TeamSTEPPS is an organized process that uses team strategies and effective communication techniques to enhance patient safety within the health care setting. The program has been tested and validated by the Department of Defense and VA hospitals and clinics, working with the Agency for Healthcare Research and Quality (AHRQ). It has been shown to be a powerful tool for improving patient safety and reducing medical errors.
TeamSTEPPS establishes a common set of tools, concepts and skills for employees and physicians to use collaboratively for teamwork discussions, and to promote accurate and effective communication.
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Key elements of the TeamSTEPPS program
Many of the TeamSTEPPS tools are similar to some of Texas Health hospitals' successful communication models, such as the interdisciplinary huddles at Texas Health Arlington Memorial Hospital and the interdisciplinary rounding in the intensive care units at Texas Health Presbyterian Hospital Dallas. In TeamSTEPPS language, these examples would be considered part of a "briefing" (see Briefs below), or a planned interdisciplinary/interdepartmental meeting at the beginning of a shift to discuss what the focused patient care plan is for the day. Briefings may also take place at the beginning of a procedure, when the care team discusses the planned procedure and any complications that might be anticipated.
The key elements of TeamSTEPPS are leadership, mutual support, communication and situation monitoring.
Leadership means providing a supportive environment where clear patient safety goals are articulated through specific team activities.
- Briefs - a conversation with all team members before a shift or procedure to discuss what is expected to occur (planning);
- Debriefs - a team conference following a shift or procedure covering what went well, what didn't go as well as it should have, and how we can improve; and
- Huddles - an unplanned or ad hoc team meeting related to a patient or department need.
This element provides team encouragement that allows any staff person to "stop the line" when they observe something that is not "quite right."
Mutual support makes the team horizontal when it comes to moving forward with a process or procedure. Everyone should comfortably speak up with a concern or request for more information.
CUS is a tool within mutual support - an acronym for Concern, Unsafe and Stop. It creates a two-challenge rule, where anyone can say to any member of the team, "I have a Concern," "I feel Unsafe," or "We have a Safety issue." At the third step, the staff member should "stop the line" until the issue is resolved. The motivation for using this tool is strictly patient safety and it allows one team member to communicate twice with this "special message" language.
Research demonstrates that following a medical error, someone involved will say that they "had a feeling" the care wasn't going as planned, yet they failed to speak up. Now every Texas Health employee is expected to speak up and say "I have a concern" when they believe something is not right, with team members responding to the word "concern" on behalf of patient safety and effective teamwork.
Tools for effective communication include the SBAR (situation, background, assessment and recommendation) technique (see next section), read backs, effective hand-offs and coaching.
Many of these practices are already in effect at Texas Health entities. An effective team environment would certainly include some of these tools.
A positive, supportive environment is critical to the success of the TeamSTEPPS process. All team members know what to expect because there is adequate communication among team members. Everyone knows one another by name, and they are comfortable and confident enough to speak up when they feel something isn't "quite right." All team members have value and know they are critical to the success of the team.
A core belief of TeamSTEPPS is that a team is better than a single individual with attitudes that are based on mutual trust that attains reliable and efficient performance.
TeamSTEPPS has already been implemented in Women's Services departments systemwide, and in coming months, the program will be rolled out to other departments throughout the system.
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The SBAR technique
SBAR (Situation, Background, Assessment and Recommendation) is an easy-to-remember acronym useful for framing any situation, especially a critical one requiring immediate attention and action. This gives members of the health care team an easy, focused way to set expectations for what will be communicated and how. In phrasing a conversation with another member of the team, consider:
- Situation - what is happening with the patient?
- Background - what is the clinical background?
- Assessment - What do I think the problem is?
- Recommendation - What would I recommend?
This technique allows individuals to speak up and express concerns in a concise manner.
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