SuperSHIFTERS Tricia Swartz, Jessica Kettles, Nada Strathearn and Gina De Souza are the Canadian Patient Safety Institute's team behind TeamSTEPPS Canada™. In this article they share their insights on this innovative SHIFT to Safety tool to improve teamwork and communications, and advance a patient safety culture.
What is TeamSTEPPS?
TeamSTEPPS® is an acronym for Team Strategies and Tools to Enhance Performance and Patient Safety. The program improves safety and transforms culture in healthcare through better teamwork, communication, leadership, situational awareness, and mutual support. TeamSTEPPS Canada™ is an evidence-based teamwork system that optimizes patient care by improving communication and teamwork skills among healthcare professionals at the point of care. It includes a comprehensive set of ready-to-use materials and a training curriculum to integrate teamwork principles into a variety of settings.
TeamSTEPPS Canada training session held in Halifax, Nova Scotia. Left to right: (left side) Nada Strathearn, Project Coordinator, CPSI; Monique Thibodeau, Project Coordinator, CPSI; Rhonda Pouliot, Lead Collaborative Learning and Education, Health Quality Council of Alberta; Maryanne D'Arpino, Senior Director Safety Improvement and Capability Building, CPSI; (right side) Gina Peck, Project Coordinator, CPSI; Denise Durfy Sheppard, Department of Health and Community Services Newfoundland Labrador; Gina De Souza, Patient Safety Improvement Lead, CPSI; and Tricia Swartz, Patient Safety Improvement Lead, CPSI.
How did you land on TeamSTEPPS as a tool to address teamwork, communication and patient safety culture?
When the SHIFT to Safety platform was launched by the Canadian Patient Safety Institute about two years ago, we wanted to move away from simply providing the healthcare field with evidence-based products on what to do, and take an approach that would help them to address problems around how to do it. When we looked at why teams were struggling with implementing evidence based practices, or accelerating their quality improvement efforts, we learned through the literature that the main issues were a breakdown in communications and teamwork, and a lack of a patient safety culture. From there, we looked at various curriculum and programs that existed nationally and internationally that specifically addressed these issues.
We reviewed about 10 different pre-existing programs and what would work best for the Canadian landscape. We landed on TeamSTEPPS®, a program designed by the Agency for Research and Healthcare Quality (ARHQ), in conjunction with the United States Department of Defense. The ARHQ is the Federal agency charged with improving the safety of America's health care system and they have trained more than 1,500 individual organizations in the United States through this program.
There were a number of the key features that stood out about TeamSTEPPS. It had over 30 years of research and evidence behind it that backed up the program. Teams across the United States and our partners in Europe had amazing improvements in patient safety using the curriculum. TeamSTEPPS encourages customization and we would be able to contextualize it to the Canadian healthcare context to make it really resonate with providers, leaders, and patients and families here in Canada – a lot of curricula are very stringent and subject to copyright and intellectual property laws that do not allow others to customize content. Finally, because TeamSTEPPS is adaptable to a variety of settings, we knew it was the right program to bring to Canada.
Another benefit of TeamSTEPPS that we valued was that it came with a very strong measurement platform. Not a lot of other curriculums came with the need to measure what you were doing to see where you had been and to evaluate your gains. We were able to customize the measurement platform using Canadian data sources and measurement methodology.
What makes TeamSTEPPS so successful?
TeamSTEPPS is more of a shared mental model. Healthcare providers tell us that work keeps piling on that they have to do and they are getting bogged down. TeamSTEPPS is not an additional thing that they need to do on top of the thousands of things they are already doing. It is not an additional checklist or task. It is more of getting on the same page and adopting the same model or way of thinking that should streamline all of those other things that you are doing. We like to say it is not something else to do; rather it is foundational to what you do.
Is TeamSTEPPS new to Canadian healthcare organizations?
One of the first things we did was an environmental scan to determine who was using TeamSTEPPS in Canada, to identify partners and areas of excellence. We identified some pocket areas, where TeamSTEPPS was being implemented in a small unit of a department. We followed-up with these individuals and teams to get a better idea of what they were doing, how TeamSTEPPS was being applied, and what challenges they had experienced. We wanted to learn from their experiences and identify gaps that we could address in building the Canadian program.
How have you customized the TeamSTEPPS Canada program?
There are a number of differences in the Canadian program that are innovative. First, we are using videos of real harm that are incredibly well done. We've swapped videos with American content and replaced them with videos that were scripted to show a real life Canadian example of harm that happened in the Canadian system and use that as a specific teaching opportunity to educate around the TeamSTEPPS tools and resources. We have an agreement with the Price family and the Health Quality Council of Alberta to use the Greg's Wings video – Falling Through the Cracks.
Second, the curriculum is open to providers from all areas of healthcare, not just acute care, which is so often the case. It is applicable to long term care, primary care, and all sorts of settings. Also, it is not strictly for clinical providers. It is also applicable to non-clinical providers and in fact, the program is far more successful when your team includes non-clinical providers.
Third, we asked representatives from Patients for Patient Safety Canada (PFPSC) to vet all of the patient engagement content and they rewrote that content for us. We are now partnering with PFPSC to create some patient-facing content that will give us a unique perspective and a customized curriculum.
Finally, the tools and information in the TeamSTEPPS program always talk about sustaining improvement. A lot of other programs deliver content where you create a one-page action plan and at the end of the day you should be able to do these things, however this isn't realistic. Throughout the TeamSTEPPS Canada program, there are tools that help you to sustain and keep the momentum going.
What major learnings can you share about the TeamSTEPPS program thus far?
The curriculum appeals to and can be used by various healthcare settings and we are seeing that diversity. Traditionally, acute care people dominate in programs like this because acute care has more staff and access to more resources. In the sessions we have done to date, we have had equal representation from private healthcare settings, quality improvement, Corrections Canada staff, regulatory colleges, and primary care providers. The group has been diverse and that is what we were hoping for.
The flexibility and variety in which you can deliver the content is extensive and variable. We have seen it delivered in a five per cent didactic approach and the rest done in group work, and vice versa. The content is so flexible and malleable that you can deliver it in any way and the content still resonates.
What challenges have healthcare teams experienced in implementing the TeamSTEPPS Canada program?
Initially, the teams thought they had to adopt everything. TeamSTEPPS addresses specific problems and provides solutions to those problems. We encourage teams to scale back and only introduce the tools they need to address a specific issue. We recommend that if you start there and understand your issue and then map that to the tools and resources within the curriculum, you can specifically and tactfully choose the solutions to implement. You don't have to implement the entire program.
Can others replicate the TeamSTEPPS program?
TeamSTEPPS Canada is trademarked and licenced to the Canadian Patient Safety Institute, as the pan-Canadian overseer of the program. Master training sessions are delivered in partnership with the Health Quality Council of Alberta, in a one-year trial program. Once the trial program has been evaluated, other regional training centers across Canada will be added.
The one thing we have heard loud and clear is that it confuses staff when you add another program and use the moniker for that program – you've heard the cries, "Oh no, it's another program we have to learn." With TeamSTEPPS, you are not required to use the terminology, or implement the whole program and call it TeamSTEPPS Canada. And, you don't have to call it a TeamSTEPPS solution, or label it a TeamSTEPPS tool. If your issue is communication and want to use a TeamSTEPPS Canada communication tool, you can brand it with your organizational branding, adopt it, adapt it and roll it out as your own.
What can we expect from TeamSTEPPS Canada program in the future?
Currently, the program is a mix of didactic, and experiential and simulation learning. We would like to scale back the didactic side and embed more simulation and play into the curriculum itself and offer the program in a more updated and innovative format to appeal to a wide range of audiences. As well, the curriculum is more about patient involvement than patient engagement. We are working with a Masters student at the Canadian Patient Safety Institute who had done environmental scans with patients with a healthcare history, patients who do not have a healthcare history, and other partners to find out how to better create patient-facing content. Out of that report we will be developing a module on Patients in TeamSTEPPS that will actually involve patients in using the TeamSTEPPS tools as part of a team.
With a broader view, we would like to see the community and more patients involved with TeamSTEPPS Canada program delivery. Whether they are patient advisors, or people who work in less formal roles within healthcare, it would be great to have them at the table learning about these tools alongside the teams that are now attending. Ultimately, our vision is to have a large, pan-Canadian community of practice where all TeamSTEPPS clinicians can connect to learn from one another.
How can you find out more about TeamSTEPPS Canada?
We would encourage you to take a Master Trainer session. To learn more about TeamSTEPPS Canada, visit www.patientsafetyinstitute.ca. Contact email@example.com if you are interested in bringing the program to your organization.