Improving Teamwork and Communication for Child Psychiatric Staff

Abstract

Problem & Purpose: There is a critical need for mental health staff to work well as a team, particularly with the increase in high acuity behavioral health patients and shortage of experienced psychiatric nurses in recent years. Staff members on an inpatient pediatric psychiatric unit have recognized elements that underpin effective teams and include efficient, effective communication, transparency and trust. Leadership on the unit have identified team communications skills as an area of opportunity to improve the staff’s perception of teamwork. The purpose of this quality improvement (QI) project is to establish a baseline measure of teamwork, equip staff with evidence-based teamwork tools based on TeamSTEPPS 2.0: Strategies and Tools to Enhance Performance and Patient Outcomes (TeamSTEPPS), evaluate success of the tools, and make recommendations for improvement. Methods: Thirty-four inpatient child psychiatric nurses and mental health technicians received education on strategies from the Mutual Support and Situational Monitoring modules of the TeamSTEPPS® 2.0 fundamental curriculum, such as C-U-S, DESC Script, and cross monitoring. These strategies helped improve the process of communication during therapeutic groups by improving staff’s interactions. Staff used the TeamSTEPPS strategies to communicate when they needed support and to actively seek out opportunities to help their team members. Charge nurses audited staff members’ communication patterns during an evening therapeutic group twice a week to assess the team’s ability to use the new TeamSTEPPS strategies. Results: Data from the domains of Mutual Support and Situation Monitoring of the Teamwork Perceptions Questionnaire (T-TPQ) were collected at baseline and post-implementation. Staff’s perception of Situation Monitoring increased significantly (p=0.01). Staff’s perception of Mutual Support increased; however, this increase was not significant (p=0.11). Although staff did not consistently meet the targeted goal of “Good” (4), the run charts of both outcomes revealed a positive trend, and staff met the goal 32% of the time during the implementation period. Conclusions: TeamSTEPPS offers a standardized approach to teach mental health providers how to support each other during therapeutic groups. Future studies should focus on reinforcement strategies and the long-term relationship between TeamSTEPPS implementation and rates of workplace violence.