Nearly two years after Saskatoon Health Region embarked on a 90-day focus on safety, initiatives are still going strong and gaining momentum.
One of those initiatives, Team STEPPS (which stands for Strategies and Tools to Enhance Patient and Performance Safety), is an evidence-based teamwork system aimed at optimizing patient care by improving communication and teamwork skills among health care professionals. In October of 2015, Team STEPPS was launched in Acute Care Pediatrics at Royal University Hospital, and the team has been building on the work ever since. (Communication and improved teamwork are also important components of the Region’s newly launched Accountable Care Unit.)
“Earlier this spring, we gave our team a survey to check in and see how we were doing,” says Tammy Lucas, Manager of Acute Care Pediatrics. According to the survey results, the team saw an overall improvement of 89 per cent in all categories, with about 120 health care providers responding. “To me, the results show that we are really building on our goal of improving patient safety, as well as safety culture on the unit. We’re creating a place to work where people feel safe reporting issues, helping each other and escalating concerns in a manner that isn’t pointing blame and I’m really proud of that.”
Members of Acute Care Pediatrics share and discuss the work they are doing with Team STEPPS on the unit. .
Areas of improvement included a 20 per cent increase in team members providing feedback to one another.
“That was huge because it can be really hard to provide feedback to a colleague in a way that promotes learning and encourages them to try something better, instead of making them feel like they’re being targeted for doing something incorrectly,” says Lucas.
Another area where the team improved was “seeking information from available resources” which jumped up 20 per cent.
“This tells me that we’re talking to each other more, and relying on each other as well as staff from other disciplines,” says Lucas. “One of the key lessons from Team STEPPS was how important it is to learn together as an interdisciplinary team and build a culture where everyone feels that they can go out and ask and learn from each other.”
This aspect of teamwork is something even the medical students are noticing.
“Lately, I find that when I’m doing feedback sessions with the medical students who come through the pediatric rotation, a lot of them are talking about how much they like the team atmosphere that we have on Peds,” says Dr. Ayisha Kurji. “They’ve said ‘Wow, you guys get along, you know who everyone is, you talk to them and you’re able to ask them things.’ It was really neat to hear that they are noticing the team feeling we are working so hard to create.”
The survey also indicated that more and more staff feel comfortable requesting assistance when feeling overwhelmed.
“We had a 15 per cent increase in that area and something like that is telling a huge story because in healthcare, we tend to have this culture of everyone feeling like they should be able to handle their own jobs without asking for someone else’s help,” explains Dr. Vicki Cattell, Director of Safety and Wellness. “But when things get busy or overwhelming, we should be asking. Tammy even created a board on the unit where people shared stories of times that they asked for help and how it impacted them. Even families contributed their own stories. It was a great opportunity for staff to be able to recognize each other for making a difference.”
The survey results also mapped out areas for improvement. The results showed that 20 per cent of the people who responded have never had Team STEPPS training or been exposed to it.
“While we are trying to embed this into the culture on the unit, we’re also getting new recruits,” says Dr. Cattell. “Overall we had set out a ‘just-in-time’ onboarding plan that was a little bit ambitious in terms of what we could actually do so we need to work on that.”
Now that the team has these results, their next step is to share them. “These results prove we are globally making a change,” says Dr. Kurji. “By sharing these results with our units, especially those areas we now know we need to work on, it will help us in making future changes.”
Lucas truly believes that the Team STEPPS training has changed the way they work as a unit and the ways they look to improve.
"Our goals are patient safety and safety culture and we are constantly trying to improve,” she says. “We also look at educational opportunities. We have lunch-and-learn events once a month and we look at topics that are multidisciplinary so that the residents and nurses can keep learning together and discussing things together to build their communication and relationships.”
“It’s becoming something that is just built into our daily work,” says Lucas. “It’s not as if we are constantly pulling out the Team STEPPS binders and looking for a tool. Doing things together as a team is happening more naturally now.”
Dr. Cattell feels that there is potential to spread pieces or modified modules of this training to other units, “because by having some standard work, along with basic team work and communication skills, this team has had success in not only the application of the tool for patient safety but they are indirectly impacting the culture of safety, which should ultimately lead to overall improved patient safety. And I think that’s worth spreading across our Region.”