3 Followup Survey

Attachment C: TeamSTEPPS Followup Survey (DRAFT)

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

TeamSTEPPS Followup Survey

Introduction

Hello! Thank you for your participation in this survey and for your continued commitment to patient safety. The Agency for Healthcare Research and Quality (AHRQ) requests your feedback 90 days after completing a TeamSTEPPS training program to help improve the course and related offerings for future participants.

You will be asked to assess the value of the program you attended as well as the applicability of the concepts, tools, and strategies that make up the TeamSTEPPS curriculum. All information you provide will remain confidential, and data will be reported only in aggregate.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is [####-####]. This information collection is to examine the degree to which the updated TeamSTEPPS program improves the team effectiveness and streamlines team communication. The time required to complete this information collection is estimated to average less than 20 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, to review and complete the information collection. This information collection is voluntary, will remain confidential, and all data will be reported only in aggregate. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: [mailing address] or [email address], Attention: Information Collections Clearance Officer.

Should you have any questions about this survey, please contact [NAME] at [EMAIL].

29 questions | Estimated time to complete: 20 minutes

The public reporting burden for this collection of information is estimated to average 20 minutes per response. Send comments regarding this estimate or any other aspect of this survey to:

AHRQ Reports Clearance Officer

Attention: PRA, Paperwork Reduction Project (NUMBER and EXPIRATION DATE to BE PROVIDED)

AHRQ

540 Gaither Road, Room # 5036

Rockville, MD 20850

Section 1 of 5: Background and Overall Impressions

To start, please provide more details about yourself, your organization, and your participation in TeamSTEPPS training.

1. Which training did you complete?

   1. TeamSTEPPS 3.0 Training

   2. TeamSTEPPS Diagnostic Improvement Course

2. For what reason(s) did you decide to participate in this training? Select all that apply.

1. To learn more about improving teamwork in health care settings.

2. To learn more about the TeamSTEPPS approach.

3. In response to a patient safety incident or near-miss at my organization.

4. To prepare for bringing TeamSTEPPS into my organization’s education programs.

5. To prepare for bringing TeamSTEPPS into my organization’s in-service program.

6. To assist another organization with improving patient safety.

7. As part of a research project.

8. As a requirement by my organization.

9. Other: [Short answer]

3. Which of the following best describes your role in implementing the training concepts?

   1. Implementation manager or organizer

   2. Part of the change team to support implementation

   3. Other: [Short answer]

4. To what extent do you feel that the training you attended prepared you to either use or support others in using TeamSTEPPS tools and strategies?

1. Very well

2. Somewhat well

3. Somewhat poorly

4. Not at all

5. To what extent do you feel that the training you attended prepared you to provide this training to others?

   1. Very well

   2. Somewhat well

   3. Somewhat poorly

   4. Not at all

6. Which of the following best describes the status of your efforts to either implement or support others in implementing the TeamSTEPPS tools and strategies from this training? Select one.

   1. Complete [SKIP to Q8]

   2. Actively in progress [SKIP to Q8]

   3. To begin in the next 6 months [SKIP to Q8]

   4. To begin in the next year [SKIP to Q8]

   5. To begin next year or later [SKIP to Q8]

   6. Unlikely to happen.

7. For what reason(s) are you unlikely to use the TeamSTEPPS tools and strategies from this training? Select all that apply.

   1. Our team is not yet ready for TeamSTEPPS.

   2. A teamwork intervention is unlikely to address our team’s specific challenges.

   3. The TeamSTEPPS approach is unlikely to address our team’s specific challenges.

   4. We were unable to secure the necessary buy-in to implement TeamSTEPPS tools or strategies.

   5. We don’t anticipate future opportunities to support others in implementing TeamSTEPPS tools or strategies.

   6. Other: [Short answer]

[Upon completing Q7, TERMINATE survey]

8. Since completing the course, at what level(s) have you implemented TeamSTEPPS concepts, tools, or strategies? Select all that apply.

1. Entire organization/facility

2. One or more units/departments

3. My unit/department

4. None of the above

9. Since completing the course, in what way(s) have you implemented or supported others in implementing TeamSTEPPS concepts, tools, or strategies? Select all that apply.

1. Established a change team.

2. Identified the teamwork problem or opportunity for improvement.

3. Conducted a site assessment.

4. Collected data on patient safety culture using an AHRQ survey.

5. Defined the goal(s) of a TeamSTEPPS intervention.

6. Developed a formal implementation plan for the intervention.

7. Developed an action plan for the intervention.

8. Briefed leadership or key personnel about the action plan.

9. Formalized the design of the intervention.

10. Developed a plan for measuring the effectiveness of the intervention.

11. Conducted a TeamSTEPPS training for the intervention.

12. Implemented the intervention.

13. Measured the effectiveness of the intervention.

14. Developed a plan for continuous sustained improvement through the intervention.

15. Developed a communication plan for the intervention.

16. None of the above

17. Other: [Short answer]

10. Since completing the course, approximately how many people at your facility have been trained on TeamSTEPPS concepts, tools, or strategies by your change team?

1. None [SKIP to Q12]

2. 1–10

3. 11–20

4. 21–50

5. 51–100

6. 101–200

7. More than 200

8. Don’t know

11. Approximately how many health care facilities do these trainees represent?

1. None

2. 1

3. 2–5

4. 6–10

5. 11–15

6. 16–20

7. 21–25

8. More than 25

Section 2 of 5: Implementation of Tools

Please tell us more about your experience either using or helping others use TeamSTEPPS tools since completing the course.

12. How helpful was each of the following resources?

Resources	Very helpful	Somewhat helpful	Somewhat unhelpful	Not helpful at all	Not used	Don’t know
AHRQ Survey of Patient Safety Culture
[If 3.0] Readiness Assessment
[If 3.0] TeamSTEPPS Learning Benchmarks
[If DI] Team Assessment Tool for Improving Diagnosis
[If DI] TeamSTEPPS for Diagnosis Improvement Knowledge Assessment
TeamSTEPPS Teamwork Attitudes Questionnaire
Team Performance Observation Tool
TeamSTEPPS Teamwork Perceptions Questionnaire
[If 3.0] Course Management Guide
[If DI] Facilitator’s Guide
[If 3.0] TeamSTEPPS Implementation Planning Guide
[If DI] Facilitator’s Implementation Roadmap
[If DI] Participant Workbook

13. For which aspect(s) of the implementation process was each resource used?

Resource	Needs Analysis	Implementation Planning	Training	Coaching	Evaluating Impact	Other [Short answer]	Don’t know
Repeat response options from Q12 EXCEPT any selected as “N/A – Did not use” or “Don’t know”

14. In which unit or department was each resource used?

Resource	Unit or department [Short answer]	Don’t know
Repeat response options from Q12 EXCEPT any selected as “N/A – Did not use” or “Don’t know”

Section 3 of 5: Implementation of Strategies

Please tell us more about your experience either using or helping others use TeamSTEPPS strategies since completing the course.

15. How helpful was each of the following tools or strategies?

Tool/Strategy	Very helpful	Somewhat helpful	Somewhat unhelpful	Not helpful at all	Not used	Don’t know
SBAR
[If 3.0] Call-Out
[If 3.0] Check-Back
[If 3.0] Handoff
[If 3.0] I-PASS
Brief
Huddle
Debrief
STEP Mnemonic
[If 3.0] I’M SAFE Assessment
[If DI] Teach-Back
Task Assistance
Feedback
Assertive Statement
Two-Challenge Rule
CUS
DESC Script
[If 3.0] STAR
[If DI] Reflective Practice
Cross-Monitoring
TeamSTEPPS Vignettes and Scenarios
[If 3.0] Coaching

16. To what extent was this tool or strategy adopted by staff members?

Tool/Strategy	Fully adopted	Somewhat adopted	Somewhat unadopted	Fully unadopted
Repeat response options from Q15 EXCEPT any selected as “N/A – Did not use” or “Don’t know”

17. How consistently are staff members applying this tool or strategy today?

Tool/Strategy	Very consistently	Somewhat consistently	Somewhat inconsistently	Very inconsistently or never	Unsure
Repeat response options from Q15 EXCEPT any selected as “N/A – Did not use” or “Don’t know”

18. In which setting(s) was each tool or strategy used?

Tool/Strategy	Unit or department [Short answer]	Don’t know
Repeat response options from Q15 EXCEPT any selected as “N/A – Did not use” or “Don’t know”

Section 4 of 5: Catalysts and Barriers to Success

Please identify the factors that either helped or prevented the successful implementation of the TeamSTEPPS training program.

19. How important was each of the following catalysts to the success of implementing the training program?

Factor	Very important	Somewhat important	Not very important	Not important at all	Did not apply
Ample time
Ample resources
Consistent information sharing
Effective communication styles
Upper management support
Staff willingness
Dissatisfaction with current practice
Desire for improved practice
Strong coordination and followup with co-workers
Visible organizational priorities
Well-managed distribution of workloads
Continuity in personnel/team
Harmonious team dynamic

20. What other factors have helped with implementing TeamSTEPPS concepts, tools, or strategies since you completed the training? [Short answer]

21. How critical was each of the following barriers to the success of implementing the training program?
    
    

Factor	Very critical	Somewhat critical	Not very critical	Not critical at all	Does not apply
Lack of time
Lack of resources
Lack of information sharing
Poor communication styles
Upper management resistance
Staff resistance
Comfort with the status quo
Resistance to change in practice
Conflicting information
Weak coordination and followup with co-workers
Distractions or other organizational priorities
Work overload or staff fatigue
Lack of continuity in personnel/team
Lack of leadership buy-in
Strained team dynamic

22. What other factors have prevented the full implementation of TeamSTEPPS concepts, tools, or strategies since you completed the training? [Short answer]

Section 5 of 5: Outcomes

Please share more about the changes you have observed firsthand since completing the TeamSTEPPS training program and conducting subsequent implementation activities.

23. _{To what extent have you noticed} improvements in team leadership in the following situations?

	Significant improvement	Moderate improvement	Minor improvement	No change	Worsened	Don’t know	Does not apply
Patients and families/caregivers are more consistently considered part of the team.
Staff members understand their roles and responsibilities in patient care.
Staff members share a mental model of the patient’s treatment plan.
Staff members are accountable for their actions.
Staff members share patient-related information in a timely manner.
Team resources are used efficiently (e.g., staff, supplies, equipment, information).
Both clinical and nonclinical staff members understand their role in patient safety.
Leaders consider staff input when making decisions about patient care.
Leaders provide opportunities to discuss team performance after an adverse event.
Leaders ensure that adequate resources are available.

24. _{To what extent have you noticed} improvements in communication in the following situations?

	Significant improvement	Moderate improvement	Minor improvement	No change	Worsened	Don’t know
Staff members give each other feedback in positive ways that promotes growth.
Staff members advocate for the patient even when it conflicts with a senior team member’s opinion.
Staff members continue to express concerns about a patient until they’re heard.
Staff members resolve their conflicts, even if they’ve become personal.
Staff members explain information to patients and families or caregivers in lay terms.
Staff members understand how nonverbal cues play a role in their communication.
Staff members share relevant information in a timely manner.
Staff members give patients time to ask questions.
Staff members use common terminology when communicating with each other.
Staff members call out critical information during emergency situations.
Staff members follow a standardized method of sharing information when handing off patients.

25. _{To what extent have you noticed} improvements in situation monitoring in the following situations?

	Significant improvement	Moderate improvement	Minor improvement	No change	Worsened	Don’t know
Staff members continuously scan the environment for important information.
Staff members share information about potential risks to the safety and coordination of patient care.
Staff members consider one another’s physical and emotional status when communicating.
The staff meets to reevaluate patient care goals when aspects of the situation have changed.
Staff members effectively manage tasks to prevent task overload.
Staff members alert one another to potentially dangerous situations.

26. _{To what extent have you noticed} improvements in mutual support in the following situations?

	Significant improvement	Moderate improvement	Minor improvement	No change	Worsened	Don’t know
Staff members resolve conflicts easily about patient care.
The staff willingly provides task assistance with or without being asked.
Staff members ask for help when they feel overwhelmed.

27. _{To what extent have you noticed} improvements to quality care in the following situations?

	Significant improvement	Moderate improvement	Minor improvement	No Change	Worsened	Don’t know
Ability to address the Joint Commission’s patient safety requirements
Patient satisfaction
Staff satisfaction
Organizational culture
Medication error rate
Management seeing patient safety as a priority
Cross-team handoffs
Patient volume
Shift handoffs
Patients noticing teamwork between doctors and nurses
Patient flow
Patient complication rate
Infection rate
Turnover rate
Ability to evaluate the effectiveness and sustainability of the TeamSTEPPS interventions
Providers’ involvement in patient safety
Staff attributing reduced risk of medical errors to the implementation of TeamSTEPPS concepts, tools, or strategies

28. What other outcomes can you attribute to your participation in the training program or your post-training activities? [short answer]

29. Would you be willing to participate in future research efforts to understand the value of the TeamSTEPPS program?

1. Yes — I consent to being contacted by email for research purposes only.

2. No — I do not consent to future contact for research purposes.