Captain James A. Lovell Federal Health Care Center

Hospital Corpsman 1st Class Robert Trottman, a TeamSTEPPS trainer, leads a class for staff members at Lovell Federal Health Care Center. All current employees completed the training, and new employees receive it during orientation. (Photo by Mary Waterman)

One Friday afternoon, hospital Corpsman 3rd Class Hanniel Diaz, a laboratory technician in Recruit Training Command clinic USS Tranquillity on the East campus of the Lovell Federal Health Care Center, noticed a Sailor waiting for phlebotomy services looked ill. Although the Sailor had just seen the doctor, Diaz felt that something was not right.

Remembering her TeamSTEPPS training, Diaz took the Sailor’s temperature and proceeded to “CUS” to the nurse on duty, a TeamSTEPPS acronym to remind staff to notify their leadership that they are “concerned, uncomfortable and worried about safety.” 

“Even though he just had an appointment in the clinic, his internal body temperature had changed from the time he walked in the door to when I saw him in the lab waiting area,” Diaz said. “I was very concerned and felt uncomfortable sending him back to the ship. I didn’t think he would be safe in his current condition.”

USS Tranquillity staff ended up transferring the Sailor to the emergency department, where he was admitted as an inpatient, and it was discovered he had a significant heart condition. The condition had not been picked up in routine medical appointments. Diaz’s quick actions helped save the Sailor from major health problems.

“HM3 Diaz used one of the TeamSTEPPS initiative’s central tools focused on speaking up,” said Lt. Lanae Hickman, TeamSTEPPS team leader for Lovell FHCC.

Hickman is a nurse in the general surgery department.

“The CUS tool, like other TeamSTEPPS tools, empowers anyone on the team to voice their concerns without fear of being ignored or reprimanded. Diaz’s action shows how important this training is. She was concerned that the patient was still ill, despite having just walked out of a medical appointment, and she was right.”

TeamSTEPPS, which stands for team strategies and tools to enhance performance and patient safety, is a patient safety initiative developed by several health care organizations, including the Department of Defense (DoD) Patient Safety Program (PSP) and the Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ). The program is designed to improve the quality, safety and efficiency of health care delivered to patients by enhancing communication and mutual support between team members.

TeamSTEPPS is meant to counteract years of findings by the Joint Commission, the leading accrediting organization for hospitals, showing communication failure was the leading root cause of adverse events in hospitals in the past 10 years.

Dave Keating, a risk manager in Lovell FHCC’s Organizational Performance Improvement Department, was one of the first advocates for the implementation of TeamSTEPPS at Lovell in 2012.

“We wanted to use TeamSTEPPS at Lovell to decrease safety incidents where a lack of, or casual communication was the contributing factor, as well as increasing effective communication and teamwork,” Keating said.

Lovell FHCC’s day-long training teaches staff to overcome these communication failures by identifying the barriers to effective communication and teaching strategies to overcome those barriers.

Hickman and Keating established the program with the goals of decreasing safety incidents caused, in part, from a lack of communication,, and also increasing effective communication and teamwork throughout the facility.

“We teach staff to identify when they are uncomfortable and concerned about an issue  whether the issue is an exam room or in a conference room,” Hickman said.

Another goal of the training is to expand the thinking of employees.

“One of the big challenges of the TeamSTEPPS program was to get the staff to think beyond just the departments they work in; we want staff to think broader and think as ‘Lovell FHCC’ bringing patients the safest level of care, regardless of whether they work in the Canteen or in Surgical Services,” Hickman said. “We have to think about how what we do in our own individual departments affects our team members the next department over.”

At the beginning of 2013, Hickman and her TeamSTEPPS trainers began the arduous task of educating all 3,000 FHCC employees. The team represented all six directorates and was made up of both civilians and Sailors.

“My team is the best,” Hickman said. “Everyone was very enthusiastic about participating and leading sessions for fellow employees. This helped make the implementation of TeamSTEPPS very smooth. I really can’t say enough about the dedication and support from the trainers as well as their departments. Remember, this is a collateral duty for every single facilitator, meaning they do this in addition to their primary jobs.”

To date, more than 95 percent of FHCC staff is trained on TeamSTEPPS. Employees either received the training during new employee orientation or through day-long seminars. The training incorporates lectures, videos and team-building exercises, so that staff not only hear the material but have a chance to try out the tools in the classroom.

From Hickman and Keating’s perspective, the implementation of TeamSTEPPS has been a huge success. Not only do they hear general feedback that the training has helped improve staff communications, but they said they have also received positive reports of TeamSTEPPS in action.

“From maintenance staff voicing safety concerns to their supervisors, to nursing staff voicing concerns about personal protective equipment, we’ve already begun to see how instrumental TeamSTEPPS is to improving patient safety; and this is just the beginning,” Hickman said.