Form #8 Form #8 Post-training Behavior Survey

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Improving the Safety of

Patients with Limited English Proficiency

Post-Training Behavior Survey

S1. Did you take the TeamSTEPPS training on improving safety for patients with Limited English Proficiency (LEP)?

1. ¹ Yes

² No

S2. Are you an interpreter?

2. ¹ Yes  Skip to Question 4

² No

1. What language(s) do you speak very well?

1. English

1. ¹ Yes

² No

1. Spanish

1. ¹ Yes

² No

1. Other languages (please list here) _____________________

____________________________________________________

____________________________________________________

5. About what percentage of your patients do not speak any of those languages very well?

_________ %

6. For those patients who do not speak any of those languages very well, about what percentage of your encounters have taken place in the presence of a trained interpreter since the TeamSTEPPS training on improving safety for LEP patients?

__________ %

7. What comments do you have about why you do or do not use interpreters to communicate with LEP patients whose language you do not speak very well?

Since the TeamSTEPPS training on LEP patient safety, how many times have you used the following tools with LEP patients?

8. Assertion or advocacy on behalf of an LEP patient (for example, to get an interpreter to the encounter, or to make sure the doctor or nurse explained things more clearly)

9. ¹ Never

10. ² Once

11. ³ Once to 3 times

12. ⁴ More than 5 times

6. Expressing concern or discomfort about communication involving LEP patients when there is a patient safety issue (e.g., using the CUS words: “I’m Concerned/ I’m Uncomfortable/ This is a patient Safety issue”)

6. ¹ Never

7. ² Once

8. ³ Once to 3 times

9. ⁴ More than 5 times

6. Briefs that include the interpreter (A brief is a short meeting of the care team before seeing the patient where the team leader describes team roles, goals, plans and risks).

7. ¹ Never

8. ² Once

9. ³ Once to 3 times

10. ⁴ More than 5 times

8. Creating psychological safety, for example by saying “please let me know if anything I say is not clear”. The interpreter can do this for the patient and other members of the care team can do this for the interpreter.

9. ¹ Never

10. ² Once

11. ³ Once to 3 times

12. ⁴ More than 5 times

9. Check-back with the patient (Repeating out loud what the patient said to check your understanding)

10. ¹ Never

11. ² Once

12. ³ Once to 3 times

13. ⁴ More than 5 times

The next questions focus on your experience of implementing these tools.

9. How easy is it to incorporate TeamSTEPPS tools into your daily routines?

10. ¹ Very easy

11. ² Easy

12. ³ Hard

13. ⁴ Very hard

11. 
    0. hardines? to incorporate TeamSTEPPS tools into your denting the TeamSTEPPS tools that were l and 180l powerfrequency tabulaWhat would make it easier to incorporate TeamSTEPPS tools into your daily routines?

11. What additional training would you find helpful to improve safety for patients with Limited English Proficiency (LEP)?

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