This is an original excerpt written by our team to show structure, depth and referencing. It is modelled on the course named above but is not a university document. Use samples as a study guide and follow your school's academic integrity policy.
The organizational problem
In the hospital described in this paper, a review of serious safety events on the surgical service found that most involved communication failures: a concern not raised, an order misheard, or a handoff that left out key information. Each profession had been trained separately, and teams rarely practiced working together. The hospital and its events are illustrative.
Evidence that team training helps
The Veterans Health Administration introduced a national Medical Team Training program for operating room staff. It required preoperative briefings and postoperative debriefings, used checklists, and included 2 months of preparation, a 1-day conference and a year of quarterly coaching. In an analysis of 182,409 procedures at 108 facilities, the 74 facilities that completed training saw an 18% reduction in annual surgical mortality, compared with a 7% decrease in the 34 facilities that hadn't yet been trained. Each additional quarter of training was associated with 0.5 fewer deaths per 1,000 procedures (Neily et al., 2010). The study was observational, but the dose–response relationship strengthens the case for a real effect.
TeamSTEPPS
TeamSTEPPS, from the Agency for Healthcare Research and Quality (AHRQ, n.d.), is an evidence-based set of teamwork tools built around four skills:
| Skill | Example tools |
|---|---|
| Communication | SBAR, call-outs, check-backs, structured handoffs |
| Team leadership | Briefs before a procedure or shift, huddles to adjust plans, debriefs afterward |
| Situation monitoring | Cross-monitoring each other's work; a shared mental model of the plan |
| Mutual support | Task assistance; the "two-challenge rule" and CUS words ("I'm concerned, I'm uncomfortable, this is a safety issue") so anyone can stop the line |
A systems leadership plan
1. Build the coalition. Bring together the chief nursing officer, the surgical chief, anesthesia, pharmacy and frontline staff from each profession. Share the hospital's own safety-event data with the published evidence.
2. Train teams together. Run interprofessional TeamSTEPPS sessions so surgeons, nurses, anesthesia providers and technicians learn the same language at the same time, using simulation of real events from the service.
3. Build tools into the work. Make the brief and debrief part of every operating room case and every shift, with a short script and a place in the electronic record.
4. Coach and reinforce. Train unit coaches from each profession, observe briefs, give feedback and recognize teams that use the tools well, following the VA model of coaching over a full year.
5. Measure. Track the percentage of cases with a complete brief and debrief, staff perceptions of teamwork with a validated survey, safety reports involving communication, and risk-adjusted surgical mortality.
Leadership considerations
Systems leaders must address hierarchy directly. Tools like CUS only work if leaders respond well when a junior team member uses them. Leaders also need to protect time for training, because teamwork that is taught once and never practiced fades.
Conclusion
Teamwork failures are system failures, and the evidence suggests they can be reduced. An MSN-prepared nurse leader is well placed to bring the professions together, adapt TeamSTEPPS to local work and keep the improvement going.
References
Agency for Healthcare Research and Quality. (n.d.). TeamSTEPPS. https://www.ahrq.gov/teamstepps-program/index.html
Neily, J., Mills, P. D., Young-Xu, Y., Carney, B. T., West, P., Berger, D. H., Mazzia, L. M., Paull, D. E., & Bagian, J. P. (2010). Association between implementation of a medical team training program and surgical mortality. JAMA, 304(15), 1693–1700. https://doi.org/10.1001/jama.2010.1506
