TeamSTEPPS Implementation Story Series
Edition #3

SOUTH AUSTRALIA DEPARTMENT OF HEALTH

Background

South Australia is the fourth largest state in Australia, with a population of 1.4 million, including 23,425 people of indigenous origin. South Australian Health (SA Health) aims to ensure healthier, longer, and better lives for all South Australians through a comprehensive and sustainable health system. SA Health works to achieve these aims by strengthening primary health care, enhancing hospital care, reforming mental health care, and improving the health of Aboriginal people. The Safety and Quality Unit of the South Australian Department of Health works in partnership with health services to improve patient safety and quality of care. Five sites in South Australia undertook a trial of TeamSTEPPS to see if it would benefit patients, particularly in regard to clinical handover. These five sites contributed to a state evaluation of the training to determine the program's transferability to the Australian health care setting.

Implementing TeamSTEPPS

The Women's and Children's Hospital (WCH) was one of the five sites that elected to participate in TeamSTEPPS training. WCH decided to try out the training after recognizing that communication errors could occur as patients were transferred from day-of-surgery admission through anesthesia, recovery, and the short-stay unit.

The WCH in South Australia received TeamSTEPPS training in March 2008. TeamSTEPPS was introduced along the patient journey rather than on a ward or unit. Implementation areas were kept small in order to assess what would be required for a successful TeamSTEPPS intervention. Following a positive evaluation, TeamSTEPPS was expanded to three additional units, including two theater suites that were not included in the 2008 trial. "There is a stark contrast in the quality of handover from the areas that are not involved in the TeamSTEPPS project when compared to those that have been," according to one registered nurse.

Challenges/Obstacles

The WCH's greatest challenges and obstacles in implementing TeamSTEPPS include:

• Convincing medical staff of the benefits of the program and, hence, getting them to attend the training.
• Getting ongoing funding to drive the initiative, assist with the training, and maintain the momentum.
• Securing 4 hours from everyone's schedule for the staff to receive the fundamentals training.
• Collecting accurate data that reflects the benefits of the TeamSTEPPS initiative.

The WCH used every opportunity to discuss with medical leaders the evidence for a TeamSTEPPS intervention. This included conducting presentations during meetings of the medical unit heads, during divisional business meetings, and during safety and quality meetings. The success of the 2008 implementation resulted in funding to support implementation for an additional 6 months, including support of new training sites. The evidence of change in practice led to the department leadership's continued support for the training.

The challenge of achieving staff training has been overcome by:

• Using allocated double staff times and using a strategic plan to have all staff rotate through the sessions.
• Using a shorter, specially prepared presentation for medical officers. This presentation was also loaded onto the hospital's Intranet system for them.

The unit also videotaped a 4-hour training session for permanent night duty staff. This was followed by a session with TeamSTEPPS coaches who could answer questions.

Accomplishments/Lessons Learned

TeamSTEPPS training was successfully delivered and sustained in three areas within the organization. Nursing overtime was reduced as staff became more efficient in handover. "TeamSTEPPS is the most well-embraced change I've seen in this hospital in 20 years," one nurse stated. Information exchange was improved through briefings and SBAR (Situation, Background, Assessment, Recommendation), and staff satisfaction was increased. Other areas now wish to become involved in TeamSTEPPS because of its successful implementation.

Factors that have contributed to the training's success include:

• Support from the department's executive leadership and willingness to support a project person to facilitate the program. This, in turn, has created a knowledge base consistency.
• Having a motivated and passionate head of anesthetics who was always "flying the TeamSTEPPS flag."
• Choosing change team members who are motivated advocates of patient safety.

Data collection to provide evidence to support the effectiveness of TeamSTEPPS is valuable. It is crucially important that the medical staff support the program by reminding them that they are part of the TeamSTEPPS team and that the training is in the best interests of patient safety.

Next Goals

Upon training completion at the present sites, more areas will be nominated to commence TeamSTEPPS training in March 2010 and October 2010 at the WCH.

For further information about these TeamSTEPPS implementation stories, please contact us at TeamSTEPPScontact@air.org.