TeamSTEPPS is a teamwork system designed for health care professionals that is:
- A powerful solution to improving patient safety within your organization.
- An evidence-based teamwork system to improve communication and teamwork skills among
health care professionals.
- A source for ready-to-use materials and a training curriculum to successfully integrate
teamwork principles into all areas of your health care system.
- Scientifically rooted in more than 20 years of research and lessons from the
application of teamwork principles.
- Developed by Department of Defense's Patient Safety Program in collaboration with
the Agency for Healthcare Research and Quality.
TeamSTEPPS provides higher quality, safer patient care by:
- Producing highly effective medical teams that optimize the use of information, people,
and resources to achieve the best clinical outcomes for patients.
- Increasing team awareness and clarifying team roles and responsibilities.
- Resolving conflicts and improving information sharing.
- Eliminating barriers to quality and safety.
TeamSTEPPS has a three-phased process aimed at creating and sustaining a culture
of safety with:
- A pretraining assessment for site readiness.
- Training for onsite trainers and health care staff.
- Implementation and sustainment.
The TeamSTEPPS curriculum is an easy-to-use comprehensive multimedia kit that contains:
- Fundamentals modules in text and presentation format.
- A pocket guide that corresponds with the essentials version of the course.
- Video vignettes to illustrate key concepts.
- Workshop materials, including a supporting CD and DVD, on change management, coaching,
Three Phases of the TeamSTEPPS Delivery System
The three phases of TeamSTEPPS are based on lessons learned, existing master trainer
or change agent experience, the literature of quality and patient safety, and culture
change. A successful TeamSTEPPS initiative requires a thorough assessment of the
organization and its processes and a carefully developed implementation and sustainment
Phase 1 - Assess the Need
The goal of Phase 1 is to determine an organization's readiness for undertaking
a TeamSTEPPS-based initiative. Such practice is typically referred to as a training
needs analysis, which is a necessary first step to implementing a teamwork initiative.
For more information about conducting a needs assessment, Select for
Phase 2 - Planning, Training, and Implementation
Phase 2 is the planning and execution segment of the TeamSTEPPS initiative. Because
TeamSTEPPS was designed to be tailored to the organization, options in this phase
include implementation of all tools and strategies in the entire organization, a
phased-in approach that targets specific units or departments, or selection of individual
tools introduced at specific intervals (called a "dosing strategy" in TeamSTEPPS
parlance). As long as the primary learning objectives are maintained, the TeamSTEPPS
materials are extremely adaptable. For more information about planning, training,
and implementing TeamSTEPPS, Select for more information.
Phase 3 - Sustainment
The goal of Phase 3 is to sustain and spread improvements in teamwork performance,
clinical processes, and outcomes resulting from the TeamSTEPPS initiative. The key
objective is to ensure opportunities exist to implement the tools and strategies
taught, practice and receive feedback on skills, and provide continual reinforcement
of the TeamSTEPPS principles on the unit or within the department. For more information
on sustaining TeamSTEPPS initiatives, Select for more information.
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Details of a Site Assessment
A site assessment entails identifying opportunities for improvement; determining
the readiness of the institution, such as leadership support; identifying potential
barriers to implementing change; and deciding whether resources are in place to
successfully support the initiative. Each part of the Phase 1 assessment is described
1. Establish an organizational-level change team
- The organizational-level change team should consist of a multidisciplinary group
that represents the breadth of health care professionals within the organization.
Successful change teams are comprised of organizational leaders who are committed
to changing the current culture.
2. Conduct a site assessment.
- A site assessment, also called team training needs analysis, is a process for
systematically identifying teamwork deficiencies so training programs can be developed
to address those deficiencies. This information is then used to identify critical
training and develop training objectives.
3. Define the problem, challenge, or opportunity for improvement.
- The team must identify the recurring problem that threatens patient safety and then
determine how this problem results from existing processes and procedures. The team
should devise a flowchart or map of the process during which the problem occurs.
With information and processes properly mapped, it becomes clear what interventions
are needed, what the objective of these interventions should be, and how ready the
organization is to engage in these interventions.
4. Define the goal of your intervention
- List the goals that will reduce or eliminate the risk to safe patient care. For
each goal, state in one sentence what will be achieved, who will be involved (whose
behavior will change), and when and where the change will occur. Ideally, a team
process goal, a team outcome goal, and a clinical outcome goal will be defined.
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Details for Planning, Training, and Implementation of
The tools and strategies needed to address opportunities for improvement in an
organization will be determined by the Phase 1 assessment. The next step is to develop
a customized Implementation and Action Plan, followed by training and implementation.
Below is a brief description of steps for planning, training, and implementation.
1. Define the TeamSTEPPS intervention.
- Decide whether "whole training" (all the tools in one sitting) or "dosing" (specific
tools targeted to specific interventions) is the best intervention tactic. Whole
training optimizes teamwork but does not maximize learning. It can also lead to
overload or uncertainty about which tools best fit improvement opportunities. Dosing
is the recommended approach because it allows for direct linking of tools and strategies
with specific opportunities for improvement to minimize training fatigue and
2. Develop a plan for determining the intervention’s effectiveness.
- There are a variety of ways to evaluate the impact of training. The plan should
assess whether trainees have acquired new knowledge, skills, or attitudes at the
end of training; if individuals are taking their learning back to the workplace
and using it on the job; and organizational outcomes.
3. Develop an implementation plan.
- Assess what groups will be trained, the order in which they will be trained (if
not together and all at once), and what level of training they will receive. Include
in the plan who will conduct training and where and when training will take place.
4. Gain leadership commitment to the plan.
- Inform leaders of all facets of the plan, including how much time will be used for
training and the desired resources to support it. Leadership commitment often yields
plan refinement. The key is to know what elements of the plan cannot be altered.
5. Develop a communication plan.
- Develop a plan for communicating what will be done and how the goal will be achieved.
Leaders (both designated and situational) should provide information to all those
in their departments or units about the initiative. It is crucial to tie together
all activities that will take place with the overall goal for the initiative (i.e.,
improved patient safety).
6 Prepare the institution.
- For any initiative to be fully successful, transfer of training must be achieved.
Transfer is achieved by ensuring new knowledge or skills are learned and applied
in the work environment. The change team must ensure the work environment is prepared
to foster transfer of training so new tools and strategies are applied on the job.
7. Implement training.
- The most effective strategy for delivering the training initiative is one that involves
teams of trainers that include physicians, nursing staff, and support staff. A
combination of the curricula is recommended when training different sets of staff
independently. The TeamSTEPPS system includes three different medical team training
curricula and a complete suite of multimedia course materials:
1.Train-the-Trainer. This 2-day training course is designed to create a cadre
of teamwork instructors with the skills to train and coach other staff members.
2.TeamSTEPPS Fundamentals.This curriculum includes 4 to 6 hours of interactive
workshops for direct patient care providers.
3.TeamSTEPPS Essentials. This curriculum is a 1- to 2-hour condensed version
of the Fundamentals Course and is specifically designed for nonclinical support
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Details for Sustaining a TeamSTEPPS Intervention
The designated change team manages sustaining interventions through coaching and
observing team performance. An effective sustainment plan should account for ongoing
assessment of the effectiveness of the intervention, sustainment of positive changes,
and identification of opportunities for further improvements. Below is a brief description
of the steps to include in a TeamSTEPPS sustainment plan.
1. Provide opportunities to practice.
- Any TeamSTEPPS based initiative will be much more successful if the change team
accounts for opportunities to practice these behaviors. It is important to embed
opportunities for practice in day-to-day functions.
2. Ensure leaders emphasize new skills.
- Leaders play a critical role in sustainment because they are responsible for
emphasizing daily the skills learned in TeamSTEPPS training. The goal is for leaders
to engage in activities that will ensure continuous involvement in teamwork.
3. Provide regular feedback and coaching.
- Regular feedback and coaching are key to ensuring interventions are sustained. Change
team members, champions from the unit, and leaders should develop and use a coaching
and feedback plan that allows for sufficient observation and feedback opportunities.
4. Celebrate wins.
- Celebrating wins bolsters further sustainment and engagement in teamwork. When using
a TeamSTEPPS-based initiative, it is critical to celebrate successes for two reasons.
First, it recognizes the efforts of those who were engaged from the beginning, and
second, it provides detractors or laggards a tangible example of how teamwork has
improved the current operations.
5. Measure success.
- The change team should measure success by demonstrating satisfaction with training,
learning, the effective use of tools and strategies on the job, and changes in
processes and outcomes. It is useful to ensure that measurement of pretraining
factors is parallel with post-training factors so changes can be assessed.
6. Update the plan.
- The final stage in any TeamSTEPPS-based intervention is to revise the plan as the
organization's needs change. The change team should determine when organizational
needs have changed and ensure the sustainment plan continues to focus on the needs
of the organization or unit where the intervention has been implemented.
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