Using a Quality Improvement Approach to Improve Teamwork in the Academic Environment

Nursing faculty can impact patient safety by integrating teamwork and communication into curriculum and role modeling behaviors. For some faculty, teamwork is a new concept, since the focus in academia is individual achievement rather than the collective efforts of a team. Maximizing the ability of nursing faculty to collaborate on all aspects of education, clinical practice, and scholarship in the search of developing and utilizing evidence-based approaches, is not only needed for nursing faculty to achieve their individual scholarship goals, but to enhance their ability to effectively engage with interdisciplinary team members (Mitchell, Parker, & Giles, 2011). A review of the literature revealed limited information regarding teamwork training programs that have been developed and deployed as an intervention to address incivility in the academic environment.

Northern Illinois University, School of Nursing (SON) saw this gap as an opportunity to adapt an evidence-based team training program for the academic environment. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) was developed by the U.S. Department of Defense and the U.S. Agency for Healthcare Research and Quality (AHRQ) (AHRQ, 2017). The TeamSTEPPS concepts are applicable to a variety of settings and populations and have been implemented in the clinical setting, with students in the academic setting and in interprofessional team training.

This Quality Improvement (QI) project began in October 2017 and was structured using the Plan-Do-Study-Act approach. QI differs from traditional research in that it is an iterative process and focused on a local problem with the intention to improve rather than generation of new knowledge. The process involves the identification of a performance issue and implementation of on-going, flexible, evidence-based activities to improve outcomes in a particular setting. Improvement interventions are most effective when they are modified over time in response to feedback (Langley et al, 2009).

PLAN - Plan the test of change, including a plan for measurement

• Convene a planning team
  • DNP faculty, PhD faculty, Instructors, Director of Operations, Advisors
• Analyze the audience perceptions related to teamwork
  • Team Perceptions Questionnaire
  • Team Structure, Communication, Leadership, Situation Monitoring, Mutual Support
• Capitalize on individual strengths
  • Strengths Finders Assessment
• Define the intended outcome
  • Maximize individual strengths to create a more productive team
  • Foster a willingness to cooperate, coordinate, and communicate while remaining focused on a shared goal
  • Develop common understandings of the team environment and apply appropriate strategies
  • Anticipate other team members’ needs
• Determine measurement criteria
  • 95% of SON faculty/instructors/staff will participate in an educational event
  • 95% of participants will Agree/Strongly Agree that the knowledge gained will positively impact their job
  • Perception of teamwork would increase after the educational event
• Design the educational program

DO – Execute the change

• 6 hour training session on the topic areas of:
  • Team Structure
  • Leading Teams
  • Communication
  • Situation Monitoring
  • Mutual Support
• Biweekly emails to reinforce concepts, share examples and provide resources
• Implementation of the tools and concepts in the academic environment
  • Assist in developing a “small test of change”
  • Support during implementation of “small tests of change”
• Facilitated by TeamSTEPPS^â Master Trainers

STUDY – Analyze the data and study the change

• The results of the “small test of change” as well as the post event T-TPQ and course evaluation were reviewed to determine if performance improved and to evaluate lessons learned.

ACT – Act on what is learned

• Decisions will be made as to what actions to take based on results and may include planning for the next PDSA cycle and developing a strategy for sustaining the gains.

Outcome

The outcomes we hope to achieve are a more cohesive faculty, improved perception of teamwork, retention of staff and practice changes that will improve processes and efficiency.

Conclusion

The QI approach not only provides a framework for implementation but also is a mechanism to role model teamwork since QI is inherently built on inclusion, collaboration and communication (Thomas, 2011). In last several years, many studies have focused on the relationship of teamwork to performance and there is evidence to show a positive correlation between the two variables (Schmutz & Manser, 2013). Salas et al., (2008) suggest team training interventions enhance team outcomes including; cognitive outcomes, affective outcomes, teamwork processes, and performance outcomes. The result includes individuals who are prepared to deal with the complexities of academia, healthcare and interprofessional dynamics.