St. Boniface Hospital in Winnipeg, MB, is our SuperSHIFTER for September. They embody the spirit of Canadian Patient Safety Institute's SHIFT to Safety program, providing support and content that improves patient safety through an emphasis on teamwork, communication and positive safety culture.
Members of the team at St. Boniface, including Michaele Rivet, Patient Safety Consultant; Jen Kostyshyn, ED nurse; Dr. Jeff Klassen, ED physician; and Cheryl Bilawka, Educational and Development Specialist, recently spoke with CPSI's Vanessa Walsh to explore their unique journey implementing the TeamSTEPPS program (click
here to learn more about TeamSTEPPS). Here is that conversation:
Q: How did St. Boniface Hospital get started with TeamSTEPPS?
A: We started implementing TeamSTEPPS in our ED and shortly after our cardiac care program in 2010-11. We really liked how simple it was, and how it provided the concepts, tools and training for free. We sent a contingent of staff, physicians and leaders to an Agency for Healthcare Research and Quality (AHRQ) regional training centre in the United States for master trainer training. We linked up with our physicians, allied health, and support staff to begin running a training plan for all staff in the ICU's and ED.
Q: How did you measure your improvement efforts?
A: We administered the AHRQ Hospital Survey on Patient Safety Culture (HSOPS) in the ED as a baseline, and again at three months, six months and one year after our initial staff trainings. Our department had a significant staff turnover, and the data reflected that change, showing we lost the initial improvements gained after a year. We gleaned two big lessons – first that we needed to build internal capacity and bring master training in-house to maintain momentum, and second, although we had a coaching model in place it seemed our biggest challenge was to keep people thinking about TeamSTEPPS after their training.
Q: How did you scale up and go hospital-wide with the training?
A: We trained 244 master trainers in 18 months! They took all the concepts and tools and spread them within their own programs and staff. We also added a TeamSTEPPS Fundamentals training to General Hospital Orientation.
Q: Did you modify the training at all?
A: We made it our own in a couple of ways. The message on the importance of patient safety can sometimes be uncomfortable, so we purposefully built in humour to help staff pay attention and get talking about it. We broke out key strategies and tools into videos, and engaged staff in whatever way they were comfortable in. The videos are educational, funny and incorporate input from staff. We knew that most staff were on some sort of social media, and leveraged these platforms to promote our focus on teamwork and communication. If we could just breakdown TeamSTEPPS messages into bite-sized, post-able pieces, so it was constantly showing up in people's news feeds, it would always be on their minds.
We also started in-situ education around a huddle once or twice a week. We took people away from what they were doing for five minutes and talked about a very specific and focused safety idea. This was done in small enough groups so it was a discussion and not a didactic lecture. It was also done right where we want these behaviours to happen, right at the bedside, so they can turn around and immediately start using it.
Q: How are you planning to sustain the gains you've made in teamwork and communication for increased patient safety?
A:STEPP UP for Patient Safety is St-Boniface's TeamSTEPPS sustainment plan. It is entering its third year this month. Driven by a representative group of staff, it is a tailored monthly refresher for everyone that includes a theme, activities for role playing, and discussion topics for huddles at all levels of the organization. Past themes have focused on communication tools and strategies for escalation, and this upcoming year will zero in on advocacy and assertion.
In the ED, we're always gathering input from staff to make sure it's relevant and delivered in the best possible way. We have a core group to distribute the information and educate people. For example, we have a trivia group, a research group, an engagement group, a huddle group, etc. We are also working on a new simulation project, to develop a simulation curriculum that incorporates all the TeamSTEPPS tools and strategies.
Q: What would you recommend to someone wanting to adopt TeamSTEPPS strategies and tools within their organization?
A: Active leadership support has been crucial to our success. TeamSTEPPS is all about knocking down hierarchies and barriers to communication. Our leaders understand the tools and concepts, use them, and expect staff to do the same.
Also, every department, even within one hospital, can be a different environment. Knowing the culture and people can make a huge difference. We really tried to understand the issues that we were facing as well as the personalities in our department to create something that would work for us.
Q: Where can people go if they're interested in learning more about your work?
A: Reach out to us at @sbh_winnipeg on Twitter or by email at
Join us next month as SHIFT to Safety features #SuperSHIFTER Dr. James Ruiter from Salas Global Corporation, sharing an innovative insight into simulation methodology for patient safety.