North Dakota Critical Access Hospitals Use AHRQ TeamSTEPPS® to Improve Patient Safety

The University of Nebraska Medical Center customized the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) curriculum for use in critical access hospitals as part of an AHRQ Knowledge Transfer project. The Medical Center also led training for 12 critical-access and three network hospitals in North Dakota in 2008.

TeamSTEPPS, a program developed by the Department of Defense in collaboration with AHRQ, is an evidence-based system aimed at optimizing patient outcomes and promoting a culture of team-driven care. The program establishes interdisciplinary team training systems to serve as the foundation for patient safety strategy. Through the TeamSTEPPS National Implementation Project, AHRQ has trained hundreds of TeamSTEPPS master trainers around the country.

North Dakota's TeamSTEPPS training was tailored to meet the needs of critical-access hospitals. Because these hospitals are relatively small, it is difficult for them to function with multiple providers away at training for up to a week. To address this issue, training was shortened to two-and-a-half days. The training was followed by six monthly conference calls to provide coaching and implementation support.

Of the 15 participating hospitals, four have since implemented TeamSTEPPS and have begun training their staff on implementing the tool. For example, the CEO of St. Andrew's Health Center in Bottineau, North Dakota, approved mandatory TeamSTEPPS training for all nursing staff. The hospital is also incorporating TeamSTEPPS into its annual "Mission and Motivation" days.

Similarly, Heart of America Medical Center in Rugby, North Dakota, incorporated the TeamSTEPPS communication and conflict resolution components into the customer service module of its annual staff education program. This program is mandatory for all of the hospital's 300 employees.

Southwest Healthcare Services in Bowman, North Dakota, has also provided TeamSTEPPS training to approximately 45 of its 150 providers and staff. The hospital's senior leadership has approved mandatory TeamSTEPPS training for all current staff and providers as well as all future staff and providers.

Following the training, Innovis Health, an 86-bed hospital in Fargo, implemented TeamSTEPPS in its operating rooms, post-anesthesia care unit, catheterization laboratory, endoscopy unit, and pre-admission testing department. More than 200 staff members and providers in these departments received TeamSTEPPS training.

In addition, Innovis Health administered AHRQ's Hospital Survey on Patient Safety Culture before and after the TeamSTEPPS training to assess the training's impact on staff perceptions of the hospital's commitment to and performance in improving patient safety. After training, there was a 12 percent improvement in the staff's perceptions of whether their colleagues help out during times when the hospital is very busy. There was also a 13 percent improvement in their perceptions of whether problems occur during the exchange of information across hospital departments.

In May 2009, Innovis Health decided to incorporate TeamSTEPPS into the hospital's patient safety program. The hospital also determined that TeamSTEPPS will be rolled out to all 21 Innovis Health clinics.