The topic was improving teamwork and communication, and more than 650 clinical and quality leaders eagerly were discussing it. This gathering was at the National TeamSTEPPS Conference in June in Denver. TeamSTEPPS — Team Strategies and Tools to Enhance Performance and Patient Safety — was developed 10 years ago by the Department of Defense and the Agency for Healthcare Research and Quality. TeamSTEPPS is based on a framework of four core competencies: communication, leadership, situation monitoring and mutual support. Hundreds of health care organizations have used TeamSTEPPS to improve communication and teamwork skills, create a culture of safety, and improve quality and clinical performance.

The MetroHealth System in Cleveland has enhanced its patient safety culture and engaged and empowered staff using TeamSTEPPS. The 700-bed public health care system incorporated teamwork into its mission statement and core values. Then a change team of clinical and nonclinical staff moved forward with the TeamSTEPPS train-the-trainer model. MetroHealth started implementing teamwork strategies and tools in high-risk areas, including its emergency department, trauma unit, surgical intensive care unit, neonatal ICU, and labor and delivery unit. The health care system has worked to create a culture of safety so that all clinicians and staff not only speak up about concerns, but also contribute to resolving the issues. For example, using TeamSTEPPS strategies and complex simulation, ED staff developed a patient management protocol that was evaluated by the Centers for Disease Control and Prevention. As a result, MetroHealth is now one of 55 Ebola treatment centers in the United States. Overall, MetroHealth has improved patient safety, outcomes and satisfaction, and boosted staff morale and retention.

ValleyCare Health System in Pleasanton, Calif., and St. Charles Health System in Bend, Ore., implemented TeamSTEPPS at their organizations and then collaborated to examine its impact. At ValleyCare, a nonprofit community health system, an interdisciplinary team attended TeamSTEPPS master training and then developed mandatory training for nurses, physicians and support staff in the perinatal setting. Because of measured success in that setting, ValleyCare expanded TeamSTEPPS training throughout its health system over two years. St. Charles Health System, a multihospital system, integrated TeamSTEPPS and in situ simulation methodology. Teams can easily modify training sessions and metrics to meet the needs of individual settings and units. After TeamSTEPPS training, 93 percent of staff at the two health systems agreed or strongly agreed that their health care team “is a safety net for patients.” Both health care systems have maintained TeamSTEPPS implementation and sustainment efforts.

TeamSTEPPS has three continuous phases, developed and based on organizational experience and research on health care quality, patient safety and culture change. To implement TeamSTEPPS successfully, a hospital or care system should: (1) thoroughly assess the organization’s readiness, (2) carefully plan for training and implementation, and (3) develop a sustainment plan. Hospital and care system leaders play an active role in emphasizing the importance of maintaining a culture of safety with the support of TeamSTEPPS principles.

Eight regional TeamSTEPPS training centers across the country offer master training courses. To learn more about training opportunities, monthly webinars and the 2016 national conference, visit the TeamSTEPPS National Implementation portal at A recent Hospitals in Pursuit of Excellence guide, “Improving Patient Safety Culture through Teamwork and Communication: TeamSTEPPS”, describes the TeamSTEPPS framework and includes examples and case studies. The guide is available at

Cynthia Hedges Greising is a communications specialist with the Health Research & Educational Trust.