Teaching Implementation Planning
Present Slide 22, "Implementation Planning"; use this slide to transition to implementation planning. Note that you need to consider measurement when implementing TeamSTEPPS, but it is not the only thing. Explain that implementation planning will equip trainees with a 10-step process for their introduction of TeamSTEPPS.
Review Slide 23, "Objectives"; save time by displaying the slide without orally reviewing each objective. Objectives include:
- Describe the steps involved in implementing TeamSTEPPS.
- Develop a TeamSTEPPS Implementation Plan.
Use Slide 24, "Shift Toward a Culture of Safety," to remind your class that TeamSTEPPS seeks to solve specific problems and foster a culture of safety. After pre-implementation activities have verified readiness and built consensus about implementation goals, implementation planning can begin.
Present Slide 25, "Key Principles of Implementation." Explain that implementation planning is a team-based process that includes each identified key activity. Call attention to the issue of sustainability, as some organizational interventions fail to be sustained. Each unsuccessful or unsustained intervention causes staff to become increasingly skeptical about the value of any new initiatives.
Use Slide 26, "10 Steps of Implementation Planning," to review the 10-step process that you'll discuss more extensively on subsequent slides. Note that smaller interventions may perform the 10 steps less formally or consolidate them into a smaller number of steps, but the implementation Change Team should take each of the 10 steps into account.
Note that the subsequent slides take participants through the contents of the Implementation section.
Present Slide 27, "Describe the Targeted Unit/Work Area." Encourage the class to consider a unit or area that is likely to respond positively as the place where they will begin their implementation.
Review Slide 28, "Step 1: Create a Change Team." Note the value of including a patient as well as a diverse mix of other key stakeholders on the Change Team.
Review Slide 29, "Step 2: Define the Problem or Opportunity for Improvement." Explain that the problem may have been defined in the pre-implementation phase, but the Change Team should review it and, if needed, refine or update it.
Review Slide 30, "Example: Problem Definition." The trainer may want to change this example to one drawn from a nonacute setting or from a virtual team, based on the backgrounds of training participants.
Display Slide 31, "Step 3: Define the Aims of TeamSTEPPS Intervention." Explain the importance of defining the aims of their TeamSTEPPS implementation and the key characteristics and types of effective aim statements.
Display Slide 32, "Step 4: Design a TeamSTEPPS Intervention." Stress that designing the TeamSTEPPS intervention is an iterative process that is likely to evolve based on discussions and lessons learned at each phase. Note that involving key stakeholders is included as Step 10, but getting their earlier input in developing the intervention is strongly recommended.
Display Slide 33, "Step 5: Develop a Plan for Testing Your TeamSTEPPS Interventions." Note that this step was discussed in the measurement section earlier and should begin during the pre-implementation phase and be refined by the Change Team. Encourage the teams to focus primarily on measurable changes at levels III and IV because that is what warrants an organizational investment in TeamSTEPPS.
Display Slide 34, "Step 6: Develop an Implementation Plan." Be sure to note the possibility of providing remote TeamSTEPPS training using a web-based platform. While this approach makes training less costly and more accessible, it also requires more planning to keep remote trainees fully engaged. Note the value of self-learning using resources on the AHRQ TeamSTEPPS website or embedded into a learning management system operated by the organization. Traditional in-person trainings are the most costly training option; if you plan onsite training, ensure it is highly participatory.
Display Slide 35, "Determine How Coaches May Be Used." Explain that coaching will be discussed after implementation planning, so trainees can revisit this section once the potential value of coaches is better understood. Also acknowledge that dedicated coaches are uncommon in most healthcare settings, and an inability to obtain dedicated coaches for TeamSTEPPS may make implementation more difficult but does not make it impossible.
Present Slide 36, "Develop a Sustainability Plan." Explain that sustainability is both important and challenging, and recommend that the Change Team think about broad sustainability plans at the start and refine these plans once implementation has begun. Sustainability plans must be adapted as you learn what is working and what isn't, since the changes that prove most challenging are the ones that may require special focus to be sustained.
In presenting Slide 37, "Step 8: Develop a Communications Plan," note that for units or small organizations implementing TeamSTEPPS, communication planning may be very informal. However, if implementation involves an entire organization, it will be essential to work with the organization's communications team on this step.
Present Slide 38, "Step 9: Develop an Implementation Plan Timeline." Encourage the team to focus on dates and details for initial activities. Specifics for later stages of the Implementation Plan timeline can be worked out once you get initial steps under way.
Present Slide 39, "Change Team Meetings." Explain that forms like this one (slide 39) can be used to document Change Team activities. However, also note that other methods for planning and documenting meeting actions can work equally well.
As you review Slide 40, "Step 10: Review Your Plan With Key Stakeholders," observe that key stakeholders, including patients, should be involved throughout the planning process. While they may not be on the Core Team, if you develop a detailed plan and then ask key stakeholders for input, they may resent not having been included earlier or may make suggestions that lead to substantial revisions. Viewing stakeholder engagement as continuous rather than something done after most planning is complete is more likely to be successful.
Review Slide 41, "TeamSTEPPS Implementation Planning Exercise." Guidance on leading this exercise is provided below. If the training group does not include teams from the same organizations that are ready to begin the implementation planning process, you may want to skip this exercise. Alternatively, provide a hypothetical scenario to participants so that each small group can quickly gain the experience of discussing all 10 steps. Examples of hypothetical scenarios are provided in the instructions below.
Exercise: Implementation Planning
For this exercise, every participant should have a copy of the TeamSTEPPS Implementation Planning Slides in either hard copy or electronic form. The slides are available on the TeamSTEPPS website at Implementing TeamSTEPPS (PPTX, 4 MB).
The Implementation Planning exercise works most effectively when the training group includes teams with the key people on the Change Team; and the teams have already obtained buy-in from senior leadership. Divide the group into teams accordingly.
Teams may not know enough about their organization's plans for TeamSTEPPS to create an implementation plan. They may not know what specific problem is being targeted, how large the intervention will be, when it is expected to begin, what resources will be available to support it, or whether organizational buy-in exists. If groups in your training are in this situation, instruct them to create a basic plan for an implementation scenario you describe to them. Samples include:
- A labor and delivery unit staff (registered nurses, physicians, midwives, certified nursing assistants, etc.) were concerned about the lack of organization during postpartum emergencies. Their goal was to change how leadership occurred during these emergencies.
- An ambulatory care respiratory clinic was often seeing patients who would check in at the desk in respiratory distress. The clinic's goal was to establish quick communication from the clinic receptionist to a clinical person using SBAR.
- A burn center wanted to improve their handwashing compliance and decided to teach patients and families how to use CUS when they were not sure whether staff entering their room had washed their hands.
Other scenarios relevant to the training participants can be created and used.
Instructions to provide to training participants:
- The TeamSTEPPS 3.0 Implementation Planning page depicts the 10 steps. For some steps, reference the exercises you may have completed at the end of the introduction and each of the four modules, in which you began to think about the teams affected by your teamwork issue and specific TeamSTEPPS 3.0 tools and strategies to implement to address the issue.
- You will have 1½ hours to work with your colleagues on your own TeamSTEPPS Implementation Plan. This is your time to begin to think through your plan to create a starting framework when you return to your organization. Note, however, that ideally this exercise works when (a) the groups are intact teams from the same organization that have done some prework; and (b) most of the key decision makers are present at the training. Any implementation planning work the teams begin during the course needs to be viewed as the start of a process that will continue after the training. The time allotted for this exercise can be adjusted based on the time available. Alternatively, since implementation planning is an extensive process, the allotted time can be used as a good review of the overall steps that implementation planning should include.
- If the actual exercise takes place, the group should reconvene as a whole, and individual groups can be asked to present what they have accomplished.
If space permits, allow teams to move to separate breakout rooms or other areas where they can easily talk through their problems and think together.
If any individual participants are not attending with a team of individuals from their organization, ask about their implementation plans and try to identify some characteristic (e.g., type of teamwork issue, unit targeted for implementation, intended systemwide implementation) that allows you to match each individual with an existing team of participants. The individual matched with a team will be able to gather thoughts from the exercise that can be generalized to their own plans, and the teams may benefit from the inclusion of a different perspective.
If possible, have people knowledgeable about the implementation process available during this exercise to walk around and spend time with each team. Participants appreciate any guidance and assistance received during this exercise.
After participants have gotten started, circulate among the groups. Spend some time listening to each group's discussion and ask questions that will help them think through their plan.
Be mindful of the time so that you can reconvene the entire group and ask participants to report on their plans. Allow others to ask questions.