Program Improves Patient Safety through Enhanced Teamwork, Communication

By John Ohab
Special to American Forces Press Service

Jan. 26, 2009 - A Defense Department program is transforming military health care during deployment by enhancing communication and teamwork skills among health care professionals, a master trainer in the program said. Developed by the Defense Department's Patient Safety Program, Team Strategies and Tools to Enhance Performance and Patient Safety, or TeamSTEPPS, is an evidence-based teamwork system aimed at improving patient safety through a "shared mental model."

Using the program, health care teams work together to establish situational awareness, solve problems and resolve conflicts.

"The tools and strategies were designed to establish a culture of patient safety and quality health care for the military health system," Dr. Shad Deering, an Army physician from Tacoma, Wash., deployed to Iraq, said Jan. 22 during a "Dot Mil Docs" audio webcast on BlagTalkRadio.com.

"[TeamSTEPPS] is a very rational approach that doesn't drag in the person," he continued. "It drags in the problem and lets you address the real issues. It allows both sides to focus on patient safety rather than emotions."

Effective medical teams continually have a shared care plan for all patients accomplished through planning, problem solving and process improvement. TeamSTEPPS offers three communication tools: brief, huddle and debrief.

In the briefing session, teams assign roles, delegate responsibility and identify potential outcomes and barriers to success. Throughout patient care, teams huddle in ad hoc meetings meant to re-establish situational awareness, assess the needs of team members and develop a cohesive treatment plan. Huddles often take place at the bedside, where team members can engage patients and include them in the plan. A final debriefing gives team members an opportunity to communicate their experiences and identify areas that can be improved in the future.

"You are trying to provide a safety net for your team by maintaining situational awareness," Deering said. "You're not calling anybody's performance into question. It's really about watching out for each other and making sure you're doing the right thing for the patient."

Army Maj. Amber Pocrnich, a labor and delivery nurse from Fort Riley, Kan., now deployed to Iraq, said TeamSTEPPS provides new avenues to communicate more effectively and enhances her ability to work in teams.

"It's a tool bag to help with communication and to work more effectively. Everybody comes with a different level of experience, communication style or personality. It's a way to help build a team," Pocrnich said.

During their work at the 86th Combat Army Support Hospital in Iraq, Deering and Pocrnich had the opportunity to observe the positive impact of the TeamSTEPPS in action.

"We saw a significant decrease in the number of errors due to communication issues and the number of medication errors that happened," Deering said.

TeamSTEPPS can be adapted to meet the challenges of a combat support hospital, including multiple casualties, unique patterns of injury, language and cultural differences and long-distance travel through the combat environment. Because health care teams often are assembled after deployment, it is critical that newly formed teams quickly develop their technical and communication skills through simulation exercises, refresher training and practice in theater.

"Medical care in the deployed environment is challenging. We all come from different areas to this one unit, and usually teams haven't worked together for very long when they get into theater," Pocrnich said.

More than 100 specialty units and clinics have received some level of TeamSTEPPS training and are in various stages of implementation in military treatment facilities. Also, more than 1,200 trainers and coaches have been trained in teamwork principles.

Deering and Pocrnich expressed optimism that TeamSTEPPS ultimately will be integrated into all military medical systems before deployment to minimize subsequent errors and foster a safer and more effective medical environment.

"Health care is our practice, but our mission is patient safety," Pocrnich said.

(John Ohab holds a doctorate in neuroscience and works for the New Media directorate of the Defense Media Activity.)