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Team STEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety

By Don Sadler

Recently, there has been an increased emphasis on patient safety at all levels of the health care delivery system. Some health care organizations are implementing a program developed with input from the Department of Defense as part of their efforts to improve patient safety.

Referred to as TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), this evidence-based framework is designed to improve health care professionals’ teamwork and communication skills as they relate to improving patient safety.

A Common Language

screen-shot-2016-11-28-at-3-07-05-pmAccording to Ellice Mellinger, MS, BSN, RN, CNOR, a senior perioperative education specialist with the Association of periOperative Registered Nurses (AORN), the TeamSTEPPS program provides a common language or vocabulary to promote effective team skills and communication. 

“These skills are especially important in the fast-paced and often stressful environment of the perioperative services area,” she says.

TeamSTEPPS is designed to teach Master Trainers a framework of skills they can take back to their health care organizations and share with personnel there.

“The goal is to implement and evaluate new patient safety initiatives, or to change, evaluate or enhance existing initiatives,” says Mellinger.

The TeamSTEPPS program also provides tools that can be used to evaluate and measure the changes that have already been implemented, as well as monitor whether or not these changes are effective and sustainable, says Mellinger.

For example, wrong-site surgery and retained surgical items are two of the most frequently reported preventable errors in the OR. Mellinger says research has concluded that ineffective communication is one of the leading causes of these and other sentinel, near-miss and adverse OR events.

Mellinger explains in more detail how TeamSTEPPS tools can be used to help prevent wrong-site surgery.

“Some departments struggle with the OR team not completing actions that are outlined in their policies for each patient’s pre-procedure activities. TeamSTEPPs assessment tools can help identify a course of action to improve the pre-procedure verification process throughout the preoperative process,” she says.

Rooted in Science

TeamSTEPPS was developed jointly by the Department of Defense’s Patient Safety Program and the Agency for Healthcare Research and Quality (AHRQ). According to the AHRQ (, it is scientifically rooted in more than 20 years of research and lessons from the application of teamwork principles.

The AHRQ says there are four specific ways that TeamSTEPPS provides higher quality and safer patient care:

  • Produces highly effective medical teams that optimize the use of information, people and resources to achieve the best clinical outcomes for patients.
  • Increases team awareness and clarifies team roles and responsibilities.
  • Resolves conflicts and improves information sharing.
  • Eliminates barriers to quality and safety.

screen-shot-2016-11-28-at-3-07-12-pmAccording to the AHRQ, there are three distinct phases in the TeamSTEPPS delivery system:

  1. Pre-training assessment for site readiness – This consists of identifying opportunities for improvements in patient safety, determining the readiness of the health care organization (e.g., leadership support) for change, identifying potential barriers to implementing change, and determining if resources are in place to successfully support the initiative.
  2. Planning, training and implementation – Options include implementation of all TeamSTEPPS tools and strategies throughout the entire organization, a phased-in approach that targets specific units or departments, or selection of individual tools introduced at specific intervals (this is referred to as a “dosing strategy”).
  3. Implementation and sustainment – The key objectives here are to ensure that opportunities exist to implement the TeamSTEPPS tools and strategies that have been taught, practice and receive feedback on skills, and provide continual reinforcement of the TeamSTEPPS principles.

Four Basic Skills

The TeamSTEPPS program is based on a framework that’s comprised of four skills: leadership, situation monitoring, mutual support and communication. Following are more details on each of these skills to help you implement the TeamSTEPPS program at your health care organization.

There are two types of TeamSTEPPS leaders: Designated leaders and Situational leaders. Regardless of which type of TeamSTEPPS leader an individual may be, he or she should be able to accomplish a number of specific steps, including the following:

  • Articulate clear goals.
  • Make decisions through the collective input of team members.
  • Empower team members to speak up and challenge leadership, when appropriate.
  • Actively promote and facilitate good teamwork.
  • Resolve conflicts among team members skillfully.

screen-shot-2016-11-28-at-3-07-21-pmThe TeamSTEPPS program includes several specific team events designed to help boost leadership skills. These include:

Team Brief: This is a short planning session that should take place prior to team formation. The goal of the team brief is to assign essential roles, establish expectations and climate, and anticipate outcomes and likely contingencies.

Team Huddle: This is a type of ad hoc planning used for problem-solving. It helps re-establish situational awareness, reinforce plans already in place, and assess whether or not it’s necessary to adjust the plan.

Team Debrief: This is an informal information exchange session designed to improve team performance and effectiveness. Team feedback will help drive future process improvements.

Situation monitoring is the process of health care team members continually scanning and assessing what’s going on around them to maintain situational awareness. This is defined by TeamSTEPPS as “knowing what is going on around you and knowing the conditions that affect your work.”

TeamSTEPPS uses the acronym STEPS to describe situation monitoring: Status of the patient, Team members, Environment, and Progress toward the goal.

Also covered under situation monitoring are cross monitoring – an error reduction strategy that involves team members monitoring each other’s actions to provide a safety net within the team – and shared mental models. These result from each team member maintaining situational awareness and sharing relevant facts with the entire team.

One form of mutual support in TeamSTEPPS is referred to as task assistance. Here, team members protect each other from work overload situations, put all offers and requests for assistance in the context of patient safety, and foster a climate where it’s expected that assistance will be actively sought and offered.

screen-shot-2016-11-28-at-3-07-31-pmFinally, TeamSTEPPS defines effective communication as complete, clear, brief and timely. It includes a technique called SBARQ for communicating critical information concerning a patient’s condition that requires immediate attention and action:

Situation: What’s going on with the patient?

Background: What is the clinical background or context?

Assessment: What do you think the problem is?

Recommendation and Request: What would you do to correct the problem?

Questions: What questions do team members have?

Implementing TeamSTEPPS Tools

Mellinger identifies a number of different ways OR personnel can implement TeamSTEPPS tools and strategies to improve patient safety, including the following:

  • Learn how to be an effective team member;
  • Speak up about patient safety concerns;
  • Communicate professionally to resolve conflicts;
  • Increase efficiency in perioperative processes; and
  • Assess and track the progress of quality improvement processes for patient safety.

One thing Mellinger especially likes about TeamSTEPPS is the fact that it is not prescriptive.

“There are so many tools and strategies available in TeamSTEPPS,” she says.

“TeamSTEPPS offers many evidence-based tools that complement the team structures in every OR,” Mellinger adds. “Using these tools encourages a common language and consistency and clarity in communication practices.”

According to Mellinger, AORN is developing a new video and study guide titled Perioperative Team Dynamics and Communication that incorporates TeamSTEPPS tools and strategies.

“This educational product should be available for purchase by the end of the year,” she says.

For more details, visit AORN online at



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