Improving Staff Communication and Teamwork As a Psychiatric Day Program

Abstract

Background: The Institute for Healthcare Improvement has identified four foundational principals for making health care systems and processes safer and more reliable: Standardized processes and care, Simplified processes, Reduced autonomy, and Highlighting deviations from practice. They recommend use of the TeamSTEPPS Situation, Background, Assessment, Recommendation/Request (SBAR) technique to maximize communication between members of healthcare teams. TeamSTEPPS is a training program that was developed by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD), with the most recent version being TeamSTEPPS 2.0. It consists of five key principals: Team Structure, Communication, Leadership, Situation Monitoring, and Mutual Support. Local Problem: A behavioral health provider in Baltimore City recognized the need to improve teamwork, communication, and efficiency during shift-change report among staff members at their psychiatric day program. Interventions: Fall of 2017, training was done with staff members at this psychiatric day program on TeamSTEPPS 2.0’s key principals of Communication and Leadership. October 3, 2018, training was done on the key principal of Situation Monitoring, implementation of the mnemonic “I PASS THE BATON” – the new evidence based standard for handoffs, and refresher training on Communication and Leadership. Participants completed the Teamwork Attitudes Questionnaire (T-TAQ) prior to training and again after a seven-week implementation period. Results: Eleven staff members (n=11) were trained on October 3, 2018. Comparison of the pretraining and post-training T-TAQ questionnaires yielded evidence of improved staff attitudes toward team structure (38%), leadership (9%), situation monitoring (23%), and communication (38%), as evidenced by a greater number of Strongly Agree responses on the post-training questionnaires. Although there was a 14% improvement in the number of Strongly Agree responses for the category of mutual support, the overall percentage of Strongly Agree responses remained fairly low at only 33%. This agency continues to encourage its staff members to utilize the “I PASS THE BATON” mnemonic during shift reports. Conclusions: TeamSTEPPS 2.0 is a good fit for improving teamwork, communication, and efficiency of shift-change reports for this psychiatric day program. Continued training and refresher training, as well as inclusion of this training as competencies for new-hires, will be essential for maintaining these skills and improving patient outcomes.