Evaluation of TeamSTEPPS Implementation for Community Hospital Patient Safety

TeamSTEPPS 社区医院患者安全实施评估

• 批准号: 7940641
• 负责人: MARCIA M WARD
• 金额: $ 48.91万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7940641
• 关键词: Evaluation; TeamSTEPPS; Implementation; Community; Hospital

DESCRIPTION (provided by applicant): The risk of patient harm is increasing as the healthcare system becomes more complex. Despite a decade of intense scrutiny and many attempts to impact these refractory challenges, there remains a need to refine and explore strategies to "hard-wire" a culture of patient safety among front-line healthcare workers. A recently disseminated strategy is Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPSTM). TeamSTEPPS was developed through a partnership of AHRQ and the Department of Defense to improve healthcare team performance through flexible training designed to enhance team knowledge, skills, and attitudes. TeamSTEPPS involves a comprehensive curriculum that spells out key actions for a culture change of teamwork including: team leadership, mutual performance monitoring, back-up behaviors, adaptability, team/collective orientation, shared mental models, mutual trust, and closed-loop communication. AHRQ is actively disseminating TeamSTEPPS through national training centers. Although firmly based in research findings on the operations and effectiveness of teamwork, many aspects of the TeamSTEPPS approach have not yet been evaluated. There remains a need to ground team performance within organizational science to facilitate the exploration and testing of relationships among the TeamSTEPPS elements and organizational performance. Thus, the purpose of this study is to examine the relationship between key TeamSTEPPS elements and outcomes through considering both retrospective and prospective implementations in hospitals chosen to represent a cross-section of complexity (Critical Access Hospital vs. nonCAH) and affiliation (independent vs. owned/managed by a system). Multi-method approaches will be used to monitor the TeamSTEPPS application to the Complex Adaptive Systems (CAS) of microsystems in a variety of hospital units. The specific aims are to: 1) Explicate organizational elements that have facilitated or precluded full integration of the TeamSTEPPS model in 10 hospital units that have previously adopted the model; 2) Prospectively examine the process and outcomes of implementing TeamSTEPPS in 12 hospitals chosen to represent a cross-section of complexity (Critical Access Hospital vs. nonCAH) and affiliation (independent vs. owned/managed by a system); 3) Test the relationship between TeamSTEPPS measures (patient safety culture, teamwork attitudes and performance, initiative fidelity, and observed knowledge-skills-attitude (KSA) behaviors) and outcomes over time; and 4) Identify the TeamSTEPPS strategies that are most successful in terms of positive outcomes and the characteristics of a high reliability organization and then determine the burden and cost of implementing these successful strategies. PUBLIC HEALTH RELEVANCE: AHRQ and the Department of Defense have developed TeamSTEPPS, an evidence-based organizational initiative designed to help front-line healthcare provider teams enhance teamwork and patient safety, thus taking another step toward becoming a high reliability team in a high reliability organization (HRO). Although firmly based in research findings on the operations and effectiveness of teamwork and well- developed as a train-the-trainer quality initiative, many components of the TeamSTEPPS approach have not yet been evaluated. The proposed study is designed to prospectively evaluate in community hospitals the elements of the TeamSTEPPS approach including patient safety culture, teamwork attitudes and performance, implementation strategies and fidelity, staff behaviors, burden/cost, and outcomes to identify the elements that are most important for success.

描述（由申请人提供）：随着医疗保健系统变得更加复杂，患者伤害的风险也在增加。尽管经过十年的严格审查和多次尝试来影响这些难治性挑战，但仍然需要完善和探索策略，以在一线医疗保健工作者中“硬连线”患者安全文化。最近传播的战略是团队战略和工具，以提高性能和患者安全（TeamSTEPPSTM）。TeamSTEPPS是通过AHRQ和国防部的合作伙伴关系开发的，旨在通过旨在提高团队知识，技能和态度的灵活培训来提高医疗团队的绩效。TeamSTEPPS涉及一个全面的课程，阐明了团队合作文化变革的关键行动，包括：团队领导，相互绩效监控，备份行为，适应性，团队/集体导向，共享心理模型，相互信任和闭环沟通。AHRQ正在通过国家培训中心积极传播TeamSTEPPS。尽管TeamSTEPPS方法的坚实基础是关于团队合作的运作和有效性的研究结果，但它的许多方面尚未得到评价。仍然有必要在组织科学的基础团队绩效，以促进TeamSTEPPS元素和组织绩效之间的关系的探索和测试。因此，本研究的目的是通过考虑在医院中的回顾性和前瞻性实施来检查关键TeamSTEPPS元素和结果之间的关系，这些医院被选择代表复杂性（关键访问医院与非CAH）和从属关系（独立与由系统拥有/管理）的横截面。多方法的方法将被用来监测TeamSTEPPS应用程序的复杂适应系统（CAS）的微系统在各种医院单位。具体目标是：1）阐明促进或阻碍TeamSTEPPS模型在10个先前采用该模型的医院单位中全面整合的组织要素; 2）在选择代表复杂性横截面的12家医院中，预先检查实施TeamSTEPPS的过程和结果（危重病医院与非CAH）和附属机构（独立与由系统拥有/管理）; 3）测试TeamSTEPPS度量之间的关系（患者安全文化、团队合作态度和表现、主动忠诚度和观察到的知识-技能-态度（KSA）行为）和随时间推移的结果;（4）确定在积极成果和高可靠性组织的特征方面最成功的TeamSTEPPS战略，然后确定实施这些成功战略的负担和成本。 公共卫生相关性：AHRQ和国防部开发了TeamSTEPPS，这是一项基于证据的组织计划，旨在帮助一线医疗保健提供者团队加强团队合作和患者安全，从而朝着成为高可靠性组织（HRO）中的高可靠性团队迈出了又一步。尽管TeamSTEPPS方法的基础是关于团队工作的运作和有效性的研究结果，并作为培训培训员的质量倡议得到了很好的发展，但TeamSTEPPS方法的许多组成部分尚未得到评价。拟议的研究旨在前瞻性地评估社区医院的TeamSTEPPS方法的要素，包括患者安全文化，团队合作态度和绩效，实施策略和忠诚度，员工行为，负担/成本和结果，以确定成功最重要的要素。