Background

TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) is an evidence-based framework striving to optimize team performance across the healthcare delivery system. It was developed by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD) in the US. It provides tools and strategies to improve communication and teamwork skills among healthcare professionals, with the ultimate goal of enhancing patient safety.

Key Components of TeamSTEPPS

1. Team Structure:

   • This component emphasizes the importance of a clearly defined team structure. It ensures that all team members, including physicians, nurses, technicians, and other support staff, understand their roles and responsibilities.

2. Communication:

   • Effective communication is vital in healthcare to avoid errors and ensure patient safety. TeamSTEPPS promotes standardized communication tools like SBAR (Situation, Background, Assessment, Recommendation), check-backs, and call-outs to facilitate clear, concise, and timely information exchange.

3. Leadership:

   • Leadership in TeamSTEPPS involves assigning a leader who can coordinate team activities, encourage team members to share ideas and information, and facilitate decision-making processes. Leaders are responsible for ensuring that the team remains focused on the task and adapts to changing circumstances.

4. Situation Monitoring:

   • Maintaining awareness of the environment and team members' activities to ensure that potential problems are identified early is critical to successful teamwork. This involves continual assessment of the situation, resources, and the team's functioning, enabling proactive adjustments.

5. Mutual Support:

   • Mutual support emphasizes the importance of team members assisting each other to ensure tasks are completed safely and effectively. It includes providing and receiving feedback, recognizing when help is needed, and offering support to others.

Implementation Tools

• Training Modules: TeamSTEPPS offers various training modules that can be customized to meet the needs of different healthcare settings. These include interactive workshops, online courses, and simulation-based training.

• Measurement Tools: To assess the effectiveness of TeamSTEPPS implementation, the program includes tools to measure team performance, such as teamwork attitude questionnaires, observational assessments, and surveys.

• Coaching and Sustaining: Continuous improvement is critical. TeamSTEPPS encourages ongoing coaching and the use of tools like huddles and debriefs to sustain teamwork improvements over time.

Accountable Care Units (ACUs)

The ACU care model reorganizes traditional hospital units to enhance accountability, teamwork, and patient-centered care. In an ACU, the entire team — nurses, physicians, pharmacists, case managers, and other allied health professionals — work together to optimize care delivery. This structure ensures that care is consistent, efficient, and aligned with best practices. Key features include:

1. Geographic Cohorting: Physicians are co-located with their the majority of their patients within a specific unit where the same multidisciplinary team provides care. This reduces variability and increases familiarity among team members with both the unit's processes and the patients. Familiarity builds trust within the team and improves communication, leading to happier staff and patients. We are aften asked do ALL of the physician's patients need to be on the same unit, and the answer is no: if approximately 80%+ of a physician's patients are on a single unit then it is more than enough.

2. Patient Centered Care: The ACU care model places patients at the center of care and supports units to implement patient-centered care processes: (1) at the change of shift to optimize the transfer of patient information from the off-going to on-coming shift and (2) during the shift to share updates and progress the plan of care and discharge.

3. Dedicated Unit Co-Leadership: Each ACU is typically led by a unit medical director and nurse director who are responsible for the performance of the unit, ensuring that the team works cohesively towards shared goals. The medical directors can of course work on other units in the hospital, but will spend most of their work days on their ACU.

4. Performance Metrics: ACUs track and report on specific performance metrics, such as patient outcomes, safety indicators, and efficiency, fostering a culture of continuous improvement. Units report back performance to the frontline teams at regular intervals, and engage and empower unit staff in local improvement initiatives to build a sense of ownership and responsibility.

Benefits and Mutual Support

TeamSTEPPS and Accountable Care Units (ACUs) share several similarities, particularly in their focus on improving teamwork, communication, and overall patient care within healthcare settings.

1. Team-Based Care Approach:

• TeamSTEPPS: Focuses on enhancing teamwork among healthcare providers, emphasizing the importance of clear roles, effective communication, mutual support, and leadership within teams.

• ACUs & SIBR rounds: Centralize care around a dedicated, interdisciplinary team that consistently works together on a specific unit, ensuring that team members are accountable for patient outcomes and are deeply integrated into the daily workflow.

2. Standardized Communication:

• TeamSTEPPS: Advocates for standardized communication tools, such as SBAR (Situation, Background, Assessment, Recommendation), to ensure information is exchanged clearly and accurately.

• ACUs & SIBR rounds: Implement daily, structured interdisciplinary rounds where team members communicate in a standardized manner to discuss each patient's care plan, ensuring that all relevant information is shared and understood.

3. Leadership and Accountability:

• TeamSTEPPS: Emphasizes the role of leadership in guiding teams, ensuring coordination, and maintaining focus on patient safety and effective teamwork.

• ACUs & SIBR rounds: Define clear leadership roles within the unit, such as a dedicated nurse leader and a physician leader, who are accountable for the unit’s performance, fostering a culture of responsibility and continuous improvement.

4. Continuous Improvement and Feedback:

• TeamSTEPPS: Encourages the use of regular debriefs and huddles to reflect on team performance, identify areas for improvement, and reinforce best practices.

• ACUs & SIBR rounds: Focus on continuous improvement through regular feedback mechanisms during SIRs and other team interactions, allowing for ongoing adjustments to care processes and team functioning.

5. Patient-Centered Care:

• TeamSTEPPS: Aims to improve patient safety and care quality by optimizing how healthcare teams work together, which inherently centers around the patient’s needs and outcomes.

• ACUs & SIBR rounds: Organize care delivery around the patient by ensuring that the same team consistently manages their care, promoting continuity, personalized treatment plans, and better patient outcomes.

6. Interdisciplinary Collaboration:

• TeamSTEPPS: Focuses on fostering collaboration across different disciplines within healthcare teams, recognizing that effective care requires input from a diverse range of professionals.

• ACUs & SIBR rounds Physically co-locate interdisciplinary team members (e.g., physicians, nurses, pharmacists) on the same unit and integrate their work processes, enhancing collaboration and communication.

7. Focus on Measurable Outcomes:

• TeamSTEPPS: Utilizes measurement tools to assess team performance, aiming to link improvements in teamwork with better patient outcomes.

• ACUs & SIBR rounds: Track specific performance metrics related to patient care (e.g., length of stay, readmission rates, patient satisfaction) to evaluate the impact of the ACU model and make data-driven improvements. Clinical, cost, satisfaction and process metrics are monitored and discussed during weekly unit leadership meetings and with staff. Unit outcomes and progress are presented to hospital leadership quarterly to align unit-level goals with organizational priorities.

Summary

Both TeamSTEPPS and the ACU model prioritize structured, team-based approaches to care, with a strong emphasis on communication, leadership, and accountability. They share a common goal of improving patient safety and outcomes by fostering more cohesive and effective healthcare teams. The primary difference lies in their scope and implementation: TeamSTEPPS offers a broad framework applicable across various settings, while ACUs represent a more specific model of care delivery within a defined hospital unit with daily processes, leadership and governance practices to support long-term success.