Nursing students expect to learn clinical skills. At Kennesaw State University, they are also learning how to speak up — before they enter a health care workplace.
The WellStar School of Nursing is implementing the principles from the TeamSTEPPS (Strategies and Tools to Enhance Performance and Patient Safety) program to its curriculum, so that students will graduate with better teamwork skills.
“Sometimes during their clinical experiences, our students would see errors in care, but would be hesitant to speak up, because they were students,” said Marie Bremner, DSN, RN, professor at KSU’s nursing school. “This program will teach them to act on their concerns, even if they are the new person on the team. That’s better for the patient and everyone else.”
Research has shown that communication and coordination skills can be just as important as clinical skills in health care. The Joint Commission estimated that from 1995 to 2005, more than 65 percent of reported sentinel events were the result of inadequate communication and teamwork. The Joint Commission defines a sentinel event as “an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.”
“TeamSTEPPS was developed through 25 years of research and evidence-based study, originally by the Department of Defense. It was used by the military and the airline industry before being applied to the health care system,” said Carey Sipp, academic programs consultant for Healthcare Team Training, a Fayetteville-based global provider of teamwork and communication training for the health care industry.
An offshoot program called TeamSTEPPS Plus was developed to teach health care professionals how to engage and educate patients to become active members of their health care team. Hospitals that have incorporated the principles have seen positive results, including at least a 50 percent improvement in HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, patient referrals and physician satisfaction, and a 50 percent reduction in length of stay and hospital-acquired infection rates, Sipp said.
“Duke University Health System was the first hospital to adopt the TeamSTEPPS program. It was looking for a way to strengthen teams and reduce medical errors after a blood type checking error led to the death of a transplant patient in 2006,” Sipp said.
Today, the Duke University Health System education department has approved the program for continuing education credit.
Bremner first encountered the program when Healthcare Team Training founder and CEO Steve Powell taught it to a group of global patient safety leaders, using the simulation center in the WellStar College of Health and Human Services. Bremner was impressed and became a certified master TeamSTEPPS trainer.
“I left that conference smiling, because I knew this training would be very valuable for our students, and that it would fit well into our simulation skills labs,” the KSU professor said. “Instead of learning and checking off individual skills in the simulation lab, we’ll create some scenarios where someone will do something wrong and students will be asked to react to that, using what they’ve learned in the TeamSTEPPS materials.”
Afterward, students analyze what questions they should have raised and what they could have done differently to produce a better outcome.
TeamSTEPPS aims to improve team performance through a shared mental model and skills that focus on leadership, mutual support, situation monitoring and communication. It teaches a common language, with words like “huddle” and “check-backs” that allow team members to question situations and support one another without assigning blame.
“You learn how to question things. If someone expresses a concern, then she can call a team huddle to discuss it,” Bremner said.
She believes that gaining the skills helps new nurses be less intimidated by experienced colleagues. “It could help break down hierarchies in hospitals and decrease errors.”
One of the program’s exercises illustrates the importance of seeing the big picture.
“We showed our students a video from the TeamSTEPPS materials where two teams are playing basketball in white shirts and black shirts,” Bremner said.
Students were divided in half and asked to count the number of times either team made a direct pass. Those watching the white-shirt team concentrated so hard that they completely missed that one member of the black-shirt team was in a gorilla costume.
“Unless health teams work together, they can miss the elephant in the room,” Bremner said.
Although team-building is taught in many hospitals, Bremner believes it’s never too early to prepare nursing students. “When you have stronger people, you’re going to have stronger teams.”
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