Timothy Clapper PhD Articles on TeamSTEPPS Communication Training Opportunities for Medical Simulation Programs

dr timothy clapper

Just received an email from my good friend Timothy Clapper, PhD regarding yet ANOTHER great article he has produced regarding TeamSTEPPS communication practices with regards to healthcare simulation. TeamSTEPPS was developed by the Agency for Healthcare Research and Quality utilizing CRM communication models from the space and aviation industry. Timothy’s work continues to innovate within our community, helping simulation champions better recognize and utilize simulation as a medium for revolutionary change within healthcare.

TeamSTEPPS is a teamwork system designed for health care professionals that is:

  • A powerful solution to improving patient safety within your organization. An evidence-based teamwork system to improve communication and teamwork skills among health care professionals.
  • A source for ready-to-use materials and a training curriculum to successfully integrate teamwork principles into all areas of your health care system.
  • Scientifically rooted in more than 20 years of research and lessons from the application of teamwork principles.
  • Developed by Department of Defense’s Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality.

TeamSTEPPS provides higher quality, safer patient care by:

  • Producing highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes for patients.
  • Increasing team awareness and clarifying team roles and responsibilities.
  • Resolving conflicts and improving information sharing.
  • Eliminating barriers to quality and safety.

Timothy’s Letter and Article Links:

Dear Lance & HealtySimulation.com Readers,

Just an update on my latest article for TeamSTEPPS. You may recall that my first article described TeamSTEPPS and the need for this tool to improve patient safety. I am happy to share that this article is still at #25 on ScienceDirect’s top 25 articles!

This was followed by a second article that outlined some reasons why TeamSTEPPS programs fail and ways to work through those issues. My latest one, just released, focuses on next steps in TeamSTEPPS, including the observation that must be done to assess additional simulation training needs.

Clapper, T. C., & Kong, M. (2012). TeamSTEPPS: The patient safety tool that needs to be implemented. Clinical Simulation in Nursing, 8(8), e367-e373. doi:10.1016/j.ecns.2011.03.002

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Clapper, T. C., & Ng, G. M. (2013). Why your TeamSTEPPS program may not be working. Clinical Simulation in Nursing,9(8), e287-e292. doi:10.1016/j.ecns.2012.03.007

Clapper, T. C. (2014, in press). Next steps in TeamSTEPPS®: Creating a just culture with observation and simulation. Simulation & Gaming. doi:10.1177/1046878114543638



Timothy C. Clapper, PhD

TeamSTEPPS Master Trainer and American College of Surgeons Advanced Trauma Life Support (ATLS) Educator
Editor, Healthcare Section, Simulation & Gaming (S&G): An International Journal of Theory, Practice and Research
Public Member, Accreditation Council for Graduate Medical Education (ACGME) Review Committee for Anesthesiology
Adjunct Professor & Sr. Instructor, Graduate Instructional Technology Certificate Program University of Colorado at Colorado Springs, College of Education
Dissertation Chair Grand Canyon University, College of Doctoral Studies
Simulation and Education Consultant – TC Curriculum & Instructional Design, LLC

If you are interested in learning about TeamSTEPPS and how it can be used by not only your healthcare staff, but simulation team staff as well, check out the Laerdal sponsored SimGHOSTS 2013 Opening Keynote address provided by Dr. Timothy Clapper, which is permanently available for free on SimGHOSTS.org thanks to Laerdal!

Also, connect with Timothy through his website TC Curriculum & Instructional Design

Medical Student Speaks Up and Saves a Life — But Not Without Persistence

medical errors

Recently read this article on KevinMD.com about a 3rd year medical student risking his ego and speaking up for a patient he felt was in danger. While this story had a happy ending, you can see how much internal struggle Andrew goes through to request and then finally demand help. With an average of 1,000 patients dying a day due to medical error we have continue to ask why new medical and healthcare professionals are being trained into a system that has serious consequences for “wasting staff time” against saving patient’s lives.

Consider this story from 3rd Year Medical Student Andrew Ho:

As a third-year medical student, we are considered to be the bottom of the totem pole in the hospital. After spending the first two years studying for our Step 1 boards, the only clinical medicine we know comes from what we have read and heard about in books and lectures. Our questions are frequently met with laughter or are berated for lacking common sense. And in the fast paced world of the ED, nobody has time to answer stupid questions. “His nurse probably knew he had a head laceration,” I reasoned . “There’s no need to alert anybody. He’s not even my patient. The ED staff is more than capable of handling this.”

A minute passed. And then another. Nobody came by to see this patient, who continued to bleed. I hesitated against speaking up, since we were in the middle of a trauma. But I couldn’t wait any longer. I asked an ED nurse if he was her patient. “No,” she said before hurrying off. I told another nurse that a man was actively bleeding and he said, “Go get his nurse!” After a few more failed attempts, I had had enough and pulled aside my resident. “I think this man has been bleeding profusely for some time. What should we do?” His eyes widened as he saw the amount of blood that had soaked into the sheets. He reached for a pair of gloves and told me, “Get a suture kit, now!”

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I hurried off to the supply closet and came back with a bunch of supplies. The patient was now writhing in pain as we dug around with our fingers inside his wound, trying to locate the bleeding vessel. We liberally injected lidocaine before exploring deeper with pickups and clamps. I tried to dab away the blood so that we could see into the laceration, but blood instantly filled the cavity. We couldn’t localize the source of the bleeding and our attempts to blindly clamp the vessel were met with frustration. Anytime we thought we stopped the bleeding, blood would spontaneously squirt out, like water spewing from a compressed hose. When the blood splashed up against our glasses, my resident and I looked at each other and knew we needed more help.

We wheeled the stretcher out of the back corner and into the trauma bay where we applied Yankauer suction into the wound. This helped us visualize the lacerated artery quickly. We clamped the vessel to stop the bleeding and tied it off with sutures. Given the amount of time he went unnoticed, we estimated that that patient’s estimated blood loss was anywhere from 500-1000 mL and gave him IV fluids to help replenish his intravascular volume. When the chaos had settled, a very surprised ED attending entered the bay. “He was playing on his cell phone just a few minutes ago!” she exclaimed. She thanked us for our work and my resident commended me with a quickly muttered, “Good job.”

A quickly muttered “good job” and no department follow-up or debrief? This was one time a medical student stood up but what about the next time his counter-part remains silent? Check out yesterday’s story on how “silence kills” in healthcare and learn about a book called “Beyond the Checklist” that shows us how we can fix this systemic problem.

Read the full story on KevinMD.com

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Silence Kills: Can Technology Drive Meaningful Cultural Change In Healthcare?

technology in healthcare communication

CEO of X Tech Ventures Robert Szczerba has posted another great article connecting the future of healthcare and technology. In this LinkedIn post he reminds us that an AACN report entitled ‘Silence Kills’ reported that out of 1700 healthcare professionals “84 percent of doctors observed colleagues who took dangerous shortcuts when caring for patients and 88 percent worked with people who showed poor clinical judgment. Despite the risks to patients, less than 10 percent of physicians, nurses, and other clinical staff directly confronted their colleagues about their concerns.” Robert continues to explore this gap in healthcare communication:

In the years following this study, there has been a strong movement by a number of companies to develop improved communication and patient safety tools. However, the 2010 follow-up study The Silent Treatment concluded, “that while safety tools are one part of the solution to improving patient care, they do not compensate for crucial conversation failures in the hospital. Silence still kills.

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A common perception in the healthcare industry is that the underlying cultural environment limits technological advances in safety and efficiency. Following this logic, no significant advances can be made until major cultural changes occur. However, what if technology was not necessarily limited by culture, but, if applied correctly, could actually be used to drive a desired cultural change?

Read the full article entitled “Silence Kills: Can Technology Drive Meaningful Cultural Change in Healthcare” on LinkedIn

July 22: Free Webinar on Improving Debriefings From International Pediatric Society for Simulation


Using Learning Theory to Improve Debriefings

Presenter: David Rodgers, EdD, NREMT -P

22 July, 2014 – 12:00 GMT

About the Presenter

David Rodgers is the manager of the Clinical Simulation Center at the Penn State Hershey Medical Center in Hershey, Pennsylvania, USA. Dr. Rodgers earned his doctorate in Curriculum & Instruction and his Master’s Degree in Communications Studies from Marshall University. Clinically, he is a paramedic with experience as a flight paramedic, EMS supervisor, and manager of a hospital-based critical care transport service. Dr. Rodgers has a wide range of experience in simulation center operations and simulation educational program development. He was the founding director of a large teaching-hospital based simulation center, helped expand the capabilities of an established pediatric simulation center, and operated his own simulation education consulting company serving a wide range of clients.

Description of Webinar

This webinar will review several aspects of modern learning theory as it relates to simulation debriefings. Included will be discussions and examples of how the tenets of adult learning theory and brain-based learning theory can be applied to the debriefing.

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At the conclusion of this workshop, participants will be able to:
1. List three interactive elements of brain-based learning theory
2. Describe how these brain-based learning theory elements can be applied to improve simulation debriefings
3. Describe how adult learning theory impacts the debriefing

About our Webinar Series

The IPSS webinars are presented every 4-6 weeks for the benefit of members of the International Pediatric Simulation Society. The goal of the webinar series is to promote learning, community and advancement of Pediatric Simulation.

A wide range of topics related to Pediatric Simulation are presented during the webinars. Core topics include: Education, Curriculum, Research, Technology, International Simulation, and Program Development.

The format for each webinar is a 20-30 minute didactic session, followed by a 20-30 minute discussion.
Start times vary to optimize international participation across the globe.

Learn more and sign up by visiting the IPSS Webinar Page today!

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“Bedside Manners” Play DVD and Workbook Help Demo & Teach Healthcare Communication Issues

I’m really excited to let you know that the play Bedside Manners by award-winning journalist and author Suzanne Gordon and Actress Lisa Hayes, is out in a wonderful new version. I have watched this play and recommend it and the workbook for ALL healthcare professional educators, especially those in simulation!

bedside manners dvd

Bedside Manners is a play and workbook designed to improve effective communication between healthcare professionals. Past participants have reported that its use enhances on-going efforts to reduce medical errors and injuries and helps to improve teamwork and workplace civility. This has resulted in improved patient safety and care.

The play is performed as reader’s theater, which means the actors do not memorize their lines but read from the script.

Topical, real-life healthcare scenarios are played out in 21 scenes that run for approximately two to five minutes. Each vignette covers topics ranging from routine daily interactions, to the breakdown of communication between team members in high stress scenarios. They also include examples of excellent teamwork and communication.

Every situation portrayed in the play is based on actual events that highlight both successful and frustratingly poor communication practices.

The best way to perform the play is to recruit members of your facility, students, or participants at a conference to act in the play. Using a combination of professional actors and staff, students, or participants is also an excellent way to present the play. The play can be presented between a half hour and sixty minutes. It is useful to follow up with a discussion or workshop, using the powerpoint provided in the teaching package or suggestions and exercises in the Bedside Manners workbook. The teaching package also contains extra scenes that include many different healthcare professionals.

When performed by professional actors, only 3 to 4 are needed. The play can also be cast with members of your staff. Using a combination of professional actors and staff is the best way to present the play. The play can be presented in less than 60 minutes.

beside manners workbook

Each character expresses the point of view and experiences of healthcare staff. Although the play focuses on the interaction between doctors and nurses, it can be adapted to incorporate the experiences of other healthcare professionals and staff.

Because all sides of communication issues are portrayed, audience members feel “their side” of the story has been expressed. This not only engages the audience members, but gives them the tools to help resolve complex workplace problems, resulting in improved team work, patient safely and job satisfaction.

Cornell University Press has published the play and workbook as a book in its Culture and Politics of Health Care Work series.  The workbook is co-authored by internationally renowned interprofessional education expert Scott Reeves.

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Even more exciting is the fact that they now have a video recording of the play! Thanks to a collaboration with the National Patient Safety Foundation, the play was filmed when performed for 900 people at the NPSF Congress in New Orleans in 2013. You can either purchase the DVD, or rent/purchase the film online through vimeo.

The DVD has an introduction by Patient Safety hero Lucian Leape. Acting in it are physicians, nurses, and other health care professionals. The DVD also has a segment on how it can be used as a teaching tool in educational and healthcare institutions, as well as substitute scenes that can be used for different healthcare settings.  As well, included with the dvd is a short powerpoint on Team Intelligence that can be used in post-performance discussions.

You can learn more about the multiple ways to use Bedside Manners as both a powerful tool enhance patient safety as well as teamwork and collaboration in healthcare by going to their website www.bedsidemannerstheplay.com.


Are you near the San Francisco Bay Area?

You’re invited to the world premiere screening of the play Bedside Manners and the launch of a new documentary film project “Beyond the Checklist” — March 5th at 7PM at Point Richmond.

The widely-performed play Bedside Manners dramatizes how failures in teamwork and communication cause hundreds of thousands of preventable deaths each year.

The film Beyond the Checklist will provide solutions to this tragic problem–ones that have been initiated and implemented by commercial airlines over the past 30 years to make airline travel safer than it’s ever been.

Join them for an intimate gathering at:

The Magick Lantern Theatre – 125 Park Place, Point Richmond, California
Wednesday, March 5, 2014 at 7:00PM

Film showing will be followed by Q&A with the playwright Suzanne Gordon, film-makers Ed Herzog and Bob Laird, and airline pilot Patrick Mendenhall. The panelists will be discussing their next health care-related film project, narrated by actor Peter Coyote – a documentary version of the book Beyond The Checklist: What Else Health Care Can Learn From Aviation Safety. They hope you’ll think about contributing to a documentary that offers a solution to many of the safety related problems depicted in Bedside Manners. Hosted by: Kathleen Burke, RN, patient advocate, Julia Hallisy, DDS, and former hospital administrator Gail Eierweiss. Wine and cheese will be served!

For more information about this event or to RSVP, simply reply to this email or call 510.842.5282.

For more on Bedside Manners and Beyond The Checklist, see www.bedsidemannerstheplay.com and www.beyondthechecklist.com.

What Else Healthcare Can Learn From Aviation

Beyond the Checklist

Beyond the Checklist has been reviewed as a book that “has the potential to revolutionize the structure of the healthcare system”. Watch this video highlight below to gain a better understanding about the opportunity that exists for healthcare providers to learn from the aviation industry.  All of which will have direct implications for the medical simulation community!

About “Beyond The Checklist: What Else Can Healthcare Learn From Aviation Teamwork and Safety”:

The U.S. healthcare system is now spending many millions of dollars to improve “patient safety” and “inter-professional practice.” Nevertheless, an estimated 100,000 patients still succumb to preventable medical errors or infections every year. How can health care providers reduce the terrible financial and human toll of medical errors and injuries that harm rather than heal?

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Beyond the Checklist argues that lives could be saved and patient care enhanced by adapting the relevant lessons of aviation safety and teamwork. In response to a series of human-error caused crashes, the airline industry developed the system of job training and information sharing known as Crew Resource Management (CRM). Under the new industry-wide system of CRM, pilots, flight attendants, and ground crews now communicate and cooperate in ways that have greatly reduced the hazards of commercial air travel.

The coauthors of this book sought out the aviation professionals who made this transformation possible. Beyond the Checklist gives us an inside look at CRM training and shows how airline staff interaction that once suffered from the same dysfunction that too often undermines real teamwork in health care today has dramatically improved. Drawing on the experience of doctors, nurses, medical educators, and administrators, this book demonstrates how CRM can be adapted, more widely and effectively, to health care delivery.

The authors provide case studies of three institutions that have successfully incorporated CRM-like principles into the fabric of their clinical culture by embracing practices that promote common patient safety knowledge and skills.They infuse this study with their own diverse experience and collaborative spirit: Patrick Mendenhall is a commercial airline pilot who teaches CRM; Suzanne Gordon is a nationally known health care journalist, training consultant, and speaker on issues related to nursing; and Bonnie Blair O’Connor is an ethnographer and medical educator who has spent more than two decades observing medical training and teamwork from the inside.  

Purchase Beyond the Checklist through Amazon today!

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Free ‘Infection Control Communication’ Online Learning Program

The Partnering to Heal website provides a free online based video learning system to simulate discussions regarding infection control communication, a program sponsored by the U.S. Department of Health & Human Services. Watch a demonstration of the video content below:

“This dramatization was developed by the U.S. Department of Health and Human Services in consultation with subject matter experts from various disciplines and sectors, as well as patient advocates. It is intended to increase awareness of the risks of healthcare-associated infections and the opportunities for preventing such infections.”

How the training works

The training focuses on prevention of surgical site infections, central line-associated bloodstream infections, ventilator-associated pneumonia, catheter-associated urinary tract infections, Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA). In addition, it includes information on basic protocols for universal precautions and isolation precautions to protect patients, visitors, and practitioners from the most common disease transmissions. The training promotes these key behaviors:

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  • Teamwork;
  • Communication;
  • Hand washing;
  • Vaccination against the flu;
  • Appropriate use of antibiotics; and
  • Proper insertion, maintenance, and removal of devices, such as catheters and ventilators.

Users assume the identity of characters in a computer-based video-simulation and make decisions as each of those characters. Based upon their decisions, the storyline branches to different pathways and patient outcomes. The training may be used by groups in facilitated training sessions and by individuals as a self-paced learning tool. While each of the five character segments can be done in about an hour, it may be desirable to schedule more time in order to allow for extended discussion.

Check out the “Partnering to Heal” website today to learn more about this free training program!


What can we learn from Aviation Industry Simulation?

Aviation and Healthcare Simulation

This week I had the privilege of meeting Captain Stephen Wilkinson, co-creator of Medical Management Resources here in Las Vegas.  Stephen was interested in learning more about the Clinical Simulation Center of Las Vegas and I was delighted to chat with him about the similarities between the aviation and healthcare simulation industries.

A great article about Stephen and his work can be found at the Las Vegas Sun website.

Here’s a little snippet:

“When Steve Wilkinson, a retired commercial pilot, and Dr. Steve Montoya, a Las Vegas obstetrician/gynecologist, were neighbors, they realized the similarities between their industries:

• They’re both high-risk and high-stress enterprises where the lives of many are in the hands of a highly trained few.

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• They both depend on teamwork and safety to protect passengers or patients.

• They are both complex, meaning success requires proper checklists, protocols and procedures to ensure no details are missed.

• In aviation, the belief was formerly that “the captain is always right” and above being challenged, and error reporting was nonexistent. A similar aura surrounds many physicians, and most hospitals woefully under-report cases of patient harm.”

I feel we have a lot to learn from the aviation industry which has been running communication and skills based learning through simulation for over 30 years now.  And while the situations are different, the resource management and communication tactics are the same.

Have you learned something from the simulation in the aviation industry?  Write to us and share with the community.

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