(33) Impact of TeamSTEPPS on Team Performance in an Oral and Maxillofacial Surgery Practice

Abstract:

Background: Effective communication and teamwork skills among oral and maxillofacial surgery (OMS) teams are essential for quality and safe patient care. As those in the profession assert that the team model for delivering anesthesia care is integral to their history of safety, the model continues to be scrutinized by professional groups whose members seek to limit oral surgeons’ ability to provide anesthesia services in the office setting.1 Although Crew Resource Management is often referenced as a model for error prevention, there is not a team training program specific to the needs of the oral surgery team. The TeamSTEPPS Office-Based Care (OBC) program was developed to support teamwork and communication in the ambulatory setting using the evidence-based curriculum of the traditional TeamSTEPPS program to optimize patient outcomes.2 However, little is known about the effectiveness of the OBC program in the ambulatory or OMS environment.

Purpose: This quality improvement (QI) project assessed the impact of the TeamSTEPPS OBC program team dynamics in an OMS practice. In addition, the opportunities, and challenges of implementation as experienced by the participants during the 60-day implementation period were identified, providing insight into how TeamSTEPPS can be meaningfully integrated into the OMS practice setting.

Method: Practice staff and surgeons were invited to attend a full-day TeamSTEPPS OBC training session led by a TeamSTEPPS Master Trainer. Prior to the session, six members of the practice leadership formed a Change Team and completed a TeamSTEPPS training to support and coach the participants during the implementation period. Regular reinforcement materials were provided post-training to all participants. The impact of TeamSTEPPS OBC training on attitudes and perceptions of teamwork was evaluated with TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ), the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ), and a qualitative tool using a mixed methods explanatory sequential design. The data was collected following the training session and 60 days post-training. Statistical analyses were conducted using a Wilcoxon Signed Rank test with Rosenthal’s r for effect size, and thematic properties were extracted from qualitative responses.

Results: Fifteen team members (79%) and two surgeons (50%) completed the training and pre-/post-assessments. The overall post-training T-TAQ scores improved significantly (p < 0.05), and while 100% of the participants (N = 17) reported enhanced teamwork, the increase in post-training T-TPQ scores was not statistically significant (p = 0.234). Huddles were the most frequently used tool during the implementation period. Participant responses highlighted the need for leadership support, surgeon endorsement, full team participation, coaching, and frequent reinforcement activities to sustain the TeamSTEPPS OBC tools and strategies.

Conclusion: The limited evidence related to its use in the dental environment presents an opportunity to examine the impact of the TeamSTEPPS OBC program on teamwork and communication in the OMS setting. The TeamSTEPPS OBC training improved attitudes and perceptions of teamwork and communication. The project established the potential for influence within the OMS practice setting. Huddles emerged as the most frequent and beneficial strategy implemented, supporting communication, situational awareness, and mutual support. This QI project also highlighted the importance of leadership and surgeon endorsement of a change initiative. Oral and maxillofacial practices desiring to create a more collaborative dynamic among team members have access to strategies through the TeamSTEPPS OBC program.

References
1. Todd, D. W., Weber, C. R., Krishnan, D. G., & Egbert, M. A. (2021). Oral-maxillofacial surgery anesthesia team model at a crossroads safety in office-based anesthesia – Lessons we can learn from aviation. Journal of Oral and Maxillofacial Surgery, 79(9), 1812–1814. https://doi.org/10.1016/j.joms.2021.05.015
2. Agency for Healthcare Research and Quality. (2021). TeamSTEPPS for office-based care version. AHRQ. https://www.ahrq.gov/teamstepps/officebasedcare/index.html