title: Deliberation Makes a Difference: Preparation Strategies for TeamSTEPPS Implementation in Small and Rural Hospitals.
abstract: Small and rural hospitals face special challenges to implement and sustain organization-wide quality improvement (QI) initiatives due to limited resources and infrastructures. We studied the implementation of TeamSTEPPS, a national QI initiative, in 14 critical access hospitals. Drawing on QI and organization development theories, we propose five strategic preparation steps for TeamSTEPPS: assess needs, reflect on the context, set goals, develop a shared understanding, and select change agents. We explore how hospitals' practices correspond to suggested best practices by analyzing qualitative data collected through quarterly interviews with key informants. We find that the level of deliberation was a key factor that differentiated hospitals' practices. Hospitals that were more deliberate in preparing for the five strategic steps were more likely to experience engagement, perceive efficacy, foresee and manage barriers, and achieve progress during implementation. We discuss potential steps that hospitals may take to better prepare for TeamSTEPPS implementation.
authors.affiliation: University of Iowa, Iowa City, IA, USA xi-zhu@uiowa.edu.
authors.forename: Xi
authors.initials: X
authors.lastname: Zhu
authors.affiliation: University of Iowa, Iowa City, IA, USA.
authors.forename: Jure
authors.initials: J
authors.lastname: Baloh
authors.affiliation: University of Iowa, Iowa City, IA, USA.
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Ward
authors.affiliation: University of Iowa, Iowa City, IA, USA.
authors.forename: Greg L
authors.initials: GL
authors.lastname: Stewart
mesh_terms: D006740:Hospital Administrators; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D020380:Needs Assessment / Q000458:organization & administration; D009936:Organizational Innovation; D017410:Practice Guidelines as Topic; D016730:Program Development; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States
keywords: TeamSTEPPS; critical access hospital; implementation process; preparation strategy; qualitative research