FAQs: TeamSTEPPS® LMS

These questions have been gathered from your fellow TeamSTEPPS® learners. The responses come from a panel of experts. If you have a question that is not already addressed here, please refer to our Ask a Question page to send it to us.

Using the LMS and Online Modules

Q: Is there a cost to enroll in the TeamSTEPPS online courses?
A: No cost is associated with this accredited online course.

Q: Do I have to complete an entire module in one sitting?
A: No. The system has been configured in such a way that if you log out of the module before completion, the system will note that and open to the slide you were last viewing when you return to the module . Keep in mind that if you are a member of a cohort group, then you have a limited time to complete the curriculum and the teach-back session.

Q: How can I get copies of the narration? There were some great examples given, and I would like to use them when I teach.
A: As you are viewing the module, you can select the transcript tab under the photo of the speaker, and, using the copy/paste function, you can highlight the content you are interested in and copy and paste it to a new document or location of your choice.

Q: When I select the “cc” button underneath the video, there does not appear to be any closed captioning. How can I view closed captioning?
A: Selecting the Transcript tab to the right of the screen under the speaker’s photo will allow you to view the closed caption (CC) of the speaker’s narration. This section contains a full transcript of the speaker’s narration. People using assistive technology may not be able to fully access information in this file. For additional assistance, please contact us by selecting the “Assistive Technology (508)” option in the help menu and sending us an email. All messages will be responded to within two business days.

Q: Once I am in the Transcript tab reading the transcript, how do I get back to continue the module?
A: Thank you for this question. At the top of the right of each module there are two tabs. You can select the “Transcript” tab on the right to view the closed caption (CC) of the speaker’s dialogue. To the left of this column is a tab labeled Outline. Selecting this tab will take you to a listing of each slide contained in the module. You can toggle between the module navigation tab on the left and the Transcript tab on the right.

Q: I cannot open the slides for Module 1. Can you please direct me on how to get to the slides?
A: To view the modules you must have Adobe Flash Player installed on your computer. To download Adobe Flash at no cost, select: http://get.adobe.com/flashplayer/. If installing Adobe Flash Player does not resolve your issue, please email us. If you are enrolled in TeamSTEPPS 2.0 Online Master Trainer Course email us at questions@tslms.org. If you are enrolled in the TeamSTEPPS for Office-Based Care Course email us at obc-questions@tslms.org.

Q: Where can I access the survey after completing the module?
A: After completion of the module, select the "Return to Course" button located above the slide near the right corner to access the survey in the main learning menu. You must view all slides in the module before you will be able to access the survey.

Q: I am unable to access, open, or reply to the readiness assessment because I am on a secure network. What should I do?
A: The Readiness Assessment is not a required document to be replied to or submitted. It is a pdf document and as such, will not allow you to answer the questions on the form itself. Review the questions in the Readiness Assessment and discuss with your change team and Leadership as appropriate. Once you have reviewed the Readiness Assessment, return to the prework course page and mark the box to the right as complete. You may download and print the document if you want to have a hard copy of the document for your records.

Q: I am having difficulty uploading my prework documents on the Prework Documents Submission page. Can you offer any assistance?
A: We apologize for the inconvenience. Occasionally, due to users’ security settings or the type of browser being used, prework documents may not upload correctly. To best assist you, please send your two prework documents as attachments (steps 1–3 of the Implementation Plan worksheet, and the Commitment and Course Preference Form) via email. If you are enrolled in TeamSTEPPS 2.0 Online Master Trainer Course email us at questions@tslms.org. If you are enrolled in the TeamSTEPPS for Office-Based Care Course email us at obc-questions@tslms.org. In your email, please include browser type, operating system, and the version of Microsoft Office you are using. We will try to diagnose your issue to prevent it from happening in the future. Once this information is received, we’ll upload and submit the documents for you.

Q: Does each team member need to register for the course and complete prework documents individually?
A: Each team member needs to register, enroll in the Prework Course, and complete the Prework Course activities individually; the team members should each submit the same Implementation Plan.

Q: What is the weekly time commitment to complete the Online Master Trainer Course?
A: The course is self-paced. If you enroll in one of the cohort sessions, you will have 120 days from the day the course begins to complete all requirements. We recommend you schedule one hour a week to work on the course.

Q: How can I increase the size of the slides? They are approximately 1 by 2 inches, and I can’t see where to enlarge them. Installing the Adobe program did not make a difference.
A: This seems to be an issue in some browsers. To see slides or videos in full size, change the size of your Web browser window. For example, in Google Chrome on a PC: 1) Click the “restore down” button in the upper-right corner of the window (next to the “close” button; 2) Click and drag the lower-right corner of the browser window to resize it; and 3) Click the “maximize” button to enlarge the window. Now the slides and videos should display properly. If you have questions, please select the “Help” button at the top of the page to be connected with our subject matter experts.

Q: The links provided within the modules to view various Department of Defense toolkits result in an error message. What are the appropriate links to these resources?
A: The DoD has updated their website, and as a result some of the links have moved. Below are the correct links to view the DoD toolkits and the TEAM UP brochure:
  Patient Safety Program Toolkits
  TEAM UP

Q: I am not able to progress past the module to complete the post-test. I have watched all slides. Is there a way to identify what I am missing so that I can move forward with other modules?
A: The most likely cause is that you did not review all slides in the module in their entirety. This may also occur if, while you were viewing the slides, you logged out or were logged out due to inactivity. Please go back and check to see if all slides were viewed to the end. You can do this by selecting slide 1 in the outline on the right of the screen, then click through each slide that you have viewed, until it comes upon the one(s) you haven't watched.

Q: The links provided within the modules to view the module instructor guides result in an error message. What are the appropriate links to these resources?
A: AHRQ has updated their website, and as a result some of the links have moved. Below is the correct link to view the module instructor guides.
  http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/fundamentals/index.html

Q: My laptop crashed, and I am trying to access the course on my mobile phone, but am having issues viewing the LMS. Do you have a solution?
A: Unfortunately, the e-learning player incorporated into the TSLMS.ORG platform may have some issues working properly on some devices that do not support Flash. The site is optimized and tested for Flash-enabled browsers on PCs (Windows or Mac), though an HTML5 version of the content is included in the e-learning, it may not play properly on all devices.

Continuing Education (CE) Credits

For TeamSTEPPS 2.0 Online Master Trainer Course

Q: I am a nurse practitioner. Will the American Association of Nurse Practitioners (AANP) recognize my certificate?
A: Yes, modules are accredited for the following disciplines: nurse practitioners (American Association of Nurse Practitioners, AANP), physicians (Accreditation Council for Continuing Medical Education), and nurses (American Nurses Credentialing Center). In addition, a general accreditation certificate is available for other health care professionals to obtain CE credits through their own specific accrediting organization.

Q: How do I get my certificate?
A: After successfully completing the module post-test (you have three tries to score at least 70 percent) and completing the postcourse evaluation, you will be able to select the link corresponding to your discipline and print your certificate.

Q: How do I determine which certificate to print?
A: The modules are accredited for the following disciplines: Nurse practitioners (AANP), physicians (Accreditation Council for Continuing Medical Education, ACCME), and nurses (American Nurses Credentialing Center, ANCC). In addition, a general accreditation certificate is available for other health care professions to obtain CE credits through their own specific accrediting organization. If you are enrolled in the TeamSTEPPS for Office-Based Care course, please note that most Allied Health professions and other non-clinical professions are able to use Joint Accreditation continuing education credit.

Q: How do I obtain continuing education credits as a Healthcare Executive (ACHE)?
A: Enduring activities that are self-study formats and not synchronous instructor led sessions do not qualify for pre-approval. These activities however do qualify for self-reported credit. If you are in the TeamSTEPPS® 2.0 course, please select the general certificate of completion for each module you complete, and then go to the ACHE website and under “My ACHE” report the activity. If you are in the TeamSTEPPS® for Office-Base Care course, print the Joint Accreditation certificate and then go to the ACHE website and under “My ACHE” report the activity. ACHE will then consider these credits for continuing education.

Q: Does completion of the TeamSTEPPS 2.0 Online course count towards any trauma CME credit?
A: While you will receive continuing education credit upon successful completion of all accredited modules, TeamSTEPPS does not count towards trauma education hours.

For TeamSTEPPS for Office-Based Course

Q: What is Joint Accreditation?
A: Joint Accreditation™ offers organizations the opportunity to be simultaneously accredited to provide medical, nursing, and pharmacy continuing education activities. Joint Accreditation is a collaboration of the Accreditation Council for Continuing Medical Education (ACCME), Accreditation Council for Pharmacy Education (ACPE) and American Nurses Credentialing Center (ANCC). It is one certificate that covers the fields of Medicine (MD’s, PA’s, NP’s, Advanced Care Providers), Nursing (NP’s, RN’s), and Pharmacy (Pharmacists, Pharmacy Techs). Please note that most Allied Health professions and other non-clinical professions are able to use Joint Accreditation continuing education credit.

Q: I’m not sure if the Joint Accreditation will cover my CE needs. How can I check?
A: Joint Accreditation is the only certificate offered for the TeamSTEPPS® for Office-Base Care courses. Should you have a question regarding whether or not your credentialing body or professional association/organization accepts or recognizes Joint Accreditation credit, please contact your individual credentialing board or professional association/organization for a direct response regarding their particular requirements for CE credits.

Q: Will pharmacists and pharmacy technicians receive continuing education credits that can be used for national licensure?
A: Yes, if you have a National Association of Boards of Pharmacy (NABP) account. Check to see that you listed your ePID# and PIN# on your registration form. If these have been provided, you will be able to use your Joint Accreditation credit for national licensure. Please note, the NABP ePID# is different from your state board of pharmacy registration number.

Q: I don’t have a NABP account, what do I need to do to receive credit towards my national licensure?
A: If you do not have a National Association of Boards of Pharmacy (NABP) account, you will need to register with the NABP to receive a number. Individuals can visit the NABP website at www.nabp.net and click on NABP e-profile log in at the top right and then select create a NABP e-profile.

TeamSTEPPS® Master Trainer

Q: I couldn't register for any of the cohort courses. If I complete all the modules individually, how can I sign up for the teach-back session and be certified as a Master Trainer?
A: Unfortunately, at this time you must be a member of the cohort course to receive online certification as a Master Trainer. Watch this site for dates when the next online courses will begin, or register to participate in the in-person training to become a TeamSTEPPS Master Trainer. Select to access the in-person training registration site: https://www.onlineregistrationcenter.com/registerlist.asp?m=347&p=19&mp=1.

Q: If I complete the entire course, am I a certified TeamSTEPPS Master Trainer?
A: Technically there is no official certification because there is no certifying body of TeamSTEPPS. With that being said, if you complete the course, you will receive your TeamSTEPPS Master Trainer certificate of completion. You can consider and call yourself a TeamSTEPPS Master Trainer.

Q: What is the difference between the TeamSTEPPS 2.0 Master Training Course and TeamSTEPPS for Office-Based Care?
A: Both courses follow the train-the-trainer model so you will become a Master Trainer upon successful completion of either. The content regarding the team competencies and tools are the same. The only difference is that the office-based care course focuses on the medical office, primary care and ambulatory settings so the examples, videos and scenarios are tailored to this setting.

Teach-back Session

Q: Where can I find more information about the teach back and the expectations?
A: The teach back is your opportunity to demonstrate your understanding of the concepts and will serves as a practice teaching session. You will be teaching to a Master Trainer who will provide you with constructive feedback. You will have 20 minutes to "teach" a module of your choice from the TeamSTEPPS Fundamentals course, (Modules 1 through 6). You will not need to actually play any of the videos contained in your module, but you will be expected to facilitate discussion of the video or exercise included in the module you are presenting. Please do not read word for word from the instructor guide, but rather teach to the slides and use examples from your work area. Consider this teach-back session as role playing, and present as if you were presenting to a class of your colleagues. In addition to the discussion of teach backs in Module 11, detailed information and materials about the Practice Teaching Session are included in the Module 12 Instructor Manual located on the AHRQ TeamSTEPPS website. The Master Trainer will use the teaching feedback form found in Module 12 as a guide to discuss your delivery, areas of strengths and opportunities for improvement.

Q: If multiple members of my organization are taking the course, may we conduct the teach back together?
A: Yes. If several people from your organization wish to conduct the teach back together, you can do so in one of two ways:

Option 1: Each member chooses a different module (from Modules 1-6) and each person has 15 to 20 minutes to conduct the teach back for that module. (If there are more people than there are modules, there can be repeats of teach backs for certain modules.)
Option 2: If there are four members wishing to teach together, then two members work together on a module, and each person teaches half. Each person has 15 minutes to teach back his or her half. The next two learners teach a different module in the same fashion. If there will be more than four in your group, select the "Ask a Question" link above to let us know how many are in your group that will be performing the teach back together, and we will work with you on a case by case basis.

When scheduling your teach back, please specify that you will be presenting as a group and which of the two teach-back methods you will use so that we can plan the timing of your presentation.

Q: Why is the link to schedule a teach-back session in Module 5 when I have to complete all the modules before I can perform the teach back?
A: The opportunity to schedule your teach-back session is located midway through the course to allow ample time to select a date and time convenient to your schedule. We took into account the fact that most facilities provide a work schedule to employees 4-6 weeks in advance, and our intent was to provide the opportunity to schedule the teach back at a time that would not interfere with the work schedule. We understand that schedules change or you may not complete the course requirements in the timeframe originally planned. If this occurs, simply reschedule your teach-back session by selecting the link in your appointment confirmation email or by selecting a new date and time in the Schedule Your Teach Back link in Module 5 before the course end date. Those learners who schedule their teach back early, have more dates and times to choose from.

Q: How do I get in contact with a Master Trainer for my teach back?
A: A Master Trainer will call you at your appointment time using the method of contact selected when making an appointment: Phone, Skype, or Google Hangout. Please make sure to indicate the correct phone number or username when scheduling an appointment. Please note that the number provided to you on the confirmation email is voicemail only.

Delivering the Training at Your Facility

Q: Where can I download the slides and videos found throughout the course modules?
A: For TeamSTEPPS® 2.0 course you can download all slides and videos here. For TeamSTEPPS for Office-Based Care course you can download all slides and videos here.

Q: How can I get copies of the slides to use at my facility?
A: TeamSTEPPS 2.0 course materials are available both online and in print. TeamSTEPPS for Office-Based Care course materials are available both online and in print.

Q: I have completed the TeamSTEPPS Master Trainer Course and am preparing to deliver the training in my facility. Is there a certificate template available that I can use to recognize the participants participation in the course, and may I use the TeamSTEPPS logo on my slides and on the certificate?
A: We are pleased to hear that you are moving forward with training and implementation at your facility. In response to your questions, we do not have a certificate template and suggest that if there is not an Education and Training Department at your facility that may have samples of certificates, you create one of your own. As TeamSTEPPS is in the public domain you may use the TeamSTEPPS logo, but not the AHRQ, DoD or DHA logos.

Instructor Guide: A limited number of assembled toolkits (including the DVD and printed materials in a loose-leaf binder) are available from the AHRQ Clearinghouse, on a single-copy basis, at cost.

Webinar Questions

Q: In Module 1 the speaker said TeamSTEPPS was customizable, Is there a point at which altering the course impacts its value (i.e., leaving out one of the components, such as identifying the types of teams)?
A: A good question. All courses are customizable in order to target the focus of your audience. Strive to make your training clinical as applicable and customized to the unit. By customizable, we are referring to the various videos and exercises, that may be used or that you may customize with your own examples, not that you can choose to delete aspects of the curriculum when teaching the course. For example, when you’re planning the training, take some amount of time to understand the flow of patients, who are the frequent physicians that participate on the unit, and also understand from unit directors and others on the unit what are the major interaction problems that occur. And then during the training take a serious or sentinel event where teamwork has failed on the unit and use that as the centerpiece of the training and also use that same case history at the end of the training and ask the participants to use what they've learned and revise this case using their teamwork skills so that it didn't occur as it did with the bad outcome.
If you choose to use your own examples or case studies, be sure to scrub each example or case of its identifying details. Confidentiality and compliance to HIPAA regulations and protocol must rule all discussions. As well, all cases discussed should be closed cases – when in doubt, involve your Risk Management department. The course management guide ,which can be found by selecting the link in this slide and typing in Management Guide in the search field on the top right of the page, is designed to help people understand how to teach a master training course, or fundamentals and essentials course, and discusses customizing the curriculum as well as detailing course versions. (http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/essentials/coursemgmt.html)

Q: What about the patient who does not want to be involved or is non compliant?
A: I believe it is important to ask why? Communication is key to relationship building between patients, families and clinicians – it requires listening and talking on both sides. As health care professionals, it is our responsibility to educate patients about their health care options and the expected outcomes of their choices. In your practice, I encourage you to consider the three levels of partnering with the patient in team-based care from the patient’s perspective: care to me – inpatient; care with me – inpatient and ambulatory; and care by me – self-management. Attention to this third level, self management is key to reducing readmission rates.

Q: Before taking this course, I always thought SBAR was to be used in critical, emergent situations. The Module discusses using it to convey information in other formats, such as shift change, or with the patient, all of which now makes perfect sense. Has the application of SBAR evolved over time from emergent to more non-emergent or has it always been appropriate in both circumstances?
A: SBAR provides a standardized framework for the team to communicate about a patient's condition. While it is useful for framing any conversation, it is especially useful in communicating critical information requiring immediate attention and action. SBAR creates a consistent format for information to be sent and creates an expectation for information to be received. Using SBAR also enables the sender to have the conversation minus the emotion, and this can be especially important in specific instances. When in a particularly emotion charged situation, and as appropriate, I have often asked staff to write down what they wish to convey in SBAR format. This allowed the staff time to think through the situation and compose a meaningful discussion with the focus on collaboration, and what is right rather than who is right. Standardized communication is essential for developing teamwork and fostering a culture of patient safety. SBAR as that standardized communication tool is appropriate in many circumstances. It’s critical that all staff are trained not only on the tools to be used, but also how the tools are to be used in the organization. Allowing staff to practice using the tools and behaviors in their daily work, and holding them accountable to the desired behaviors.

Q: How do you suggest getting M.D. champions?
A: One technique is to include your chief medical officer in the training or other department chiefs. Once you get a group of leaders from your medical staff going through the training, it is very easy to buy into the program. The TeamSTEPPS concept initially may not be understood, but usually once they sit through the training, they understand how important and how effective the initiative could be in improving patient safety within the organization. It is also important to engage staff, so when you identify an opportunity for improvement, involve the leaders of those areas. Of course, leadership requiring physician participation is always a plus to get them in the seats, and again once they understand what you are trying to do and that it can be fun – make it fun, you have buy in. Sort of the theory if you build it they will come, and this sometimes works, but also sharing the outcomes engages individuals into the process. It’s important to let physicians or anyone for that matter, know what’s in it for them and their patients. It is about taking the best care of their patients. Frame it as “We’re looking to take great care of your patients” It’s hard for even the most stubborn resistor to argue when someone says they’re doing something in the best interest of your patient, as well as to make your day go smoother.

Q: When teaching, how do you suggest handling negative reflections of current managers and directors?
A: There may be discussion about ineffective leaders. As the facilitator, move the discussion towards the characteristics and not the individual. Safe to say, we have all worked with ineffective leaders, but that in itself is a learning experience of what not to do. You might consider asking what tools could be employed to change the situation.

Q: In your experience, where have you seen the debrief process implemented in health care? For example, is it only being implemented in direct patient care situations like nursing or the clinic? Or, does the speaker see it being implemented in areas of indirect patient care, like in the lab?
A: Debriefs are an effective tool in any area for analyzing performance, learning and improvement when stakes are high and poor performance is costly. A meta-analysis performed by Tannenbaum and Cerasoli (2012) concludes debriefs are a common tool of learning with ambiguity in their design that can improve team and individual performance by 20 – 25%.
I am aware of debriefs at use in indirect patient care areas, such as radiology, laboratory and the pharmacy, as well as nutritional services. I am also aware of the tool’s use with physician office staff, and in dental clinics. I encourage leaders to be creative in the use of debriefs wherever a 20 – 25% improvement is helpful.

Q: Do you recommend including providers in the brief or debrief who are not interested in participating?
A: Let’s look at this from the patient’s perspective. Ask any patient, “Is it OK with you that that it is optional for leaders, providers, or staff to be interested in or participate in your safety?” “Do you care whether leaders, providers, or staff use evidence-based practices and regularly work to improve their performance and your care?” “Do you care whether leaders, providers, or staff use the experience from the last case to better help you?” How would you answer these questions if you were the patient?
As a leader and facilitator, it is important to structure folks for success. Ask why they don’t want to participate, and then listen to the answer. Do you understand the answer? If not clarify with the individual.
Invite feedback and push-back with any initiative - many times there are valid concerns that must be addressed. It is critical we don’t cause another safety issue in our attempt to resolve one.
What is the resistor hearing in your message of safety – if they hear “do more with less” like most, they will resist; Involve the resistor in the designing of the process. Respect them as you wish to be respected. Embrace, use and value their knowledge and perspective. Stop and ask yourself if you were seeing this behavior as feedback instead of resistance might I refine the change effort?

Q: My question is as to “cross monitoring” or “watching each other’s back.” Is cross-monitoring distinct from situation monitoring? I note that “cross monitoring” is not separately referenced the same as STEP, Situation Awareness, and Shared Mental Models in the Instructor’s Guide.
A: Thank you for this question. Cross monitoring is used to help maintain situation awareness and prevent errors. Not everyone fully understands that included in the individual skill of situation monitoring is the action of monitoring the behavior of other team members (to include the patient) by providing feedback and ensuring mistakes or oversights are caught quickly and easily. Unfortunately, there are individuals that are of the belief it is not their “job” to watch their team members behavior and others see it as “spying.” Trust is an important aspect of teamwork. When all members of the team trust the intentions of their team members a strong sense of team orientation and psychological safety results. The focus should be doing the right thing for the patient and keeping each other safe.

Q: In discussing Feedback, the instructor guide states “Never attribute a team member’s poor performance to internal factors. Please clarify what is meant by “internal factors.”
A: One of the rules of effective feedback is that it be respectful. It should not be personal and it should not be about personality. When we say one should never attribute a team member’s poor performance to internal factors, we are referring to personality,or things like motivation – factors that can’t be improved with instruction or coaching. The focus should be on the behavior.

Q: Can the Two-Challenge Rule and CUS, be used interchangeably? In the video about Edna and the exchange between the lab technician and the nurse, would it have been equally appropriate for the lab tech to have used CUS? Can they be used consecutively, i.e., CUS after Two-Challenge?
A: While the 2 Challenge Rule and CUS are both mechanisms to speak up, alert staff and/or “stop the line,” typically the 2 Challenge Rule is used to initiate clarification and confirmation by advocating for the patient. “Dr. Jones, we’re planning to remove the mole from Sally’s right arm, is that correct?” If no response, and the provider continues to proceed to begin work on the left arm, the second challenge may sound something like this, “Dr. Jones, I have prepped the right arm because the consent indicates we are removing the mole from her right arm.” The 2 Challenge Rule could be used to alert a team member to a safety breach, such as a hole in a glove or if they have contaminated the sterile field or themselves. These actions are not to be taken lightly, but require stopping immediately to resolve the safety issue. CUS is a signal word to alert all staff that something is not right and that a second look or attention is warranted. Some facilities escalate to CUS when the 2 Challenge Rule is ineffective. If CUS does not yield a positive result a stronger course of action is necessary.

Q: There was a statement made by the facilitator in this module to “give people time to mourn their actual losses.” Please clarify what this means.
A: Often before staff members can move forward with changes, they sometimes need to be given time and/or permission to “mourn” the old process or practice. In this context, “loss” refers to the loss of what was normal, or the old way of doing things. William Bridges (the author of “Transitions: Making Sense of Life’s Changes”) speaks to this sense of loss.

Q: Under “dealing with failure,” it reads, “Patience can be a virtue or an enabler of more failure, so use it wisely.” What is the intended meaning of this statement?
A: A coach needs both patience and the ability to give actionable feedback. If I as a coach am eternally patient with those who choose to avoid new behaviors, they have been given no reason to adapt. There are only a few reasons that people don’t demonstrate an expected behavior:
• They don’t know how.
• They don’t know they are supposed to.
• They choose not to.
• They aren’t being held accountable.
Coaches need the communication and feedback skills to address any of these reasons for failure. They also need leadership and administrative support to create the need to comply (accountability) once skills are learned and expected.

Q: Ms. Hubbard discussed an option of matching coaches with team members and an option for training different coaches for different skills. Does this mean, for example, that in the OB unit, one member of the clinical team identified as a coach might “specialize” in a TeamSTEPPS tool, such as SBAR, and coach as to SBAR, or does it mean “specialization” in one of the competencies of a coach, such as providing feedback?
A: The answer is both — and more! A coach may specialize in the application of multiple tools in a specialty setting and be called on to coach those employees, or he or she may be so skillful in the application of a particular tool that the expertise can be applied across different areas and functions. Expertise can be developed in the coaching competencies, but for implementation purposes a coach needs the understanding of TeamSTEPPS content and application to be useful.

Q: Does the clinical area of expertise make a difference in coaching? Could an RN from the medical/surgical unit be called on to coach in the OB unit? Also, is there a concern with a non-clinician coaching clinicians?
A: Because coaches should coach to the behaviors, the answer is “yes” to your general question about whether non-clinicians can coach clinicians. That said, it is important to understand the current culture of your organization. Are clinicians ready to accept feedback from non-clinicians? This is one reason that interdisciplinary training is important. All members of the team need to be trained on the tools and the expected use of the tools. They also need to understand the role of the coach and, if possible, who the coaches are, so they are not surprised or offended when someone unexpected speaks up appropriately. Having an interdisciplinary cadre of coaches is also advantageous. Yes, a medical/surgical nurse could assist with coaching on the OB unit if he or she was skilled in the use of the tools and was able to explain how they would apply on the OB unit.

Q: Can you clarify the distinction between the T-TPQ and the AHRQ Safety Culture Survey?
A: The AHRQ Safety Culture Survey measures staff perceptions of the extent to which safety practices are valued within the organization. It measures staff perceptions of culture. The T-TPQ assesses the TeamSTEPPS skills.

Q: Why are staff perceptions of safety as measured by the AHRQ Survey on Patient Safety Culture classified as a process measure, rather than an outcome measure?
A: A process measure assesses those behaviors, attitudes and values that produce an outcome. So in trauma care, you can think of “time to intubation” as a process measure; a corresponding outcome might be mortality. Further, the safety culture in the trauma unit could influence how trauma resuscitations are run (making culture a process measure) that again could be related to mortality.

Q: Would the T-TPQ and the T-TAQ be completed by the core team only? Can we include the ancillary and support services team? Does it depend on the aim and tool or strategy being deployed?
A: The TPQ and TAQ are tools to measure staff perceptions of teamwork and staff attitude towards teamwork. As such, they should be administered to those staff members who will be involved in the implementation of the initiative, regardless of where they work. The class should be interdisciplinary, and we encourage including ancillary and support staff in your training of clinical units. Every day, staff from many areas will be working with one another, and they all will need to understand these tools and how they are used.

Q: Should the T-TPQ and the T-TAQ be repeated at any specified intervals after their initial use?
A: These surveys are tools in your toolkit. Deciding which (if any) you use is up to you and leadership. They are a good starting point to identify where the organization is pre-implementation. They can then be administered six months after implementation and again a year later as a means to monitor progress.

Office-Based Care Online Webinars

Q: When will the Webinars for the TeamSTEPPS for Office-Based Care Online course be available, and am I required to view Webinar 1 before I can begin Module 4?
A: TeamSTEPPS for Office-Based Care Online course Webinar 1 is available for viewing. Webinar 2 will be available May 26, and Webinar 3 will be available mid July. Once the Webinars are available you may view at any time, and you do not need to view the Webinar before working on the next module. For example, it is not a requirement to view Webinar 1 before you can proceed to Module 4.

TeamSTEPPS 2.0: Module 1

Q: You refer to SBAR and other tools I am not familiar with. How can I find out more about these tools?
A: SBAR is an acronym for Situation-Background-Assessment and Recommendation. As this first module is an introduction to the tools, strategies, and behaviors of TeamSTEPPS®, the tools mentioned will be fully explained in subsequent modules. We do not expect learners to be familiar with them before taking the course.

TeamSTEPPS 2.0: Module 2

Q: What's with all the penguins?
A: The graphic design of the TeamSTEPPS® course materials is inspired by the John Kotter (2006) book Our Iceberg Is Melting: Changing and Succeeding Under Any Conditions. This book describes Kotter's eight stages of change—a set of steps to initiate and sustain change in an organization—through the story of a penguin colony faced with a melting iceberg. User experience and feedback on this book sparked the graphic design concept for the instructor guide.

Q: When you say the patient is part of the team, what about the patient who is noncompliant?
A: As health care professionals, it is our responsibility to educate patients about their health care options and the expected outcomes of their choices. Nobody knows the patient better than the patient him/herself. Patients have all the information, and it is important not only to encourage patients and their families to actively participate in their care, but also to give them permission to speak up and ask questions. Ask why they are not following the prescribed plan of care and listen to their answers. Listening to our patients and asking for their feedback is an important step in making them feel they are valued members of the health care team. In your practice, consider the three levels of partnering with the patient in team-based care from the patient's perspective: care to me (inpatient); care with me (inpatient and ambulatory); and care by me (self-management).

TeamSTEPPS 2.0: Module 3

Q: There are only two people in my section; why do we need to learn about communication? We are always talking to one another.
A: Communicating effectively goes beyond talking with one another. The use of a check-back is important to ensure that the message you heard is what was actually said and that you clearly understood the intent of the message. This closed-loop communication strategy is a mechanism to verify and validate the information exchanged. It is an opportunity to correct misinterpretations. Think back to the Starbucks example provided by the guest speaker. In the example, the exchange of information at each interval was between two people, but they needed to make sure their communication was clear, precise, and understood to reach a positive outcome: a satisfied customer.

TeamSTEPPS 2.0: Module 4

Q: I work in human resources. How does Leading Teams apply to me?
A: The tools, strategies, and behaviors of TeamSTEPPS® apply to all areas of the organization, and can be customized to meet the needs of your work area. The brief is simply discussing among the team the plan for the day. What do you and your team members, whether there are two or 10, need to share? For example, what time is each staff member going to lunch? Who is available to assist if help is needed? What are the priorities for the day? Who has appointments during the day, and who will cover for them? Being proactive and planning decreases team frustration, surprises, and errors.

Q: Is there a requirement to document the discussions that take place as part of the debrief, so the team can develop a body of knowledge that they can refer to (and create something similar to your FAQ’s)?
A: One of the things we stress in teaching TeamSTEPPS® is that the material has to be modified to fit the specific institution’s environment, there are no “rules” that fit everyone. Decisions on requiring documentation of the debrief are up to both the institution and site. For example, in the OR, it may be required as part of a surgical checklist, but debriefing should be done in as many team situations as possible (rounds, etc.) and you probably wouldn’t want to require documentation for everything. The purpose of the debrief is to learn what will help (or not be a problem) for the next time that activity occurs.

Q: Regarding the composition of the team, what is the relationship of the manager to the designated leader – which in the videos was a doctor? I am asking this because it is possible that the standard of practice of one doctor may not be congruent to the standards of the hospital, which changes often because of regulations and fast paced organizational changes. If an organization has employees that try to please the doctor only and are blind to the need to follow the unit’s manager – it can be problematic.
A: One of the key messages is that our goal is patient safety, not pleasing physicians. If you have a problem with a physician who is not happy with activities that are important for patient safety, than there are bigger issues to address and there should be an appropriate chain of command to address this issue. On the other hand, there are clearly differences of opinion that arise regarding care and the real issue is determining how the physicians and the institution address these legitimate conflicts. If the focus is on the patient and assuring safety of the patient, whatever the decision, it is likely to be a better one.

Q: In relation to the tools discussed in Module 4, are there exercise examples and scenarios involving teams that are predominately or exclusively non-nursing teams?
A: Additional scenarios and videos are available on the AHRQ site https://www.ahrq.gov/teamstepps/instructor/index.html. In addition, several organizations have created their own examples based on events and near-misses that have occurred within their facility.

TeamSTEPPS 2.0: Module 8

Q: There was a statement made by the facilitator in this module to “give people time to mourn their actual losses.” Please clarify what this means.
A: Often before staff members can move forward with changes, they sometimes need to be given time and/or permission to “mourn” the old process or practice. In this context, “loss” refers to the loss of what was normal, or the old way of doing things. William Bridges (the author of “Transitions: Making Sense of Life’s Changes”) speaks to this sense of loss.

TeamSTEPPS 2.0: Module 9

Q: Under “dealing with failure,” it reads, “Patience can be a virtue or an enabler of more failure, so use it wisely.” What is the intended meaning of this statement?
A: A coach needs both patience and the ability to give actionable feedback. If I as a coach am eternally patient with those who choose to avoid new behaviors, they have been given no reason to adapt. There are only a few reasons that people don’t demonstrate an expected behavior:
• They don’t know how.
• They don’t know they are supposed to.
• They choose not to.
• They aren’t being held accountable.
Coaches need the communication and feedback skills to address any of these reasons for failure. They also need leadership and administrative support to create the need to comply (accountability) once skills are learned and expected.

Q: Ms. Hubbard discussed an option of matching coaches with team members and an option for training different coaches for different skills. Does this mean, for example, that in the OB unit, one member of the clinical team identified as a coach might “specialize” in a TeamSTEPPS tool, such as SBAR, and coach as to SBAR, or does it mean “specialization” in one of the competencies of a coach, such as providing feedback?
A: The answer is both — and more! A coach may specialize in the application of multiple tools ina specialty setting and be called on to coach those employees, or he or she may be so skillful in the application of a particular tool that the expertise can be applied across different areas and functions. Expertise can be developed in the coaching competencies, but for implementation purposes a coach needs the understanding of TeamSTEPPS content and application to be useful.

Q: Does the clinical area of expertise make a difference in coaching? Could an RN from the medical/surgical unit be called on to coach in the OB unit? Also, is there a concern with a non-clinician coaching clinicians?
A: Because coaches should coach to the behaviors, the answer is “yes” to your general question about whether non-clinicians can coach clinicians. That said, it is important to understand the current culture of your organization. Are clinicians ready to accept feedback from non-clinicians? This is one reason that interdisciplinary training is important. All members of the team need to be trained on the tools and the expected use of the tools. They also need to understand the role of the coach and, if possible, who the coaches are, so they are not surprised or offended when someone unexpected speaks up appropriately. Having an interdisciplinary cadre of coaches is also advantageous. Yes, a medical/surgical nurse could assist with coaching on the OB unit if he or she was skilled in the use of the tools and was able to explain how they would apply on the OB unit.

TeamSTEPPS 2.0: Module 10

Q: Can you clarify the distinction between the T-TPQ and the AHRQ Safety Culture Survey?
A: The AHRQ Safety Culture Survey measures staff perceptions of the extent to which safety practices are valued within the organization. It measures staff perceptions of culture. The T-TPQ assesses the TeamSTEPPS skills.

Q: Why are staff perceptions of safety as measured by the AHRQ Survey on Patient Safety Culture classified as a process measure, rather than an outcome measure?
A: A process measure assesses those behaviors, attitudes and values that produce an outcome. So in trauma care, you can think of “time to intubation” as a process measure; a corresponding outcome might be mortality. Further, the safety culture in the trauma unit could influence how trauma resuscitations are run (making culture a process measure) that again could be related to mortality.

Q: Would the T-TPQ and the T-TAQ be completed by the core team only? Can we include the ancillary and support services team? Does it depend on the aim and tool or strategy being deployed?
A: The TPQ and TAQ are tools to measure staff perceptions of teamwork and staff attitude towards teamwork. As such, they should be administered to those staff members who will be involved in the implementation of the initiative, regardless of where they work. The class should be interdisciplinary, and we encourage including ancillary and support staff in your training of clinical units. Every day, staff from many areas will be working with one another, and they all will need to understand these tools and how they are used.

Q: Should the T-TPQ and the T-TAQ be repeated at any specified intervals after their initial use?
A: These surveys are tools in your toolkit. Deciding which (if any) you use is up to you and leadership. They are a good starting point to identify where the organization is pre-implementation. They can then be administered six months after implementation and again a year later as a means to monitor progress.