Reducing System Barriers Within the Public Health Nurse and Licensed Alcohol Drug Counselor Collaborative: An Evidence-based Quality Improvement Project

Background: Interprofessional barriers negatively impacted the delivery of coordinated services and quality of care in a public health nurse (PHN) and licensed alcohol drug counselor (LADC) Collaborative serving chemically dependent pregnant women in a rural county of Minnesota. The aim of this quality improvement (QI) project was to reduce collaboration barriers for the PHN and LADC Collaborative through implementation of the Agency for Healthcare Research and Quality (AHRQ) TeamSTEPPS team-training program and communication tools. Methods:The project site was a community health Collaborative proving chemical dependency services to pregnant women. Three primary methods of measuring improvement included: TeamSTEPPS�(R) Teamwork Perceptions Questionnaire (T-TPQ), TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ), and Team Collaboration Assessment (TCA) worksheets were used to measure participant perception of barriers to collaboration. After implementation of the intervention, an additional measure was added to the TCA to assess the intervention. The Plan-Do-Study-Act quality improvement methodology was used to study the impact of the intervention on the outcome measures. Intervention: The intervention implemented to address barriers to collaboration included TeamSTEPPS training about optimal teamwork and communication tools, the SBAR and STEP. After the training, PHNs and LADCs were instructed to use one or both intervention communication tools, SBAR and STEP, for each episode of client care. Results: Baseline data collected on the pre-implementation TCA worksheets, indicated that the top three barriers to collaboration included gaps in communication between the PHN and LADC, lack of clarity about team leadership roles and responsibilities, and gaps in communication related to data sharing. The results of the improvement project indicate a reduction in the perception of barriers to collaboration that showed the potential for sustained improvement overtime. Findings from the, the TeamSTEPPS T-TAQ questionnaires showed statistically significant improvement in participants attitudes related to the construct of Team Structure. Conclusions: The results of this QI project show the benefit of implementing evidence-based TeamSTEPPS team-training and the SBAR and STEP tools within a community health interprofessional collaborative. The interventions reduced participant perception of barriers to collaboration and improved team collaboration, coordination of care, interprofessional communication and leadership role clarity.