Pocket Guide

Table of Contents

TeamSTEPPS®
Framework and Competencies 1
Key Principles 2

Team Structure
Multi-Team System 4

Communication
SBAR 6
Call-Out and Check-Back 7
Closed Loop Communication 8
Handover 9
“I PASS THE BATON” 10

Leading Teams
Effective Team Leaders 12
Team Events 13
Brief Checklist 14
Debrief Checklist 15

Communication • 2
 Table of Contents

Situation Monitoring
Situation Monitoring Process 17
STEP 18
Cross-Monitoring 19
I’M SAFE Checklist 20

Mutual Support
Task Assistance 22
Feedback 23
Advocacy and Assertion 24
Two-Challenge Rule 25
CUS 26
DESC Script 27

Team Performance
Observation Tool 28

Barriers, Tools and

Strategies, Outcomes 30

Contact Information 31
Framework and Competencies

Team
Competency
Outcomes

Patient,
Leading Mutual
Teams Family & Support
Care Team
Situation
Monitoring Communication

TeamSTEPPS is an evidence-based framework to

optimize team performance across the health care
delivery system. It is based on team structure and four
teachable learning skills: Communication, Leading
Teams, Situation Monitoring and Mutual Support. Team
structure includes everyone on the patient care team:
patients, families, direct caregivers and all individuals
who play a supportive role.
Through TeamSTEPPS, the following team competency
outcomes can be achieved:
Knowledge Attitudes Performance
• Shared Mental • Mutual Trust • Adaptability
Model • Team Orientation • Accuracy
• Productivity
• Efficiency
• Safety
1
Key Principles

Team Structure
Identification of the components of a multi-team
system that must work together effectively to
ensure patient safety

Communication
Structured process by which information is clearly
and accurately exchanged among team members

Leading Teams
Ability to maximize the activities of team members
by ensuring that team actions are understood,
changes in information are shared, and team
members have the necessary resources

Situation Monitoring
Process of actively scanning and assessing
situational elements to gain information or
understanding, or to maintain awareness to support
team functioning

Mutual Support
Ability to anticipate and support team members’
needs through accurate knowledge about their
responsibilities and workload

2
 Patient,
Leading Mutual
Teams Family & Support
Care Team
Situation
Monitoring Communication

Team Structure
Multi-Team System

• Team structure refers to the composition of a team. In

healthcare, multiple teams are involved in patient care.
This model is known as a multi-team system or MTS.
• Each team within an MTS is responsible for various
parts of patient care, but all must act in concert to
ensure quality patient care.
• A key component of the MTS is the patient. Patients are
part of the patient care team and should be embraced
and valued as contributing partners to patient care.
• In addition to the patient, the multi-team system is
composed of several different teams.

Team Structure • 4
 Patient,
Leading Mutual
Teams Family & Support
Care Team
Situation
Monitoring Communication

Communication
SBAR

SBAR is a technique for communicating critical

information that requires immediate attention and action
concerning a patient’s condition

Situation - What is going on with the patient?

“Dr. Smith, this is Barb on 2 West. I am calling
about Mrs. Joseph in room 251. Chief complaint
is shortness of breath of new onset.”

Background - What is the clinical background or context?

“Patient is a 62-year-old female post-op day one
from abdominal surgery. No prior history of cardiac
or lung disease.”

Assessment - What do I think the problem is?

“Breath sounds are decreased on the right side
with acknowledgement of pain. Would like to rule
out pneumothorax.”

Recommendation and Request - What should I do to

correct it?
“I feel strongly the patient should be assessed now.
Can you come to room 251 now?”

Communication • 6
Call-Out and Check-Back

A call-out is a strategy used to communicate important

or critical information. A call-out:
• Informs all team members simultaneously
during situations.
• Helps team members anticipate next steps.
• Directs responsibility to a specific individual assigned
to carrying out the task.
A check-back ensures that information conveyed by the
sender is understood by the receiver as intended.

Example:

”
Dr. Smith:“Barb, give me 25 mg Benadryl IV push.”
Barb:“25 mg Benadryl IV push”
Dr. Smith:“That’s correct.”

Communication • 7
Closed-Loop Communication

Using call-outs and check-backs can help you in the vital

process of closed-loop communication.

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Use closed loop communication in every clinical

and non-clinical setting.

Communication • 8
Handover

Handover is the transfer of information (along with

authority and responsibility) during transitions in care
across the continuum. It includes an opportunity to ask
questions, clarify, and confirm.

Examples of transitions in care include shift changes;

transfer of responsibility between and among nursing
assistants, nurses, nurse practitioners, allied health
practitioners, physician assistants, and physicians;
and patient transfers.

Communication • 9
Handover

One useful handover tool is “I PASS THE BATON.”

It enhances information exchange during transitions
of care.

I Introduction Introduce yourself and your role/job

(include patient)
P Patient Name, identifiers, age, location
A Assessment Present chief complaint, vital signs,
symptoms, and diagnoses
S Situation Current status/circumstances, including
code status, level of (un)certainty, recent
changes, and response to treatment
S Safety Critical lab values/reports,
Concerns socioeconomic factors, allergies,
and alerts (falls, isolation, etc.)
THE
B Background Comorbidities, previous episodes,
current medications, and family history
A Actions Explain what actions were taken or are
required. Provide rationale.
T Timing Level of urgency, explicit timing and
prioritization of actions
O Ownership Identify who is responsible
(person/team), including patient/family
members
N Next What will happen next? Anticipated
changes? What is the plan? Are there
contingency plans?

Communication • 10
 Patient,
Leading Mutual
Teams Family & Support
Care Team
Situation
Monitoring Communication

Leading Teams
Effective Team Leaders

The following are responsibilities of effective team

leaders:

• Organize the team

• Identify and articulate clear goals (i.e., the plan)
• Assign tasks and responsibilities
• Monitor and modify the plan; communicate changes
• Review the team’s performance; provide feedback
when needed
• Manage and allocate resources
• Facilitate information sharing
• Encourage team members to assist one another
• Facilitate conflict resolution in a learning environment
• Model effective teamwork

Leadership • 12
Team Events

Sharing the Plan

• Brief - Short session prior to start to share the
plan, discuss team formation, assign roles and
responsibilities, establish expectations and climate,
anticipate outcomes and likely contingencies

Monitoring and Modifying the Plan

• Huddle - Ad hoc meeting to re-establish situational
awareness, reinforce plans already in place, and
assess the need to adjust the plan

Reviewing the Team’s Performance

• Debrief - Informal information exchange session
designed to improve team performance and
effectiveness through lessons learned and
reinforcement of positive behaviors

Leadership • 13
Brief Checklist

During the brief, the team should address the

following questions:

Who is on the team?

Do all members understand and agree upon

goals?

Are roles and responsibilities understood?

What is our plan of care?

What is staff and provider availability

throughout the shift?

How is workload shared among team

members?

What resources are available?

Leadership • 14
Debrief Checklist

The team should address the following questions

during a debrief:

Was communication clear?

Were roles and responsibilities understood?

Was situation awareness maintained?

Was workload distribution equitable?

Was task assistance requested or offered?

Were errors made or avoided?

Were resources available?

What went well?

What should improve?

What is one thing that could be done

differently next time?

Leadership • 15
 Patient,
Leading Mutual
Teams Family & Support
Care Team
Situation
Monitoring Communication

Situation Monitoring
Situation Monitoring Process

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Situation monitoring is the process of continually

scanning and assessing a situation to gain and maintain
an understanding of what’s going on around you.

Situation awareness is the state of “knowing what’s

going on around you.”

A shared mental model results from each team member

maintaining situation awareness and ensures that all
team members are “on the same page.”

Situation Monitoring • 17
STEP

STEP is a tool for monitoring situations in the delivery

of healthcare.

Components of Situation Monitoring:

S tatus of the Patient

T eam Members

E nvironment

P rogress Toward Goal

Status of Team Environment Progress

Patient Members Toward Goal
• Facility
• Patient • Fatigue Information • Status of
History • Workload • Administra- Team’s
• Vital Signs • Task tive Patient(s)?
• Medications Performance Information • Established
• Physical • Skill • Human Goals of
Exam • Stress Resources Team?
• Plan of Care • Triage Acuity • Tasks/
• Psychosocial • Equipment Actions of
Issues Team?
• Plan Still
Appropriate?

Situation Monitoring • 18
Cross-Monitoring

Cross-monitoring is a harm-reduction strategy

that involves:
• Monitoring actions of other team members.
• Providing a safety net within the team.
• Ensuring that mistakes or oversights are caught
quickly and easily.
• “Watching each other’s back”.

Situation Monitoring • 19
I’M SAFE Checklist

Each team member is responsible for assessing his

or her own safety status.

I = Illness

M = Medication

S = Stress

A = Alcohol and Drugs

F = Fatigue

E = Eating and Elimination

Situation Monitoring • 20
 Patient,
Leading Mutual
Teams Family & Support
Care Team
Situation
Monitoring Communication

Mutual Support
Task Assistance

Helping others with tasks builds a strong team. Key

strategies include:
• Team members protect each other from work overload
situations.
• Effective teams place all offers and requests for
assistance in the context of patient safety.
• Team members foster a climate where it is expected
that assistance will be actively sought and offered.

Mutual Support • 22
Feedback

Feedback is information provided to team members

for the purpose of improving team performance.

Feedback should be:

• Timely – given soon after the target behaviour has
occurred
• Respectful – focuses on behaviors, not personal
attributes
• Specific – relates to a specific task or behaviour that
requires correction or improvement
• Directed toward improvement – provides directions for
future improvement
• Considerate – considers a team member’s feelings and
delivers negative information with fairness and respect

Mutual Support • 23
Advocacy and Assertion

Advocate for the patient when team members’ viewpoints

don’t coincide with that of the decision maker.

Assert a corrective action in a firm and respectful

manner
• Make an opening
• State the concern
• State the problem (real or perceived)
• Offer a solution
• Reach agreement on next steps

Mutual Support • 24
Two-Challenge Rule

A Two-Challenge Rule empowers all team members

to “stop the line” if they sense or discover an essential
safety breach.

When an initial assertive statement is ignored:

• It is your responsibility to assertively voice
concern at least two times to ensure that it
has been heard.
• The team member being challenged must
acknowledge that concern has been heard.

If the safety issue still hasn’t been addressed:

• Take a stronger course of action, or
• Utilize supervisor or chain of command.

“Stop the Line”

Mutual Support • 25
CUS

Assertive Statements:

I am C ONCERNED!
I am U NCOMFORTABLE!
This is a S AFETY ISSUE!

“Stop the Line”

Mutual Support • 26
DESC Script

D Describe the specific situation or

behaviour; provide concrete data

E Express how the situation makes

you feel/what your concerns are

S Suggest other alternatives

and seek agreement

C Consequences should be stated in

terms of impact on established team
goals; strive for consensus

Mutual Support • 27
Team Performance Observation Tool

A Successful Team:
Team Structure
• Assemble team
• Assign or identify team members’ roles and
responsibilities
• Hold team members accountable
• Include patients and families as part of the team

Communication
• Provide brief, clear, specific, and timely information
• Seek information from all available sources
• Use SBAR, call-outs, check-backs, and handover
techniques to communicate effectively with team
members

Leading Teams
• Identify team goals and vision
• Utilize resources efficiently to maximize team
performance
• Balance workload within the team
• Delegate tasks or assignments, as appropriate
• Conduct briefs, huddles, and debriefs
• Role models teamwork behaviors

Team Performance Observation Tool • 28

Team Performance Observation Tool
continued...

Situation Monitoring
• Monitor the state of the patient
• Monitor fellow team members to ensure safety
and prevent errors
• Monitor the environment for safety and availability of
resources (e.g., equipment)
• Monitor progress toward the goal and identifies
changes that could alter the care plan
• Foster communication to ensure a shared mental
model

Mutual Support
• Provide task-related support and assistance
• Provide timely and constructive feedback to team
members
• Effectively advocate for the patient
• Use the Assertive Statement, Two-Challenge Rule,
or DESC Script to resolve conflict

Team Performance Observation Tool • 29

Barriers, Tools and Strategies, Outcomes

Barriers
• Inconsistency in Team • Conflict
Membership • Lack of Coordination and
• Lack of Time Follow-up With Coworkers
• Lack of Information • Distractions
Sharing • Fatigue
• Hierarchy • Workload
• Defensiveness • Misinterpretation of Cues
• Conventional Thinking • Lack of Role Clarity
• Complacency
• Varying Communication
Styles

Tools and Strategies

Communication Situation Monitoring
• SBAR • STEP
• Call-Out • I’M SAFE
• Check-Back Mutual Support
• Handover • Task Assistance
Leading Teams • Feedback
• Brief • Assertive Statement
• Huddle • Two-Challenge Rule
• Debrief • CUS
• DESC Script

Outcomes
• Shared Mental Model • Mutual Trust
• Adaptability • Team Performance
• Team Orientation • Patient Safety

Barriers, Tools and Strategies, Outcomes • 30

Contact Information

For more information about TeamSTEPPS Canada™,

visit patientsafetyinstitute.ca

Adapted from the Department of Defense Patient Safety

Program in collaboration with the Agency for Healthcare
Research and Quality

TeamSTEPPS Canada™ 2.1 Pocket Guide

Contact Information • 31