Strategies and Tools to Enhance Performance and Patient Safety

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Slide 1

Strategies and Tools to Enhance Performance and Patient Safety

Cindy Brach
Agency for Healthcare Research and Quality

Slide 2

Health Care and Teamwork

• Communication failures account for the overwhelming majority of adverse events.
• Medical care is complex and human performance has inherent limitations.
• Effective teamwork can prevent mistakes.
• Embedding evidence-based training and team behaviors can enhance safety.

  Leonard, Graham, & Bonacum, 2004.

• Team training has a positive impact on work force retention.

  Pronovost in press Leonard, Graham in press.

Slide 3

AHRQ/DoD Partnership

• Activities began in 2002.
• Expert Panel.
• Comprehensive literature review and case study analysis.
• Clinical measures of teamwork (RAND evaluation contract Mod).
• Medical Team Training Curriculum TeamSTEPPS.
• Edited Handbook.
• National Implementation.

Image: Red arrows form a circle, indicating a continuing process, between three elements: Principles and Guidelines, Evidence-Based Methods, and Tools for Training and Measurement.

Slide 4

Easy-to-Use Multimedia Kit

• Contains:
  • Instructors/Leader's Guide.
  • Camera ready materials for handouts.
  • Presentation materials (PowerPoint® slides & videos).
  • Evaluation instruments.

Battles JB, Sheridan MM The FLEXTRA Kit: a model for instructor support materials. J Biocommunication 1989:6;3;1-13.

Slide 5

National Implementation Project

• Created a national infrastructure to support the adoption of TeamSTEPPS:
  • Quality Improvement Organizations.
  • Hospital Engagement Networks.
  • ACTION Partners.
  • Academic Medical Centers.
  • Other Countries (Japan, Australia, Netherlands).
• Spread TeamSTEPPS: trained over 5000 Master Trainers who trained 25,000 trainees to date.

Slide 6

Products and Materials

• Core TeamSTEPPS:
  • Rapid Response Systems (RRS) Module.
  • Limited English Proficiency (LEP) Module.
• Primary Care.
• Long-term Care.

Image: The covers of TeamSTEPPS materials are shown.

Slide 7

More Information

• For more information about TeamSTEPPS, the TeamSTEPPS National Implementation Project or to find out if your organization is eligible to receive Master Trainer training preparation under the TeamSTEPPS National Implementation Project, please Email us at AHRQTeamSTEPPS@aha.org.
• http://teamstepps.ahrq.gov/.