Module 11

IMPLEMENTATION PLANNING
(DRAFT)

SUBSECTIONS
•
•
•

•

Implementation Overview
Key Principles
The 10 Steps of
TeamSTEPPS
Implementation
Implementation Planning
Exercise

TIME: 150 minutes
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INSTRUCTOR OVERVIEW: IMPLEMENTATION
WORKSHOP
Instructor Note: In this module, you will describe the three
phases of the TeamSTEPPS model for change and walk
participants through the 10-step TeamSTEPPS implementation
process.
The key activity within this module is the Implementation Planning
Exercise, which allows participants time to work with their
colleagues to develop their own Implementation Plan.
It is recommended that the information on pages 4-7 be used to
introduce the Implementation Planning Exercise. If time permits,
use the information provided on pages 8-21 to further describe
each of the 10 steps. Importantly, allow time for the participants to
work on their Implementation Plan and report back to the group at
the end of the allotted time.

Implementation
Planning
Slide
MODULE
TIME:
150 minutes

MATERIALS:
• TeamSTEPPS
Implementation
Guide

The Implementation module includes the content provided in the
outline below.
Content

Page #

Approx. Time

1. Introduction,
Overview, and Key
Principles

4-6

5 mins

2. The 10 Steps of
TeamSTEPPS
Implementation

7 - 21

20 mins

3. Implementation
Planning Exercise

22 - 23

125 mins

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Implementation
Planning

OBJECTIVES
SAY:
Upon completion of this module, you will be able to:
•

Describe the steps involved in implementing TeamSTEPPS; and

•

Develop a TeamSTEPPS implementation plan.

Slide

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TeamSTEPPS for Long-Term Care | Implementation Planning

IMPLEMENTATION OVERVIEW

Implementation
Planning

SAY:
A TeamSTEPPS initiative involves three continuous phases:
Phase I – Assessment; Phase II – Planning, Training, &
Implementation; and Phase III – Sustainment. TeamSTEPPS
provides guidelines, tools, and resources for completing each
phase and for gathering data needed to progress to the next
phase. Keys to success at each phase include involvement of the
right people, use of information-driven decision making, and
careful planning before acting.

Slide

Let’s review each phase.
Phase I: Assessment
• The goal of Phase I is for a nursing home (or individual unit,
department, or work area) to determine if it is ready to
undertake a TeamSTEPPS Initiative. A nursing home is ready
if it has a climate conducive to change and objective
information to support the need for a TeamSTEPPS
intervention.
Phase II: Planning, Training, and Implementation
• The goal of Phase II is for the Change Team to develop a
detailed plan for their entire TeamSTEPPS initiative. Then, the
Change Team must follow that plan to train the staff needed to
implement the TeamSTEPPS intervention.
Phase III: Sustainment
• The goal of Phase III is to sustain and spread improvements in
teamwork and in associated clinical processes resulting from
the TeamSTEPPS initiative. Specific objectives are to integrate
teamwork behaviors and tools into daily practice; monitor the
ongoing effectiveness of the TeamSTEPPS intervention;
identify opportunities for continued improvement; and spread
positive changes throughout the nursing home.
TeamSTEPPS implementation is a dynamic process. While the
information in this module will help you and your fellow change
team members begin to develop your implementation plans, you
will need to review and revise your strategy throughout the course
of your initiative.

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Implementation
Planning

KEY PRINCIPLES
SAY:

Slide

The TeamSTEPPS Implementation Guide is based on the
principle of improving resident safety and quality of care by
improving health care team processes. A team process is a series
of interdependent actions that lead toward a desired endpoint.
Examples of processes include admitting a resident, administering
a medication, and transferring a resident from one unit to another.
Improving a team process includes the following steps:
•

Identify a recurring problem or opportunity for improvement
that, if addressed, could lead to better resident safety or quality
of care. What is it specifically that you want to “fix” or improve?

•

Flowchart or map the process during which the targeted
problem or opportunity for improvement occurs. Write down
the process steps as they currently occur and identify who is
doing what, when, and with which tools.

•

Study the process to identify weak points where things could
go wrong and lead to a recurrence of the target problem or
opportunity. These weak points are called risk points.

•

Design and implement interventions aimed at eliminating or
reducing the impact of the risk points. This in turn will prevent
the targeted problem from recurring or will lead to your
targeted improvements.

•

Test the intervention to ensure that it did in fact eliminate or
reduce the target problem or resulted in your targeted
improvement.

•

If the test shows that the intervention was successful, monitor
intervention effectiveness, sustain positive process changes,
and identify opportunities for further improvement.

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IMPLEMENTATION PLANNING: 10 STEPS

Implementation
Planning

Instructor Note: The remainder of this module walks
participants through 10 steps of TeamSTEPPS implementation
planning. The slides for each step contain the template the
participants can use to record their plans. These templates are
also provided in the TeamSTEPPS Implementation Guide, which
can be found in Tab E after this instructor guide.
Slide
DO:
Provide participants the TeamSTEPPS Implementation Guide.

SAY:
Implementing TeamSTEPPS involves 10 steps. The 10 steps,
which are included in the TeamSTEPPS Implementation Guide,
are:
1.

Create a Change Team.

2.

Define the problem, challenge, or opportunity for
improvement.

3.

Define the aims of your TeamSTEPPS intervention.

4.

Design a TeamSTEPPS intervention.

5.

Develop a plan for testing the effectiveness of your
TeamSTEPPS intervention.

6.

Develop an implementation plan.

7.

Develop a plan for sustained continuous improvement.

8.

Develop a communications plan.

9.

Putting it all together – Develop an implementation plan
timeline.

10. Review your TeamSTEPPS Implementation Plan with key
personnel, and modify according to input.

Continued…
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Implementation
Planning

IMPLEMENTATION PLANNING: 10 STEPS
(Continued)

Slide
Instructor Note: If time permits, review each of the steps
with the participants. Then, facilitate the Implementation Planning
Exercise described on page 22. Allow participants to work on
their plans with their colleagues. A total of 2.5 hours has been
recommended for this module, including the planning exercise and
report-outs by participants.
If time is limited, you may advise participants that the content on
the following pages may be useful reference materials as they
work through the implementation exercise. Provide participants
with the exercise instructions found on page 22.

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DESCRIBE THE TARGETED UNIT/WORK
AREA

Implementation
Planning

SAY:
Before you begin the first step of implementation planning, think
about and describe the unit, department, or work area in which
you plan to implement TeamSTEPPS. Identify what that unit,
department, or work area looks like in terms of size and staff
composition. This information will be important in identifying an
Action Plan that is feasible within the targeted unit, department, or
work area. This information may also be useful in providing your
organizational leadership with an overview of your plan.

Slide

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Implementation
Planning

STEP 1. CREATE A CHANGE TEAM
SAY:
The objective of Step 1 is:
•

To assemble a team of leaders and staff members with the
authority, expertise, credibility, and motivation necessary to
drive a successful TeamSTEPPS initiative.

Slide
Key actions for Step 1 include:
1. Select a multidisciplinary Change Team.
2. Ensure representation from different leadership levels,
including senior leadership, clinical/technical experts, and
frontline leadership.
3. Ensure that at least one or more members have completed the
TeamSTEPPS Master Trainer course.
4. If possible, ensure that at least one member has experience in
performance improvement. Relevant skills include data
collection, analysis, and presentation.

Tips for success in Step 1 include:
•

The Change Team will focus on improving processes within its
own unit, department, or work area. Choose members with
relevant clinical expertise, workplace location, credibility, and
direct involvement in the processes that will be affected by the
TeamSTEPPS intervention.

•

Ideally, all Change Team members will attend TeamSTEPPS
Master Training.

•

The optimal Change Team size is five or six individuals.

•

Where relevant, involvement of both physicians and nurses
from the unit, department, or work area is essential.

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STEP 2. DEFINE THE PROBLEM OR THE
OPPORTUNITY FOR IMPROVEMENT

Implementation
Planning

SAY:
The objective of Step 2 is:
•

To state the problem, challenge, or opportunity for
improvement that will be targeted by your TeamSTEPPS
intervention.
Slide

Key actions for Step 2 include:
1. Identify a problem, challenge, or opportunity that could be
improved with enhanced teamwork. Strategies include:
– Reviewing unit, department, or work area performance
and safety data, such as incident reports, the AHRQ
Nursing Home Survey on Patient Safety Culture, the
TeamSTEPPS Teamwork Perceptions Questionnaire for
Long-Term Care and site-specific process and outcome
measures.
– Asking frontline staff, “What bad outcomes are waiting to
happen because of breakdowns in the transfer of critical
information?” “What things keep you up at night?”
2. Identify the process during which the problem, challenge, or
opportunity occurs by stating what the process is, who is
involved, and when and where it occurs.
3. If you completed the TeamSTEPPS Implementation
Worksheet as part of the Fundamentals Course, refer to the
teamwork issue you identified in that exercise as a starting
point (see responses to Module 7: Summary questions).

Continued…

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Implementation
Planning

STEP 2. DEFINE THE PROBLEM OR THE
OPPORTUNITY FOR IMPROVEMENT (Continued)
SAY:

Slide

This slide provides an example of defining the problem or
opportunity for improvement. Here, we see that the Change
Team would like to address suboptimal communication among
nurses and dietary staff. They have further identified the what,
who, when, and where as it relates to the team process.

Tips for success in Step 2:
Change Teams may want to define three or four problems or
opportunities and then select the highest priority issue for the
TeamSTEPPS intervention.
Look for problems or opportunities that meet the following criteria:
•

The associated process occurs frequently.

•

Breakdowns in team performance could result in harm
to residents.

•

Process change is feasible and likely within the short term.

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STEP 3. DEFINE THE AIMS OF YOUR
TEAMSTEPPS INTERVENTION

Implementation
Planning

SAY:
The objective of Step 3 is:
•

To state in measurable terms what you hope to achieve with
the TeamSTEPPS intervention: what will be achieved, who will
be involved, and when and where the change will occur.

Key actions for Step 3 include:

Slide

1. Develop one to three measurable aims for your TeamSTEPPS
intervention, and state in one or two sentences what you hope
will be achieved, who will be involved, and when and where the
improvements will occur. Aims should align with your defined
teamwork problem or opportunity for improvement. Aims can be
based on the process of the TeamSTEPPS intervention itself or
on the outcomes of that intervention.
– Team process aims focus on how well or often your staff
carries out your TeamSTEPPS intervention. For example,
you may state, “Increase the use of daily huddles by 40% to
ensure proposer distribution of staff resources relative to
workload requirements. Huddles will include the unit’s
nursing staff and will be conducted using a briefing
checklist.”
– Outcome aims focus on changes that occur because your
staff carries out the intervention. These aims can be directed
changes in team performance (team outcome aims) or in
clinical results (clinical outcome aims). An example of a team
outcome aim is “Increase monitoring of residents skin
conditions by nursing staff in the unit within 6 months of
implementing TeamSTEPPS. We will use the TeamSTEPPS
Teamwork Perceptions Questionnaire for Long-Term Care
immediately after training and 6 months post-training.” An
example of a clinical outcome aim is “20 % reduction in the
number of residents experiencing pressure ulcers within 4
months of the TeamSTEPPS implementation.”
2. It is ideal (but not necessary) to have a team process aim, a
team outcome aim, and a clinical outcome aim. This becomes
particularly important when testing the effectiveness of your
TeamSTEPPS intervention.
3. Review the information you recorded on the TeamSTEPPS
Implementation Worksheet to help you identify your aims.
Continued…
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Implementation
Planning

STEP 3. DEFINE THE AIMS OF YOUR
TEAMSTEPPS INTERVENTION (Continued)
SAY:
Tips for success in Step 3 include:
•

Develop aims that specifically address the target problem
identified during Step 2.

•

Put time and thought into defining the problem and defining the
aims of your TeamSTEPPS intervention, since they are the
most important steps in Implementation Plan development. The
target problem and stated aims drive the development of all
remaining components of the Implementation Plan.

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STEP 4. DESIGN A TEAMSTEPPS
INTERVENTION

Implementation
Planning

SAY:
The objective of Step 4 is:
•

To design a TeamSTEPPS intervention that will address your
targeted problem or challenge and achieve your stated aims.

Key actions for Step 4 include:

Slide

1. Flowchart or map the process during which the target problem,
challenge, or opportunity occurs. Write down the process
steps as they currently occur and identify who is doing what,
when, with what tools, and where teamwork is required.
2. Identify risk points where things could or do go wrong and lead
to a recurrence of the problem, challenge, or opportunity.
3. Determine which TeamSTEPPS tools or strategies would work
best to eliminate the process risk points.
4. Draft your TeamSTEPPS intervention. State what tools and
strategies will be implemented; who will use them, when and
where.
– If you completed the TeamSTEPPS Implementation
Worksheet during the Fundamentals Course, refer to the
tools and strategies you identified, as well as the multiteam system to which the intervention will be targeted.
5. Evaluate your TeamSTEPPS intervention for potential benefits
and negative effects:
– Flowchart the redesigned process as you imagine it
would look with your TeamSTEPPS intervention in place.
– Identify potential failure points in the redesigned process.
How will you reduce the probability or severity of these
failures?
– Identify potential benefits and negative effects of the
redesigned process on units outside your workspace.
How will you control potential negative effects?

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Implementation
Planning

STEP 5. DEVELOP A PLAN FOR TESTING
YOUR TEAMSTEPPS INTERVENTIONS
SAY:
The objective of Step 5 is:
•

To develop a method to determine if your TeamSTEPPS
intervention achieved your aims.

Slide
Key actions for Step 5:
Ideally, you will test if your TeamSTEPPS intervention achieved
each one of the aims you generated during Step 3. If time and
resources are limited, select only one aim for testing. Base your
selection on the importance of the aim and on the feasibility of
testing it.
Testing does not need to be complicated. Basic performance
improvement trending and tracking methods generally suffice.
For each aim you select, create a testing method by performing
the following key actions:
1. Identify who on your Change Team will be responsible for data
collection, analysis, and presentation (generation of graphs
and charts).
2. Identify a measure and define target ranges for that measure.
3. Measure before and after you implement TeamSTEPPS to see
if the desired changes occurred.
Tips for success in Step 5 include:
•

Keep it simple. Select one solid measure for each aim.

•

If you use any resident data, ensure that your plan adheres to
all resident rights and privacy laws and regulations (e.g.,
HIPAA).

•

Use existing data sources whenever possible. Determine what
data your nursing home, unit, or department already collects
that you may be able to use.

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STEP 6. DEVELOP AN IMPLEMENTATION
PLAN

Implementation
Planning

SAY:
The objective of Step 6 is:
•

To develop a plan for training your staff on the TeamSTEPPS
tools and strategies you plan to implement and to develop a plan
for putting your TeamSTEPPS intervention into place.

Key actions for Step 6 include:

Slide

1. Identify your audiences and their training requirements.
2. Determine who (staff members within a targeted unit or
department) needs to be trained on what TeamSTEPPS skills
and by when.
3. Identify the instructors for each audience.
4. Develop a training plan for each audience, including:
– Who will attend the training sessions;
– What skills you will teach;

Slide

– When the training sessions will occur and for how long;
– Where the sessions will occur;
– How you will train (method of presentation, tools,
supplies); and
– Logistics such as schedules, equipment, impact of training on
other operations, additional resources required, and
notification of trainees and other key stakeholders.
5. Determine if any of your audiences will require refresher
training. If so, repeat the above actions for refresher training.
6. Create your training timelines.
7. Include time for developing your materials and managing
logistics.
8. Include initial, newcomer, and refresher training, if needed.
9. Determine whether and how coaches will be used to sustain
your implementation plan. If coaches will be used, consider:
– How many are needed;
– When and how they will be trained; and
– How they will be used, including expectations for the role.

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Implementation
Planning

STEP 7. DEVELOP A SUSTAINMENT PLAN
SAY:
The objective of Step 7 is:
•

Slide

To develop a sustainment plan for your TeamSTEPPS
intervention, including plans for ongoing assessment of the
effectiveness of the intervention and for identification of
opportunities for further improvements.

Key actions for Step 7:
The purpose of the sustainment plan is twofold: to determine if
your intervention continues to achieve your aims and to identify
opportunities for further process improvement. Designing a
sustainment plan is similar to designing a testing plan (Step 5).
The sustainment plan is often just a simplified version of the
testing plan, with fewer and less frequent measurements.
1. For your monitoring plan, determine:
– Measures and target outcomes;
– Data source or sources (e.g., existing QI database);
– Methods for data collection;
– Methods for data analysis and interpretation;
– Resources required (money, time, equipment, personnel,
expertise); and
– Persons responsible for implementation and oversight.
2. Determine how data from your monitoring plan will be used
to continually improve processes and performance.
Tips for success in Step 7 include:
•

Integrate your TeamSTEPPS intervention into existing
processes for long-term sustainment. Make it part of your
unit’s normal daily routines.

•

Publicize your successes. Examples include visibly displaying
large wall charts in your workspace showing positive
performance trends; writing articles in local publications and
journals; and giving presentations on your results at staff
meetings.

•

Develop standardized procedures for integrating newly
acquired staff.

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STEP 8. DEVELOP A COMMUNICATIONS
PLAN

Implementation
Planning

SAY:
The objective of Step 8 is:
•

To create a communications plan targeting major stakeholders
that will generate initial and ongoing support for the
TeamSTEPPS initiative and promote the maintenance and
spread of positive changes.

Slide

Key actions for Step 8 include:
1. Identify your stakeholders:
– Whose support will be important for achieving the aims of
your intervention and for maintaining positive changes?
– Consider organization leaders, medical director,
frontline leaders, staff directly involved in the
intervention, residents, support staff, and other units,
departments, or work areas affected by the
intervention.
2. For each of your identified stakeholder groups, develop a
communications plan, including:
– Goals for communication with this group. What do you
want to achieve?
– Who will receive the information?
– What information will you communicate?
– When and how often will you communicate?
– How will you communicate (e.g., reports, presentations,
e-mails)?
3. Identify a person on the Change Team who will be responsible
for implementation and oversight of the communications plan.
Tips for success in Step 8 include:
•

Stay focused on your goals for communication with each
stakeholder group. Keep asking, “What do I hope to
accomplish for the initiative (e.g., buy-in, resources,
participation) by communicating with this group?” The goals
will drive the development of your communications plan.

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Implementation
Planning

STEP 9. DEVELOP A TEAMSTEPPS
IMPLEMENTATION PLAN TIMELINE
SAY:
The objective of Step 9 is:
•

To generate a written Implementation Plan, based on Steps 1
through 8, that will function as your “How-To Guide” for every
component of your TeamSTEPPS initiative.

Slide
Key actions for Step 9:
If you completed each of the worksheets for Steps 1 through 8,
you have already written your TeamSTEPPS Implementation
Plan. Ensure that your final Implementation Plan includes all of
the following elements:
1. Identification of the Change Team

Slide

2. Identification of the problem, challenge, or opportunity for
improvement that will be the focus of the TeamSTEPPS
initiative
3. Stated aims of the TeamSTEPPS intervention
4. Detailed description of the TeamSTEPPS intervention
5. A plan for testing the effectiveness of the TeamSTEPPS
intervention
6. An implementation plan for both staff team training and for the
TeamSTEPPS intervention
7. A monitoring plan for ongoing assessment of the
effectiveness of the TeamSTEPPS intervention
8. A communications plan to generate support for the
TeamSTEPPS initiative, to keep major stakeholders informed
of progress, and to maintain and spread positive changes
9. Timelines
10. Resources required

Tips for success in Step 9 include:
•

Save your original 10-step worksheets. They may contain
information and ideas you might want later.

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STEP 10. REVIEW YOUR PLAN WITH KEY
STAKEHOLDERS

Implementation
Planning

SAY:
The objective of Step 10 is:
•

To generate support and elicit ideas from major stakeholders,
and to identify barriers to program implementation.
Slide

Key actions for Step 10 include:
1. Identify stakeholders who could contribute significantly to the
Implementation Plan. Consider nursing home leaders,
frontline leaders, persons directly involved in the intervention,
and personnel with special expertise such as facility data
analysts.
2. Ask key stakeholders to review your Implementation Plan and
to provide input. Specifically request that they identify any
potential problem areas and offer solutions.
3. Modify your Implementation Plan based on their input, if
needed.
Tips for success in Step 10 include:
•

You may want to ask some stakeholders to review only certain
sections of the Implementation Plan.

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Implementation
Planning

EXERCISE: IMPLEMENTATION PLANNING
Instructor Note: If, due to time, you did not review each of
the steps on the prior slides with the participants, you may wish to
briefly orient them to the TeamSTEPPS Implementation Guide,
which is provided in Tab E, after this instructor guide. As noted
previously, you may want to advise participants to reference the
information on the prior pages as they work through the exercise.

Slide

TIME:
2 hours
MATERIALS:
•

TeamSTEPPS
Implementation
Guide

Note that the timing of this exercise is flexible. That is, you may
wish to increase the time that participants have to work on
planning and select a few teams to provide very brief report-outs
on their progress when you reconvene the group.
SAY:
Your TeamSTEPPS Implementation Guide will walk you through
the 10 steps. For some of the steps, you may want to reference
the TeamSTEPPS Implementation Worksheet you completed
during the Fundamentals course, on which you began to think
about the teams affected by your teamwork issue and specific
TeamSTEPPS tools and strategies to implement to address the
issue.
You will have 1½ hours to work with your colleagues on your own
TeamSTEPPS Implementation Plan. This is your time to begin to
think through your plan so that you have a starting framework
when you return to your nursing home.
At the end of this exercise, we will reconvene as a group and you
will be asked to present what you and your team have
accomplished.

Instructor Note: If space permits, allow teams to move to
separate breakout rooms or other areas where they can talk
through their problems and think together.
If any individual participants are not attending with a team, ask
about their implementation plans and try to identify some
characteristic (e.g., type of teamwork issue, work area targeted for
implementation, intended facility wide implementation) that allows
you to match each individual with an existing team of participants.
The individual matched with a team will be able to gather thoughts
from the exercise that can be generalized to their own plans, and
the teams may benefit from the inclusion of a different perspective.
Continued…
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EXERCISE: IMPLEMENTATION PLANNING
(Continued)

Implementation
Planning
Slide

Instructor Note: It is strongly recommended that individuals
who are knowledgeable about implementation are available during
this exercise to walk around and spend time with each team as
they work. Participants appreciate any guidance and assistance
received during this exercise.

DO:
• After the participants have gotten started, circulate among the
groups. Spend some time listening to each group’s discussion
and ask questions that will help them think through their plan.
• Be mindful of the time so that you can reconvene the entire
group and ask participants to report on their plans. Allow
others to ask questions.

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