TeamSTEPPS: optimizing teamwork in the perioperative setting

AORN Journal, July, 2007 by Carolyn M. Clancy

Although teams play an important role in the delivery of health care in virtually every setting, those of us who have worked in or near the OR understand that teamwork is essential. The quality and effectiveness of care can vary greatly, how ever, depending on how well a team functions. A truly effective health care team will maximize the use of information and the skills and resources of team members to achieve optimal outcomes, resulting in increased patient safety and improved health care quality--a key part of our mission at the Agency for Healthcare Research and Quality (AHRQ). Effective teamwork is not a given but a goal that requires training and cultivation.

At the AHRQ, we recognize that patient safety and improved health care quality also are part of AORN's mission. We applaud your commitment and efforts to provide resources and education to clinicians regarding safe patient care in the perioperative setting. AORN's Patient Safety First program, started in 2002, is a shining example for all health care clinicians. Your leadership efforts in the development of the Council on Surgical and Perioperative Safety demonstrate a commitment to collaboration and teamwork. AORN has recently acted on that commitment by introducing the perioperative Patient Hand-Off Tool Kit, available free of charge at http://www.aorn.org/Practice Resources/ToolKits/Patient HandOffFool Kit. This resource will assist perioperative clinicians in improving one of the key elements of teamwork--communication. This tool kit is based in part on TeamSTEPPS, a product that the AHRQ developed jointly with the US Department of Defense (DoD).

Paul M. Schyve, MD, senior vice president of the Joint Commission, has said, "Our challenge ... is not whether we will deliver care in teams but rather how well we will deliver care in teams." (1 (p183)) We have observed increased public attention to the concept of teamwork in health care. This attention is based on the growing realization of its importance in promoting high-quality care and preventing medical errors. In large part, this is the result of the 1999 publication of the Institute of Medicine's report To Err Is Human: Building a Safer Health System. (2) One of the principal findings of that report was that systemic failures in the delivery of health care account for more errors than does poor performance by individuals.

SOLUTION FOR IMPROVING TEAMWORK

So what can we do to improve the system and build effective and efficient teams? For more than 20 years, the AHRQ and its predecessor agencies have collaborated with the DoD--which encompasses one of the largest health care delivery systems in the world--to explore the field of medical teamwork. Recently, the two agencies announced the availability of an outstanding new resource for training health care providers in better teamwork practices, TeamSTEPPS, which stands for Team Strategies and Tools to Enhance Performance and Patient Safety. The new training package capitalizes on the DoD's expertise in medical and non-medical team performance and the AHRQ's research in the fields of patient safety and health care quality.

DESIGN OF TEAMSTEPPS

TeamSTEPPS offers a flexible, evidence-based tool kit designed for health care facilities and providers to improve patient safety through enhanced communication and other teamwork skills. The program is more than just a one-shot training session that nurses or other health care providers can implement. A TeamSTEPPS initiative occurs in three continuous phases:

* assessment;

* planning, training, and implementation; and

* sustainment.

Each phase incorporates the following key actions:

* set the stage,

* decide what to do,

* make it happen, and

* make it stick. (3)

To develop TeamSTEPPS, an expert panel drew on input from more than 35 health care-related organizations. The curriculum addresses the requirements set by the DoD's Health Care Team Coordination Program. TeamSTEPPS can be tailored to any health care setting. It was designed to train health care professionals who work not only in high-stress areas such as surgical suites, emergency departments, and intensive care units, but also in ambulatory care settings, including physicians' offices. Another important feature is that TeamSTEPPS may be implemented in full or in part. More than 130 scenarios (ie, mini-case studies) are available to be customized to a specialty area, such as the surgical suite. The training materials have stand-alone modules to choose from, depending on what best meets an organization's specific teamwork needs and resource availability.

ELEMENTS OF TEAMSTEPPS

TeamSTEPPS is based on four core competency areas:

* Team leadership--the ability to direct and coordinate activities of team members, assess team performance, assign tasks, develop team knowledge and skills, motivate team members, plan and organize, and establish a positive team atmosphere.

* Situation monitoring (or mutual performance monitoring)--the capacity to develop common understandings of the team environment and apply appropriate strategies to monitor teammate performance accurately.