FAQs: TeamSTEPPS® Online Master Trainer Course

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.

Q: Is there a cost to enroll in the TeamSTEPPS for Office-Based Care Online courses?
A: No cost is associated with the accredited online courses.

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, try using a different browser. Some learners have had issues accessing the modules using Google Chrome, and have been successful using Safari or Firefox. If you continue to have issues, please 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. In order to best assist you, please send as attachments your two prework documents (steps 1–3 of the Implementation Plan worksheet, and the Commitment and Course Preference Form) via email to obc-questions@tslms.org. Additionally, we ask that you also share the 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: 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: 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.

Q: How do I enroll in the TeamSTEPPS 2.0 Individual Modules?
A: AHRQ will no longer be offering the accredited 2.0 Core Curriculum individual modules. AHRQ will continue to offer the accredited TeamSTEPPS for Office-Based Care Master Trainer Course and the accredited Office-Based Care Individual Modules.

Q: I am a nurse practitioner. Will the American Association of Nurse Practitioners (AANP) recognize my certificate?
A: Yes. 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).

Q: How do I get my certificate?
A: After successfully completing the module post-test (you have three tries to score at least 80 percent) and completing the postcourse evaluation, you will be able to select the link and print your certificate.

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. 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 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.

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.

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 cohort course, you will receive your TeamSTEPPS Master Trainer certificate of completion. You can consider and call yourself a TeamSTEPPS Master Trainer. If you are working in the Individual Modules, you will not receive a Master Trainer certificate upon completion of the 11 modules.

Q: What is the difference between the TeamSTEPPS 2.0 Master Training Course and TeamSTEPPS for Office-Based Care?
The TeamSTEPPS 2.0 and TeamSTEPPS for Office-Based Care content regarding the team competencies and tools are the same. The difference is that the office-based care course focuses on the medical office, primary care and ambulatory settings so the examples, videos, scenarios and implementation of the tools, strategies and behaviors are tailored to this setting.

Q: I am interested in earning a TeamSTEPPS 2.0 Master Trainer certificate. When will the next cohort begin?
A: Thank you for your interest in TeamSTEPPS. AHRQ is no longer offering the accredited TeamSTEPPS 2.0 Master Trainer Course or the TeamSTEPPS 2.0 Core Curriculum Individual Modules course. We are currently accepting prework submissions for the TeamSTEPPS for Office-Based Care Course, which does provide a Master Trainer certificate upon successful completion. Visit the home page at https://tslms.org/ to enroll in the Office-Based Care Prework Course.

Q: The Office-Based Care Course does not apply to my work environment. I want to complete the TeamSTEPPS 2.0 Core Curriculum and earn a Master Trainer certificate. What should I do?
A: Several organizations offer TeamSTEPPS training for a fee. A list of offerings may be found by Googling "TeamSTEPPS training."

Q: Will I receive a Master Trainer certificate if I complete all 11 modules in the Individual Modules course?
A: No, you will not receive a Master Trainer certificate upon completion of the 11 TeamSTEPPS for Office-Based Care Individual Modules. However, you will receive CEs for each successfully completed accredited module.

Q: Does the clinical area of expertise make a difference in coaching? 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.

Q: Will I receive a Master Trainer certificate if I complete all 11 modules in the Individual Modules course?
A: No, you will not earn a Master Trainer certificate upon completion of the 11 Individual Modules. However, you will receive CEs for each successfully completed accredited module.

TeamSTEPPS for Office-Based Care Course

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: What are the different options for the teach-back appointments?
A: You can complete your teach back via a phone session or by turning in a recorded PowerPoint presentation. For more details, read below.

Q: What is the phone session option?
If you choose this teach-back method, you will be responsible for presenting a quality improvement situation or a module for about 15- 20 minutes to a TeamSTEPPS Master Trainer.

Q: What is the recorded PowerPoint option?
A: If you choose this teach-back method, you will be responsible for a 15- to 20-minute recorded PowerPoint presentation on one of the two subjects outlined below. For instructions on how to record a PowerPoint presentation, select this link. As with a live performance, we are not looking for perfection. This is a great opportunity for you to create and practice a presentation that you can use again within your own organization after you complete this course.
Subject Options:

  1. Teach Back a Module: Teach a module of your choice from the TeamSTEPPS Fundamentals Modules (2-6). You will be expected to facilitate a discussion around one or more of the videos or exercises from the module you are presenting. Consider this teach-back session as role play, and present as if you were presenting to a class of your colleagues. You are expected to make this your own and include personal stories or examples throughout the presentation.
  2. Quality Improvement Situation: Present a situation-either real or imagined-where an error, near-miss, or opportunity for improvement occurred in an office-based health care setting. Explain how you can overcome the challenge using two or more TeamSTEPPS tools and how these tools will be implemented in the health care setting. For more detailed instructions, please select this link.

Q: Is there a template I can use for the recorded PowerPoint option?
A: Yes. To download a template for the "Quality Improvement Situation" recorded PowerPoint option, please select this link. If you would like to download a template for the "Teach Back a Module" recorded PowerPoint option, please refer to the slides on AHRQ's website by selecting this link.

Q: My recorded PowerPoint (PPT) presentation is too large to send by email. What should I do?
A: If your PPT presentation file is too large to send as an email attachment, you can upload it to our OpenDrive file-sharing account*. Please log into OpenDrive by using the following information and select the folder labeled "Upload Your OBC Teach Back Here." You can then drag and drop your presentation into the folder.

  • Link: https://www.opendrive.com/login
  • Username: obc-admin@tslms.org
  • Password: TeamSTEPPS
*Be sure to email obc-admin@tslms.org once you have uploaded your presentation into OpenDrive; The TeamSTEPPS Support Team will then review the presentation and provide a grade.

Q: If I want to reschedule my teach back, what should I do?
A: Please return to the confirmation email you received after scheduling your original teach-back appointment. Select "My appointments," cancel your appointment, and reschedule. You can also log into your Schedulicity account to reschedule. If you have any questions or if you need assistance, please email obc-admin@tslms.org.

Q: I completed my teach back but I can't print my Master Trainer certificate. What do I do?
A: Please return to your course page and review the last required activities. To print your Master Trainer certificate, you must meet all course requirements:

  1. Ensure all modules and webinars are marked as complete.
  2. Complete your teach back.
  3. Submit the "Summarize Your Learning" activity.
  4. Submit your answers to the Evaluation.

Q: Can I present my teach back with other members from my team?
A: If other members from your organization are enrolled in a TeamSTEPPS for Office-Based Care course, you may perform the teach back together.
If your team wishes to present via phone, please have one member of your team sign up for the desired phone session and then email obc-admin@tslms.org with the names of the other team members that will also be completing their teach-back. If your team wishes to present via PowerPoint, please have every member of the team sign up for the same desired time slot, then have one team member email obc-admin@tslms.org with the names of the other team members that will be on the same presentation. Please limit teach-back teams to no more than 3 learners.
If you sign up for the PowerPoint as a team, you may only choose the Quality Improvement Situation option. If you prefer the "Teach Back a Module" option, each team member will need to complete his or her own presentation and turn it in individually.

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 online. 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.

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: 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: 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.

Q: It was said that 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.

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%.
We are aware of debriefs at use in indirect patient care areas, such as radiology, laboratory and the pharmacy, as well as nutritional services. We are 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.
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: Can the Two-Challenge Rule and CUS, be used interchangeably?
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: 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.