Staten Island University Hospital Incorporates TeamSTEPPS® in Process Improvement

Staten Island University Hospital (SIUH), part of the Northshore-Long Island Jewish (LIJ) Health Care System, is using AHRQ's TeamSTEPPS® in staff training to improve teamwork and collaboration in an effort to improve patient safety.

In 2007, SIUH conducted AHRQ's "Hospital Survey on Patient Safety Culture," which provided the hospital with baseline measures of its safety culture. The survey identified "teamwork across hospital units" as an opportunity for improvement, as well as "hospital handoffs and transitions." In 2009, the Northshore-LIJ Health Care System adopted the TeamSTEPPS training curriculum to help its employees with communication and process improvement. Northshore-LIJ chose TeamSTEPPS because its core competencies—leadership, situation monitoring, mutual support, and communication—closely align with Northshore-LIJ's Collaborative Care Model, which helps hospital staff adhere to their values while delivering high-quality care to the community it serves.

Karen Lefkovic, RN, Vice President of Quality and Risk Management at SIUH, says, "Poor communication and lack of teamwork are well-documented causes of adverse events and impact quality of care and patient safety. Through the adoption of the TeamSTEPPS program, we have been given an evidenced-based, organized program to provide staff with the tools to address these issues."

Since its adoption, approximately 6,300 SIUH employees have been trained in TeamSTEPPS, and it has become a foundation of the hospital's care, providing many tools that staff use daily to improve patient care and safety. The "Brief, Huddle, Debrief" model has been incorporated into the hospital's Surgical and Procedural Safety Checklists, which are used for all procedures occurring in and out of the operating rooms; "I PASS the BATON" is being used at the patient bedside to improve handoffs; the "CUS" (I am Concerned; I am Uncomfortable; this is a Safety issue) technique has been incorporated into the hospital's Escalation Policy; and "SBAR" (Situation-Background-Assessment-Recommendation) is being used to standardize critical communication among staff. The hospital's use of TeamSTEPPS principles in its Collaborative Care Councils has also led to numerous successful staff-driven patient safety projects.

When the "Hospital Survey on Patient Safety Culture" was repeated at SIUH in 2011, there was an 8 percent improvement in the "teamwork across hospital units" dimension since 2007, as well as smaller improvements in the dimensions of "hospital handoffs and transitions" (1.6 percent) and "teamwork within units" (4.6 percent). According to Cynthia D'Auria, RN, Patient Safety Officer, the program has also improved employee morale, by empowering employees to make change that affects patient care, patient safety, and employee satisfaction.

"The TeamSTEPPS training program is interesting and engaging and consistently receives favorable reviews from our staff. It provides a strong foundation for our Collaborative Care Model and the fulfillment of our mission," D'Auria says.

SIUH continues to build TeamSTEPPS principles into its policies and protocols. Staff are encouraged daily to use the tools to improve teamwork and collaboration. Each month the hospital distributes a "TeamSTEPPS Word of the Month," and all departments are expected to review the word and focus on that tool throughout that month. SIUH also holds two monthly training classes (the "Fundamental" and "Essential" courses) for new employees and for any other employee who desires or is recommended for a refresher.

SIUH is a 714-bed, specialized teaching hospital located in New York City's fifth and fastest-growing borough. The hospital provides quality care to the people of Staten Island, the New York metropolitan region, and to patients from around the world.