Tips and Suggestions for Enhancing Organizational Readiness

Below are some tips and suggestions for actions you can take to help assess and enhance the readiness of your institution to implement TeamSTEPPS.

• Use assessment tools to further assess readiness and clarify needs. Examples include the AHRQ Patient Safety Culture Survey, surveys of patient and staff satisfaction, unit- or site-specific process and outcome measures (patient flow, hospital acquired infection rates, preventable deaths). Gather data that will provide a baseline of the organization's current status and can be used to develop a business case or leader briefings.

• Conduct a briefing for senior leaders and key stakeholders about the TeamSTEPPS program, including its purpose and goals, what's required from an organizational perspective, and what's required of them to make the initiative a success. Be sure they are aware of what will be needed for your organization to gain the benefits from TeamSTEPPS and allow them to make an informed decision. Reinforce the concept that TeamSTEPPS is more than just a training program. It's an ongoing effort to enhance teamwork. This will reduce the likelihood of a "false start," where the training is conducted but no actions are taken to ensure the behaviors become incorporated into everyday actions.

• Gather information regarding the need within your institution and assemble a business case that you can present in support of initiating TeamSTEPPS. Identify who will receive the business case presentation (e.g., senior leaders), what you need from them (e.g., decisions, support for the program, resources), and the type of information that will mean the most to them and that they will rely on to inform their decisions (e.g., evidence-based research, hospital safety statistics, success stories). Present a compelling rationale for why the change effort is necessary (e.g., the problem that it will solve) and the benefits that will potentially be obtained. A report from The Conference Board in 2005 suggested that a lack of urgency and unclear rationale are two of the most common derailers of change efforts. If there really isn't a clear, compelling rationale, it is best to determine that up front and postpone the effort.

• Identify all the changes that are currently occurring within the organization, determine who the changes are impacting (e.g., specific units), and create a timeline of the progress of each change effort. Based on this timeline, identify a good time to implement TeamSTEPPS for a specific unit. Ideally, start with a group that has a need and the capacity to handle the change effort. Postpone the start, if necessary, until another major change has been completed if it is organization wide. Sometimes delaying the start for a few months can make a big difference. Having too many changes underway that exceed peoples' change capacity is a common reason why change efforts fail. In some cases you may be able to work with leaders to identify whether any of the other change efforts are unnecessary, freeing capacity for TeamSTEPPS.

• Identify units that are prime candidates for TeamSTEPPS by applying the following matrix. First, identify the capacity of various units to handle the change as well as their level of readiness. Then determine the level of teamwork required within the units. Use this information to determine a rollout plan or sequence within the institution. Units that are both ready and require great teamwork are logical candidates for an early launch.

• For any effort, especially if the institution is not at a high level of readiness, consider starting small rather than launching an organization-wide effort.
  • Gather leadership support and buy-in for a targeted effort.
  • Select a specific unit, considering both its readiness and need for enhanced teamwork. The selected unit should neither be the easiest nor the most difficult one to start with.
  • Identify champions and change agents from both physician and nurse areas within the unit. Make sure they clearly understand the rationale for the effort and their roles.
  • Identify a problem the unit has that it wants or needs to fix. (What keeps you up at night? What can we fix?) Focusing on a problem the unit wants to address can help keep it motivated.
  • Select a specific TeamSTEPPS tool or process that best addresses the problem and can be most effective for that unit. Look for tools or processes that fit into the unit's current processes.
  • Provide the unit training on teamwork and how to use the tool or process.
  • Reinforce the use of the tool or process through ongoing coaching and leadership support and recognition.
  • Measure how the tool or process is being used and how the problem is being addressed. Capture successes and recognize when adjustments are needed.
  • Identify and apply lessons learned from this unit to begin the process with another unit.
  • Discuss additional opportunities for this unit.

• Try to identify champions from both the physician and nurse areas. Champions help support the effort, encourage others, and maintain energy. Both physician and nursing champions are important, but without a physician champion, the effort is less likely to succeed.

• Involve key influencers in the process. These can be leaders, but they can also be staff. Which individuals tend to have the greatest influence on other team members? Who do team members look to when deciding if something is useful or a waste of time? Ideally, you'd like them to be champions, but even if they aren't champions at the beginning of the effort, try to find ways to involve them in decisions (e.g., which problems to address, which tools to use). Research has shown that participation in change efforts is related to subsequent success (Lines, 2004).

• Identify current safety and quality initiatives (e.g., Lean Six Sigma) that may be occurring within the institution, and identify how TeamSTEPPS can fit with or reinforce those efforts. What is the purpose of those efforts and how might a TeamSTEPPS tool or process support that purpose? This ties the new team behaviors to an existing initiative. Identify measures that are being used for the safety and quality initiatives and determine whether any can be linked to TeamSTEPPS. One caveat: Avoid linking TeamSTEPPS with an extremely unpopular or unsuccessful effort.

• Identify ways that the TeamSTEPPS behaviors can be incorporated into existing work processes within the organization or unit. For example, TeamSTEPPS behaviors can be used during normally occurring handoffs to enhance information sharing and patient safety. Connecting TeamSTEPPS to regular work processes and requirements can make better teamwork part of doing the job rather than an unrelated or academic concept.

• Seek behavioral commitments from leaders. Ask them to help launch the effort, agree to followup on progress, reinforce key behaviors, and exhibit the behaviors themselves. Sometimes leaders don't sponsor efforts effectively because they don't know what they need to do. Coaching them can help them be better sponsors. A study of change efforts in 225 organizational change efforts showed that leader commitment is closely related to organizational success (Sirkin et al, 2005).

Emphasize the ongoing effort required to reinforce the TeamSTEPPS tools or processes over time. This includes the need for team meetings, huddles, and debriefs to discuss and reinforce the learned concepts and the need for coaches to provide team or one-on-one feedback regarding the use of the tools or processes. More learning occurs on the job than in classrooms (Tannenbaum, 1997), so coaches and supervisors are a key factor in ensuring ongoing learning and reinforcement of training (Tracey et al, 1995).

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References

1.  Beaman KV and Guy GR. The Conference Board. Effecting change in business enterprises. New York, NY. August 2005. Report No. R-1371-05-RR.
2.  Lines R. Influence of participation in strategic change: Resistance, organizational commitment and change goal achievement. Journal of Change Management 2004 4(3):193-215.
3.  Sirkin HL, Keenan P, Jackson A. The hard side of change management. Harvard Business Review 2005 83(10):109-118.
4.  Tannenbaum SI. Enhancing continuous learning: Diagnostic findings from multiple companies. Human Resource Management 1997 36(4):437-452.
5.  Tracy JB, Tannenbaum SI, Kavanagh MJ. Applying trained skills on the job: The importance of the work environment. Journal of Applied Psychology 1995 80(2):239-252.