Running head: TEAMSTEPPS AND THE CHANGING HEALTHCARE ENVIRONMENT

An Appraisal of TeamSTEPPS and the Changing Healthcare Environment

Amy J. Herrington
Ferris State University

TEAMSTEPPS AND THE CHANGING HEALTHCARE ENVIRONMENT

Abstract
The healthcare environment is changing at a rapid pace and impacting nursing education. A
significant movement to improve quality and safety in healthcare has contributed to the changing
environment. TeamSTEPPS is one quality and safety initiative that was developed in response to
the call for improved quality and safety. TeamSTEPPS focuses on teamwork and
communication to improve patient outcomes. The Affordable Care Act has also brought about
change in healthcare and impacted nursing education, particularly highlighting the nursing
shortage and the need to redesign nursing education to keep up with the complexity of care
required of the changing patient population. The author will examine how both the Affordable
Care Act and TeamSTEPPS has impacted nursing education and how each can be incorporated
into the nursing curriculum.
Keywords: TeamSTEPPS, ACA, healthcare environment, nursing education

TEAMSTEPPS AND THE CHANGING HEALTHCARE ENVIRONMENT

An Appraisal of TeamSTEPPS and the Changing Healthcare Environment

The United States healthcare environment has been going through a momentous
transformation. Quality and safety is at the forefront of the change. The shift in focus onto
quality and safety has resulted in many new initiatives including Team Strategies and Tools to
Enhance Performance and Patient Safety (TeamSTEPPS). The Affordable Care Act has also
created change in the healthcare environment. The purpose of this paper is to explore how
nursing education has been affected by TeamSTEPPS and other recent changes in the healthcare
environment and the measures that can be taken in nursing education to adapt to the changes.
TeamSTEPPS
In 1999, the number of deaths caused by medical errors was revealed in the publication
To Err is Human, this provoked an upsurge of attention on patient safety (King, Battles, Baker,
Alonso, Salas, Webster, Toomey & Salisbury, 2008). TeamSTEPPS was developed by the
Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD) in
response to the need for improved quality and safety. TeamSTEPPS was initiated in 2003 and
released in 2006. AHRQ and DoD examined the literature on the relationships between patient
safety and teamwork and also assembled a group of experts on human factors and error, as well
as healthcare team training, which was the guiding force for the research and development of
TeamSTEPPS (King et al., 2008).
TeamSTEPPS boosts patient outcomes through a teamwork structure that is evidenced
based and focuses on enhancing communication and collaboration skills among the healthcare
team (AHRQ, 2014a). A training curriculum, as well as tools and materials are available through
TeamSTEPPS for any health care system to utilize. Support and guidance is provided to all users
of TeamSTEPPS from initiation through full integration (AHRQ, 2014a).
The TeamSTEPPS framework is comprised of four teachable-learnable skills and teamrelated outcomes. Leadership, situation monitoring, mutual support and communication are the
four teach-learnable skills (AHRQ, 2014b). TeamSTEPPS provides the training curriculum to

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help healthcare teams achieve the noted skills. For example, some tools for successful leadership
of the team include using briefs, huddles and debriefs. Situation monitoring utilizes monitoring
teammates and using an Im Safe Checklist. Feedback and task assistance are tools used in
mutual support. Finally, the skill of communication employs tools such as Situation Background
Assessment Recommendation (SBAR), call outs and handoffs (AHRQ, 2014b). The teamrelated outcomes include knowledge and understanding of the task and teamwork, attitudes that
embrace mutual trust and team focus and the ability to perform adaptably, accurately,
productively, efficiently and safely (AHRQ, 2014b). Employing the tools to achieve the four
skills and meet the team-based outcomes can improve safety and quality of care (AHRQ, 2014b).
The Changing Healthcare Environment
As aforementioned, patient safety and quality of care were brought into the national
spotlight with the release of the publication, To Err is Human. As a result, multiple safety and
quality initiatives were developed. Though there has been a steady improvement in quality of
care, there remains room for improvement (Billings & Halstead, 2012).
Nursing professionals hold a crucial role in furthering quality and safety in healthcare.
This was highlighted in the Institute of Medicines Future of Nursing: Focus on Education
(2010) which called for a rethinking of the nursing role in regards to transforming the health
care system to provide the needed quality and safety improvements (p. 1). Nurses work in
unique position that allows for close collaboration with patients, physicians and other healthcare
professionals. This position puts nurses in a pivotal role for identifying needed changes and the
ability to be a leader in quality and safety transformation (IOM, 2010). However, IOM (2010)
recognizes nursing education needs to be revised if future nurses are expected to fill the
expanding roles in the ever-changing, complex healthcare system.
The Affordable Care Act (ACA) has produced many changes in the healthcare
environment. The increase in availability in insurance alone can make an impact on the nursing

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profession. An increase in demand for healthcare may result in an increase in the nursing
shortage. The United States Bureau of Labor Statistics projects a 1.2 million nurse shortage by
2020 (American Association of Colleges of Nursing, 2014a). The ACA includes provisions to
ensure healthcare workforce availability. The ACA includes improvements in training,
recruitment and retention to aid in increasing the supply of health care workers (United States
Senate, 2014a).
A quality initiative within the ACA involves the development of new patient care models
(United States Senate, 2014). The focus of caring for the chronically ill in the community setting
versus the hospital setting could create different role specialties for nurses. The potential to
place nurses in a role never performed before could result in nurses not having the needed
knowledge, skills and attitudes to safely deliver care in that role. This highlights the need for
changes in nursing education.
Impact on Nursing Education
Instilling a culture of quality and safety into nursing students is vital in improving
outcomes in healthcare. TeamSTEPPS provides a way to instill this culture into students by
focusing on teamwork and communication. According to Brock, Abu-Rish, Chiu, Hammer,
Wilson, Vorvick, Blondon, Schadd, Liner & Zierler (2013), communication failures among
healthcare teams has been identified as causes of medical error and negative health outcomes,
reducing quality and safety. If the tools identified in the TeamSTEPPS initiative are integrated
into a curriculum, the students could develop the skills and outcomes of an effective team player
and communicator. If these skills are taught in nursing education, novice nurses would be
prepared with team skills that could result in less communication failures and ultimately
improved patient safety and quality.
Nurse educators are faced with the challenge of keeping abreast of all the changes
impacting nursing education. Assimilation of quality and safety into the curriculum has become

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widespread, particularly with the release of the Quality and Safety Education for Nurses (QSEN)
project. TeamSTEPPS could be seamlessly integrated into the QSEN competency of teamwork
and collaboration. If nursing educators are currently utilizing the QSEN competencies, the tools
and curriculum of TeamSTEPPS could be employed in students meeting their outcomes related
to teamwork and collaboration.
Nursing education felt the impact of the nursing shortage far before the enactment of the
ACA. However, with the potential for the nursing shortage to become further intensified by the
increase in availability in healthcare for individuals, this issue could become more significant.
There is currently not enough nursing faculty to educate the number of nursing students applying
for programs. In the 2012, 79,659 qualified applicants were turned away from United States
baccalaureate and graduate nursing programs due to a shortage of faculty, clinical sites and
budget limitations (AACN, 2014b). Nurse educators must continue to advocate for funding and
support from the government to support continuing nursing education, as well as inspire
qualified nurses to enter the academic field of nursing.
The increasing complexity of care in the hospital and community, as well as the required
competencies needed for entry level nurses impacts nursing education significantly (Institute of
Medicine, 2010). Nursing curriculum is currently overladen with required content, adding
additional content can be challenging. In addition, entry level nurses have a wide spread range
of practice in which they must be prepared; it is difficult to add more competencies and roles to
that identity. Adding extra content to the curriculum is not the only challenge, nursing faculty
must also stay up to date and well educated in the new roles and competencies required of
nurses. Nursing faculty can adapt to these changes by engaging in continuous education,
maintaining some clinical practice, performing periodic assessments of the curriculum and
looking for opportunities to incorporate new competencies into the curriculum.
Incorporation into the Curriculum

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The incorporation of TeamSTEPPS into a curriculum could occur in the classroom,

clinical or lab. However, a teamwork and communication module based on TeamSTEPPS would
best be done in a combination of classroom and lab. Ideally, other health profession students
would be included such as medical, respiratory therapy, social work or physical therapy to help
strengthen the practice of collaboration. The module would include lecture educating students
on the importance of teamwork, collaboration and communication and how quality and safety is
impacted by each. The class would be divided into small groups and the groups would
collaborate on different communication techniques and practice different skills through role play
and simulation. For example, students could be given a patient situation and they must role play
different tools such as Im Safe Checklist and SBAR. After having the opportunity to learn about
different teamwork and communication techniques and tools, the students would be given the
opportunity to practice using the tools and techniques during a simulation. At a course level, the
student would be expected to recognize the importance of communication and teamwork in
providing quality and safe care and be able to identify the tools and techniques used in effective
teamwork and communication. Attainment of these outcomes could be evaluated by observing
students role play and also having students create a concept map showing how improved
teamwork and communication impacts quality and safety. At the program level, the student
should be able to employ the learned tools and techniques into their practice. This could be
evaluated in a high fidelity simulation setting which would allow the instructor to observe the
teamwork and collaboration among students and how the tools were utilized.
Incorporation of new care models could be combined into the curriculum through
classroom content and a clinical rotation. Students could be exposed to the new care model
through a four to six day clinical rotation. Students should be able to recognize needed
knowledge, skills and attitudes to perform in the particular nursing role. This could be evaluated

TEAMSTEPPS AND THE CHANGING HEALTHCARE ENVIRONMENT

through a reflection assignment. At the program evaluation level, the student could be provided
with case studies related to different care models and must complete the case studies showing
competency in the role.
Conclusion
The myriad of changes in the healthcare environment will continue to impact nursing
education. Nurse educators must continue to be aware of and adaptable to upcoming changes in
healthcare. A focus on quality and safety in nursing education will prepare future nurses with a
quality and safety culture inherent within and could result in improved patient outcomes.

TEAMSTEPPS AND THE CHANGING HEALTHCARE ENVIRONMENT

References
Agency for Healthcare Research and Quality [AHRQ]. (2014a). TeamSTEPPS: National
implementation. Retrieved from http://teamstepps.ahrq.gov/aboutnationalIP.htm
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American Association of Colleges of Nursing. (2014a). Nursing shortage. Retrieved from
http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage
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United States Senate. (2014). The Patient Protection and Affordable Care Act. Retrieved from
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