Team Effectiveness Intervention Using TeamSTEPPS in Healthcare: A Literature Review

In healthcare, effective teamwork and communication are essential. Medical errors are prevalent because there is a lack of a patient safety culture. This article's goal is to highlight TeamSTEPPS interventions that improve team effectiveness in the healthcare industry. Using Google Scholar, Science Direct, and PubMed with restrictions for the years 2018 through 2023, a review of published articles was conducted. In order to assess the efficacy of TeamSTEPPS, the six studies under consideration used a variety of instruments, including the Hospital Survey of Patient Safety Culture Questionnaire, the Short Assessment of Patient Satisfaction Scale, the Nursing Culture Assessment Tool, and the Patient's Adverse Events Questionnaire. The TeamSTEPPS program's interprofessional participants demonstrated improved coordination, cooperation


INTRODUCTION
Medical error is an error, an unexpected event that will occur, which is not desired in the provision of medical services so that it can cause injury or not cause injury to the patient.(Makary et al., 2016).According to Carver et al., (2020), the rise in medical errors that lead to death is a serious issue for the healthcare system where the most reported cases are adverse drug events, misdiagnosis, patient falls, surgical injury, and patient misidentification where the percentage of these cases often occur in the ICU (intensive care unit), and emergency department often associated with low levels of communication and teamwork.
In an attempt to improve patient safety throughout the healthcare system as a whole, a focus on root causes analysis has emerged.Medical Research Establishment (1999).King et al. (2008) performed research showing that even highly trained experts make mistakes when providing services to clients due to human limits and complicated work process systems.Therefore, health services and health policymakers work to lessen the occurrence of medical mistakes via the development of initiatives including fostering open lines of communication and mutual support among members of the health team.As reported by (King et al., 2008).
According to Nur et al., (2018), one training intervention that has proven effective in building and improving healthcare workers' communication skills is Team Stepps (Team Strategies and Tools to Enhance Performance and Patient Safety) This is a training programme for teams that was chosen because of has solid empirical foundation.The five pillars of Team Stepps-team structure, communication, leadership, situation monitoring, and mutual support-are all interconnected and work together to boost productivity, expand access to high-quality medical care, and strengthen the emphasis on patient safety.(AHRQ, 2017).
Based on several published systematic reviews from Weaver et al., (2010), McCulloch et al., (2011), and Marlow et al., (2017), there are significant benefits of training interventions in improving teamwork among health workers and communication in patient safety culture in emergency departments.This study aims to narratively summarize the literature on interventions on team effectiveness using TeamStepps (Team Strategies and Tools to Enhance Performance and Patient Safety) in healthcare.

METHOD
Using the Prisma-LvR Research Diagram as a guide, it was decided which articles could be used for this literature review by going through each stage in turn.Various journals from several academic databases, including PubMed, Science Direct, and Google Scholar, were used for database collection.By using several elimination criteria, including the publication year of the article, which was limited to the last five years, the full text's accessibility for the related article, and the representation of the title, abstract, and desired keyword matches.After going through the elimination process, 6 journals were selected to be the references for this literature review.

RESULTS AND DISCUSSION
The implementation of interventions on team effectiveness using the TeamSTEPPS method in health services was discussed in all articles reviewed related to prior research using data extraction tables.
After applying the inclusion criteria to the 501 articles found through the initial search, a total of 6 articles were chosen.
These studies aimed to do three main things: (1) describe the implementation of the TeamSTEPPS programme to improve health workers' perceptions of inter-team communication (2 articles); (2) evaluate the impact of TeamSTEPPS programme training on health services (2 articles); and (3) measure the impact of TeamSTEPPS programme training on health services (2 articles).All studies were carried out in healthcare facilities that included a variety of installation units, including hospitals, operating rooms, primary care facilities (puskesmas), and emergency rooms.Including a range of respondents from the health sector, including physicians, nurses, midwives, managers, and leaders of service divisions.
The two most prevalent health professions, medicine and nursing, as well as a number of other professionals, were successfully using TeamSTEPPS, according to a scoping review conducted by Chen et al. (2019).Because of the use of strategies and tools to enhance communication, collaboration, and perceptions of teamwork, there is now more teamwork among health professionals as a result of training in the TeamSTEPPS program.(Mohsen et al., 2021).
Despite the fact that interprofessional teams frequently deliver care together, members of these teams hardly ever receive training collectively because they frequently hail from various academic fields or scientific specialties.(O'Connor et al., 2016).There must be coordination between health professionals in order to provide patients with the care they need and protect them from the risk of medical errors, which frequently occur.(Ward et al., 2017).
The TeamSTEPPS training program, which was used in some of these studies, involved intervening from the five TeamSTEPSS program elements of team structure, communication, leadership, situation monitoring, and mutual support in order to assess the effectiveness of the team (Sheppard et al., 2013).With the help of this training program, professionals can improve the culture surrounding patient safety while strengthening teamwork and achieving shared objectives.TeamSTEPPS interventions have a significant impact and last a long time in team orientation.(Siddons et al., 2016).
The study's findings after completing the TeamSTEPPS training program and assessing the outcomes revealed that there was an improvement in the quality of performance in health services.Teamwork and communication are crucial in interprofessional health work.As an illustration, consider the installation unit for an emergency room, where professionals are required to work both independently and in teams, creating a very different environment from other installations.(Alsabri et al., 2020.As a result of this TeamSTEPPS program, communication and teamwork gaps will be lessened among emergency room staff members who will be more aware of one another.(Louise et al., 2020).
The TeamSTEPPS program's implementation in the healthcare industry was hindered by a number of factors, including the staff's lack of concentration during training, insufficient guidance from TeamSTEPPS, and altered simulation procedures.Doctors lack the leadership skills they would have acquired through their previous formal education and this lack of training results in a rigid and highly procedural attitude in how they exercise control over the team.(Clapper et al., 2013).
Because the team leader will typically be the main decision-maker in practice, the tools available for formal team training can also train interprofessional leadership development.Patient safety depends heavily on teamwork, so leadership training can explore ways to enhance team dynamics with careful discussion and guidance.(Vertino, 2014).Given that healthcare teamwork is known to lack regulated leadership standards, TeamSTEPPS training can lay a foundation for perceived communication that will improve staff performance even before the training.The TeamSTEPPS training program is therefore very helpful for reinforcing situational awareness that may not have been previously formed.(Chen et al. 2019).

LIMITATION OF THE STUDY
Despite employing rigorous search strategies and inclusion criteria, the number of identified articles may have been relatively small, restricting the breadth and depth of the literature review.The scarcity of studies could stem from various factors.Firstly, the focus on specific databases (Google Scholar, PubMed, and Science Direct) may have inadvertently excluded relevant studies available in other databases or published in other sources.Therefore, the review's findings may not encompass the entirety of the literature on team effectiveness in healthcare service improvement using TeamSTEPPS.Despite these limitations, the review aims to provide a comprehensive analysis of the available literature within the selected databases and highlights the need for further research to address the gaps and limitations identified.By acknowledging the limited availability of relevant studies, the literature review emphasizes the current state of knowledge on team effectiveness in healthcare service improvement using TeamSTEPPS and provides valuable insights into the existing evidence base.

CONCLUSIONS AND SUGGESTIONS
This literature review article leads to the conclusion that training interventions using the TeamSTEPPS program can improve team effectiveness in healthcare, Several instruments, including the TeamSTEPPS Teamwork Perceptions and Attitudes Questionnaires, the Collaboration and Satisfaction about Care Decisions in Teams Questionnaire, and the Hospital Survey of Patient Safety Culture Questionnaire, can be used to evaluate the TeamSTEPPS programme before and after it has been implemented, the Short Assessment of Patient Satisfaction Scale, the Nursing Culture Assessment Tool and the Patient's Adverse Events Questionnaire.The outcomes of the TeamSTEPPS intervention demonstrated an improvement in teamwork in coordination, communication, and leadership development in decision-making.The author, therefore, hopes that this literature review will make policymakers in the health services more aware of the need for TeamSTEPPS training in the installation unit, particularly in the emergency department and operating room, as there is still a lack of coordination and cooperation between health workers who usually work in their respective fields.