this project was to describe staff
perceptions toward the application of TeamSTEPPS
into clinical practice. Three focus groups (n = 20)
were conducted to gather this qualitative information. Table 2 displays the common themes that resulted from a content analysis of the responses.
Exit Survey
All eligible participants (n = 74) who completed the
exit survey 1 month after training (67% response rate)
reported that they attended a training session prior to
answering these questions. Improved teamwork was
reported by 81% (n = 60) of staff, and improved
communication was reported by 85% (n = 63) of
staff. Following the training sessions, 89% (n = 66) of
staff reported that they used a TeamSTEPPS tool or
demonstrated a behavior at work during the past
month since their training. The top 3 reported tools
that were used following training included huddles,
I need clarity, and debriefs.
Course Evaluation
Questions 1 to 9 (n = 110) pertained to overall staff
satisfaction with the training sessions, and staff selected good or excellent 96% to 100% of the time.
Question 10 (n = 97) asked how likely they are to
use the training materials in their clinical practice,
and staff reported 66% (n = 64) definitely, 33% (n =
32) likely, and 1% (n = 1) not likely. Question 11
asked which tools or behaviors staff plan to use
immediately following the training, and the top 3
reported tools included briefs, 2-challenge rule, and
debriefs.
Patient Incident Reports
The number of patient incident reports voluntarily
reported by staff via the electronic reporting system
3 months before training was 87 and 3 months after
training was 87.
Discussion
The results indicate that TeamSTEPPS training improved staff perceptions of teamwork and communication as measured by both the T-TPQ and the
HSOPSC tools, supporting previous findings.9-26 A
comparison of these 2014 HSOPSC results to baseline 2013 HSOPSC results shows the OSL exceeded
both the overall academic health center results and
the AHRQ comparative database 75th percentile benchmarking results.
Although the primary outcome measures (T-TPQ
and HSOPSC) showed statistical significance, the LBT
and the patient incident report numbers were basically
unaffected by the training. The LBT had only a 2%
knowledge increase and did not support the results
of previous studies.16-18 The pretraining scores were
higher than expected with a 92% mean, possibly
indicating either the test was too easy or the staff
already had sufficient baseline knowledge of teamwork, communication, and patient safety. The number
of patient incident reports, although a broad measure
of how teamwork training can impact staff behaviors
and patient care, surprisingly remained unchanged,
thus not substantiating 2 previous studies25,26 from
the literature.
In addition, other positive outcomes included
staff satisfaction, behavior change, and staff input.
The course evaluation showed that staff were satisfied with the training, which can be helpful in the
momentum and sustainment of a QIP. Signifying a
positive behavior change, 89% (n = 64) of staff reported that they used a tool in clinical practice that
they learned from their training session. Without
TeamSTEPPS research studies including focus groups
to reflect upon, the benefits of staff insight regarding
facilitators, barriers, and sustainability ideas are key.
This information can be beneficial for nursing
leadership moving forward. Overall, QIP outcomes
1, 2, and 4 were met, whereas outcome 3 was not met.
Limitations
There are several limitations that may affect the interpretation and application of these results. As with
many QIPs, the health center_s OSL self-selected to
participate. A convenience sample was used, therefore lacking a control group. Direct behavioral observation of posttraining behaviors and a longer evaluation
time frame were beyond the scope of this project,
which limits a thorough evaluation of training. The
electronic patient incident reporting system lacks a
specific category for incidents related to poor teamwork and/or communication. Lastly, the LBT results
may not be comparative to other studies because the
test was modified.
Conclusions
Promoting and sustaining a culture of patient safety
remain challenging for nurse leaders. The data from
this QIP support the effectiveness of the 2-hour TeamSTEPPS training with coaching for improving staff
perceptions for both teamwork and communication.
Future efforts to promote sustainability of the tools
and behaviors within the OSL may include adding
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205
this training program to the patient care unit_s orientation program, including physicians in the training,
maintaining an adequate supply of MTs, supporting direct observational methods with coaching, promoting visual/written/verbal reminders about the
patient safety program, and providing more ongoing,
educational in-services. TeamSTEPPS information is
available at http://www.ahrq.gov/professionals/
education/curriculum-tools/teamstepps/index.html.
Nurse leaders can use the information from this QIP
to better guide their future implementation and evaluation efforts. The customized 2-hour TeamSTEPPS
curriculum proved to be a practical, effective, and
low-cost training program with high acceptance by
participants.
Acknowledgment
The authors thank Dr Julie Thompson (statistician
at Duke University School of Nursing) for her significant contribution to the data analysis.
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JONA Vol. 46, No. 4 April 2016
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207
PRACTICE IMPROVEMENT
CHANGING TEAM MEMBER PERCEPTIONS BY
IMPLEMENTING TEAMSTEPPS IN AN EMERGENCY
DEPARTMENT
Authors: Connie Obenrader, DNP, RN, NE-BC, Marion E. Broome, PhD, RN, FAAN, Tracey L. Yap, PhD, RN, CNE, WCC, FAAN, and
Florame Jamison, DNP, APRN, CNP, Tahlequah, OK and Durham, NC
Earn Up to 7.5 Hours. See page 115.
Methods: The ED team consisted of 57 employees, including
Contribution to Emergency Nursing Practice
The purpose of this practice improvement project was to
improve communication and the team’s perceptions of
communication among ED staff.
The primary outcome of this practice improvement project was the team’s improved perceptions of communication and teamwork within the emergency department.
Key implications for ED nursing practice-based on this project are implementation of the TeamSTEPPS program
improves perceptions of teamwork and communication
among ED staff.
Abstract
Introduction: The emergency department is an environment
where teamwork and communication are of utmost importance
and are the foundation for improved patient satisfaction, staff
satisfaction, patient safety, and the reduction of clinical errors.
An ED staff perceptions of communication and teamwork influences their ability to provide efficient, high quality care to
patients.
Connie Obenrader is Nurse Practitioner at Northeastern Health System,
Tahlequah, OK.
Marion E. Broome is Dean and Ruby F. Wilson Professor, School of Nursing,
Duke University, Durham, NC.
Tracey L. Yap is Associate Professor, School of Nursing, Duke University,
Durham, NC.
Florame Jamison is Nephrology Nurse Practitioner, Northeastern Health
System, Tahlequah, OK.
For correspondence, write: Connie Obenrader, DNP, RN, NE-BC, 13899 N
510 Road, Tahlequah, OK 74464; E-mail: connie.obenrader@gmail.com.
J Emerg Nurs 2019;45:31-7.
Available online 12 October 2018
0099-1767
Copyright Ó 2018 Emergency Nurses Association. Published by Elsevier Inc.
All rights reserved.
https://doi.org/10.1016/j.jen.2018.08.006
January 2019
VOLUME 45 ISSUE 1
nurses, mid-level providers, and non-licensed individuals, who
work within, or directly with, the department. This quality
improvement project trained 57 members of the ED staff using
the TeamSTEPPS training program. Forty-six of the participants
completed assessments at all 3 time points (baseline, 2 weeks
and one month): Team STEPPS Teamwork Perceptions and
Attitudes Questionnaires and The Nursing Culture Assessment
Tool (NCAT).
Results: Formal group TeamSTEPPS training improved the
emergency department team members’ perceptions of, and
attitudes about, communication and teamwork. Discussion:
As a result of TeamSTEPPS training in an Emergency
Department, the staff of that department perceived that both
teamwork and communication improved. The TeamSTEPPs
program should be made sustainable by incorporating the
verbiage and tools from the program into policy and culture
within the department.
Key words: Communication; Teamwork; Perception; TeamSTEPPS; Hospital; Community hospital; Emergency department
E
very health care entity strives to maintain a safe
environment. To accomplish this, the workplace
culture must value patient safety and quality care.
Essential components of a culture of safety include
communication, resources, commitment, and openness
to creating structures that promote safety within the organization. 1 Nurses feel empowered when those components, including effective communication, exist as was
documented in an exploratory study based on Kanter’s
theory of structural empowerment.2 There are acquired
assumptions—which are actually values and beliefs—
about communication that are shared among occupational subgroups within every organization. Those
assumptions influence the perceptions, and therefore
the actions, of the individual members of the group.
Mutual trust, as well as confidence in the efficacy of
WWW.JENONLINE.ORG
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PRACTICE IMPROVEMENT/Obenrader et al
preventive measures—including communication and
an environment where everyone feels responsible—are
components of a culture of safety.3
The emergency department is an environment in which
teamwork and communication are of utmost importance
and are the foundations for improved patient satisfaction,
staff satisfaction, patient safety, and the reduction of clinical
errors.4 Each department within the hospital has a unique
nursing culture. The Association of Operating Room
Nurses (AORN) promotes an organizational structure that
“encourages reporting, ends blame, involves senior leadership, and focuses on systems and offers standard communication as an underpinning.”5 Teamwork is enhanced by
communication containing the effective exchange of information.6 Effective communication can be arduous and challenging in a high-paced, complex environment such as the
emergency department, where numerous staff members
are caring for patients as part of the health care team.7
Communication may be improved by structures or protocols that aid individuals in standardizing the order in which
information is shared.8
One method for improving communication and team
processes around safety is the use of the TeamSTEPPS
program. TeamSTEPPS was developed by the Agency for
Research and Quality between 2002 and 2005. The
program has been used in health care across a variety of settings to improve teamwork.9 Using structured training, a
work environment can be built so it may transfer new
knowledge enhancing communication, and hence safety.10
Setting
The setting for this project was an emergency department
within a 99-bed health system in the Midwest United
States. The department sees an average of 55 patients daily.
There were challenges experienced among staff members
during the communication processes related to patient
care. The care team had developed a complacent attitude
regarding communication. For example, during emergent
situations, the team did not communicate with others
involved in the emergency care of patients when tasks
were completed. They believed that other members of their
team knew them so well that they could adequately communicate by exception: meaning that unless otherwise stated,
the task had been completed. Poor communication, a risky
behavior, can develop as a result of a team working together
daily and believing that clarifications are not needed.
The emergency nurse must be diligent in communicating all care and treatments in the emergency department.
Without intentional clarification, the receiving nurse may
32
JOURNAL OF EMERGENCY NURSING
inadvertently duplicate or omit a treatment. Implementing
structured communication tools can aid the team in
improving the quality of their communication. Therefore,
the primary aim of this quality improvement project was
to improve the perception of communication among ED
team members before and after implementation of the
TeamSTEPPS program and tools. A secondary aim was to
improve the perception of teamwork in the emergency
department.
Methods
The ED team consisted of 57 employees including nurses,
nurse practitioners, physicians assistants, and non-licensed
individuals who work within, or directly with, the department. This group made up the convenience sample used
in this project. Exclusion criteria included those individuals
who did not complete all 3 assessments. Physicians were not
included in the convenience sample owing to physician staff
changes that occurred midway through the project. For this
repeated measures-designed project, TeamSTEPPS initial
training and data collection took place during a 1-week
period. Fifteen and then 30 days later, the participants
were asked to complete the tools again for the data collection. To sustain the program, TeamSTEPPS was included
in policy verbiage, and additional TeamSTEPPS tools
were slated for implementation at a future time across
selected units in the institution. New employees are introduced to TeamSTEPPS during orientation and are provided
training for TeamSTEPPS tools, which are in use within the
emergency department.
TeamSTEPPS is an evidence-based teamwork system
derived from more than 20 years of Crew Resource Management by the Department of Defense. The program was
designed to influence the following: (1) Expand the team’s
ability to adapt to changing situations; (2) create a shared
understanding of team plans; (3) develop positive attitudes
about being part of the team; and (4) establish a safe and reliable environment in which to practice.9 The components of
TeamSTEPPS have proven effective in improving communication and teamwork in many work settings including
aviation, medical, nuclear power plants and community
emergency agencies.
The Team STEPPS Fundamentals course was conducted in person for the ED staff.9 The course was presented by a
Master Trainer. The fundamentals course consists of video
vignettes, table discussions, and role playing to learn and
practice new communication skills. The new communication skills were supported by tools from the Team STEPPs
program, which were selected by the ED leadership and core
staff members.
VOLUME 45 ISSUE 1
January 2019
January 2019
TABLE 1
Communication
VOLUME 45 ISSUE 1
Instrument
TTAQ
TTPQ
NCAT
a
Mauchly’s
Test of Sphericity
Time of Measurement
Before
training
Time 1
met, x2(2, N¼43)
T1M¼.3.77,
¼ .91, P ¼ .63
SD¼ .03
a
2
Violated , x (2, N¼43) T1M¼4.09,
_ .001
¼ 27.79, P <
SD¼.01
met, x2(2, N¼22)
¼ 5.338, P ¼ .07
Significance
Result
Fifteen days after
training Time 2
Thirty days after
training Time 3
Time 1
and time 2
Time 1
and time 3
Time 2 and
time 3
T2M¼3.91,
SD¼ .07
T2M¼3.92,
SD¼.02
T2M¼3.91,
SD¼ .07
T3M¼4.58,
SD¼ .02
P ¼ .03
P ¼ .001
P ¼ .04
_ .001
P<
_ .001
P ¼
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