title: Medical team training and coaching in the Veterans Health Administration; assessment and impact on the first 32 facilities in the programme.
abstract: BACKGROUND
  Communication is problematic in healthcare. The Veterans Health Administration is implementing Medical Team Training. The authors describe results of the first 32 of 130 sites to undergo the programme. This report is unique; it provides aggregate results of a crew resource-management programme for numerous facilities.
  
  
  METHODS
  Facilities were taught medical team training and implemented briefings, debriefings and other projects. The authors coached teams through consultative phone interviews over a year. Implementation teams self-reported implementation and rated programme impact: 1='no impact' and 5='significant impact.' We used logistic regression to examine implementation of briefing/debriefing.
  
  
  RESULTS
  Ninety-seven per cent of facilities implemented briefings and debriefings, and all implemented an additional project. As of the final interview, 73% of OR and 67% of ICU implementation teams self-reported and rated staff impact 4-5. Eighty-six per cent of OR and 82% of ICU implementation teams self-reported and rated patient impact 4-5. Improved teamwork was reported by 84% of OR and 75% of ICU implementation teams. Efficiency improvements were reported by 94% of OR implementation teams. Almost all facilities (97%) reported a success story or avoiding an undesirable event. Sites with lower volume were more likely to conduct briefings/debriefings in all cases for all surgical services (p=0.03).
  
  
  CONCLUSIONS
  Sites are implementing the programme with a positive impact on patients and staff, and improving teamwork, efficiency and safety. A unique feature of the programme is that implementation was facilitated through follow-up support. This may have contributed to the early success of the programme.
authors.affiliation: VAMC (11Q), 215 North Main Street, White River Junction, VT 05009, USA. Julia.neily@va.gov
authors.forename: Julia
authors.initials: J
authors.lastname: Neily
authors.forename: Peter D
authors.initials: PD
authors.lastname: Mills
authors.forename: Pamela
authors.initials: P
authors.lastname: Lee
authors.forename: Brian
authors.initials: B
authors.lastname: Carney
authors.forename: Priscilla
authors.initials: P
authors.lastname: West
authors.forename: Katherine
authors.initials: K
authors.lastname: Percarpio
authors.forename: Lisa
authors.initials: L
authors.lastname: Mazzia
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Paull
authors.forename: James P
authors.initials: JP
authors.lastname: Bagian
mesh_terms: D000328:Adult; D006268:Health Facilities / Q000592:standards; D006295:Health Resources / Q000458:organization & administration; D006801:Humans; D007318:Inservice Training; D007362:Intensive Care Units / Q000592:standards*; D007857:Leadership; D009873:Operating Rooms / Q000592:standards*; D010348:Patient Care Team / Q000592:standards*; D017064:Process Assessment, Health Care / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs