Assessing the Impact of the National Implementation of TeamSTEPPS Master Training Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #1 Training participant questionnaire	Form and Instruction	New	Available
Form Form #1 Semi-structured interview	Form and Instruction	New	Available
Supporting Statement Part B -- Assessing the Impact of the TeamSTEPPS Training 4-30-2010.docx	Supporting Statement B	Uploaded 2010-07-09	Available
Attachment A -- Healthcare Research and Quality Act of 1999.pdf	Supplementary Document	Uploaded 2010-07-09	Available
ATTACHMENT B--Logic Model of Post-TeamSTEPPS Master Training Patient Safety Activities and Outcomes by Participant Role.docx	Supplementary Document	Uploaded 2010-07-09	Available
ATTACHMENT D -- Advance notice, invitation, reminder notices, and thank you letters for training participant questionnaire.docx	Supplementary Document	Uploaded 2010-07-09	Available
ATTACHMENT F -- AHRQ NITS Informed Consent Form.docx	Supplementary Document	Uploaded 2010-07-09	Available
Supporting Statement Part A -- Assessing the Impact of the TeamSTEPPS Training 4-30-2010.docx	Supporting Statement A	Uploaded 2010-07-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
193967	Training participant questionnaire	Form and Instruction	New
193966	Semi-structured interview	Form and Instruction	New

ICR Details

OMB Control No: 0935-0170	ICR Reference No: 201007-0935-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Assessing the Impact of the National Implementation of TeamSTEPPS Master Training Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/04/2010
	Date Received in OIRA: 07/28/2010
Terms of Clearance: OMB approves this package, consistent with the limitations outlined in Supporting Statement B.1.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2013	12 Months From Approved
Responses	2,481	0	0
Time Burden (Hours)	881	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Implementation of TeamSTEPPS program represents a new approach to team training for AHRQ. This program focused on disseminating teamwork, communication, and patient safety information, building skill sets, and ultimately fostering a national network of individuals who support and promote the adoption of TeamSTEPPS. To meet the objective of creating a national infrastructure, AHRQ first required that each organization's application include a readiness assessment and a letter of endorsement and support from each team member's Chief Executive Officer (CEO) or equivalent regarding the organization's participation in the program. In addition, participants were selected, in part, on the expectation that they would later disseminate their newly acquired knowledge and skills to others in their home organizations or in other organizations locally, regionally, or state-wide. The program involved training teams of participants, led by representatives from either Quality Improvement Organizations (QIOs) or members of individual hospitals or healthcare systems. As a result of the time and commitment invested over the three years of program implementation, AHRQ seeks to learn the extent to which they have succeeded in spreading TeamSTEPPS and forming the requisite infrastructure to support on-going and future patient safety efforts.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 23269	05/03/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 38107	07/01/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Semi-structured interview	Form #1	Semi-structured interview guide
Training participant questionnaire	Form #1	Training participant questionnaire

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,481	0	0	2,481	0	0
Annual Time Burden (Hours)	881	0	0	881	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This information collection request is for a new data collection.

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Annual Cost to Federal Government: $181,521

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/28/2010

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