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Eighty to 90 percent of medical center leaders at Private Diagnostic Clinic (PDC), a multispecialty physician practice affiliated with Duke Health, reported fewer communications breakdowns and better handling of disagreements after using AHRQ’s TeamSTEPPS^® team training curriculum. As a result, leaders have embedded TeamSTEPPS into PDC’s new performance improvement system and into patient experience quality improvement efforts.

PDC is the independent multispecialty practice within Duke Health, a Durham, North Carolina-based academic health system. It comprises 1,850 physician members and 2,300 advanced practice providers across more than 140 sites, mostly in central and eastern North Carolina.

For years, PDC had used several internal surveys to measure how employees perceived the safety culture in the workplace. The scores were consistently good, but in early 2017, they started to slip—not badly, but enough to cause concern. At the same time, Sanne Holbrook Henninger, Ed.D., PDC’s Director of Patient Experience, observed that the practice lacked a formal teamwork model to support a safety culture or assist teams in distress. She turned to TeamSTEPPS, the evidence-based program developed by ����APPand the Department of Defense.

“We wanted a formal way to provide an evidenced-based teamwork training for all of our leadership and staff across our entity, and we needed to have it specific to ambulatory care,” Dr. Henninger says. “With a mental health background of 22 years, I have spent much of my career building teams and equipping leaders to manage staff conflict, but it wasn’t with an organized structure that could easily be taught or applied to various team problems or improvement initiatives. TeamSTEPPS is evidenced-based with national success and so well organized, and we were able to add our own pieces to tailor it to our needs.”

Over the course of a year, Dr. Henninger led site-specific TeamSTEPPS training sessions. At each site, she trained four leaders: the lead physician, the clinic manager, the nurse manager, and the office staff supervisor. She trained nearly 400 clinician and staff leaders on the curriculum’s core concepts of teamwork, communication, and conflict resolution. They, in turn, trained their onsite constituents (with physician leaders training physicians, nurse leaders training nurses, and so on) to ensure clinic-wide buy-in and learning.

Dr. Henninger started with TeamSTEPPS for Office-Based Care, then supplemented it with support materials such as PDC-specific handouts and a “tip of the month” at the system’s monthly managers’ meeting. She also embedded the learning into PDC’s new performance improvement system and into patient experience efforts. The effort had three goals:

1. To provide clinicians and staff with tools for improving communication with each other.
2. To teach leaders how to assess their clinics’ needs.
3. To advise leaders how to select and apply TeamSTEPPS tools to strengthen a safety culture.

The process went smoothly. “Thankfully, we didn’t encounter resistance because our senior leadership team was on board, and leaders were already in need of teamwork solutions,” Dr. Henninger recalls. “Time and scheduling for physician leaders was, of course, a barrier because they’re very busy. The training took a couple of months longer than we might have liked—but we were able to train others on site earlier and start doing great work right away.”

By internal measures, it worked. Across the system, 80 percent of leaders reported fewer breakdowns in communication, 90 percent felt better equipped to manage disagreements, and 84 percent reported that disagreements were handled appropriately. More than 80 percent of staff said that it was not difficult to speak up about a perceived problem with safety after going through TeamSTEPPS.

Beyond the measured improvements in teamwork, Dr. Henninger says an unexpected benefit is the renewed sense of systemwide camaraderie. “Now that we have a framework for solving internal issues, we have developed a network in which medical directors and facility leaders can consult with each other or they know they can reach out to me,” she says. “To give our people at our clinics someone they can call if they run into an issue, that’s really powerful for them.”