Through my studies in leadership, I focused some time on researching the value of communication and teamwork training. I completed my DNP project on teamwork and communication and its effect on the team’s perception of teamwork. This project was developed due in part to poor teamwork and communication attributes occurring in my previous ASC where I served as administration for approximately 16 years.


Over time, with turnover, I had raised up future nurses, physicians, and surgical techs. This time, I had several leaving for college at the same time. This left deficits in the number of trained staff I had working at the center. The beginning of this project began pre-COVID and still was a time that was proven difficult to find experienced staff.

This meant a lot of training on the part of my remaining staff. Our team had developed a detailed orientation and training progression that typically worked very well in taking someone with no experience to work in the various areas within the center.

I noticed that with a few of the newer hires, there were difficulties in communication with other staff that had received on-the-job training. These were staff without any previous healthcare work experience. This meant no other ASC or hospital experience. Often, at least with hospital training, there is some level of communication or teamwork training available. This got me thinking about our situation.

There was a possible near-miss scenario where two of the techs were having communication issues and not talking with one another. The tech with less experience was asked to go and get a tech with more experience during a case. Instead of this tech going 30 steps to get to the more experienced tech, she proceeded to go all the way across the 5000 square foot center to the other side to seek out another tech for assistance.

This was unacceptable as the surgical team awaiting the assistance waited a considerably longer time. What if this was an urgent matter for the surgeon or the patient? How could this have affected the patient’s outcome? What could I have done as the leader to have prevented this? And what would be adequate solutions to this matter now?

Pondering those questions brought me to the implementation of a communication and teamwork training intervention. The key word here is intervention. Had this been part of an orientation process, would these behaviors have taken place?


I found TeamSTEPPS training on the AHRQ website. It is available in the public domain. They have a full module and training program for various settings. It is a great resource for the implementation and measurement of the project. They have power points for download and offer recommendations for the process. If you do this on your own, there is no cost, except manhours. There are courses available that teach TeamSTEPPS and would provide the information needed to train the trainer.

In my research, I found that SBAR communication, huddles, and debriefings work very well and have statistical significance for improvement. These were areas that I felt would best influence the communication changes I was hoping for and bolster the perception of teamwork within the organization. I did include the physicians as they are also leaders within the team and needed to assist us in championing this project.

It was performed in a pre/post-questionnaire design. I really tried to simplify the process and focus squarely on the three interventions using Kotter’s 8-step process for change as a foundation. Change is hard and this project took energy and several man hours to implement. The good news was I had leadership buy-in and support. Without their support, the project would have been difficult to implement.


Although I had a small sample, the increases in the post-questionnaire showed statistically significant improvement overall. The team’s perception of teamwork had improved. I could see improved communication among the team. The physicians were participating in debriefings which were so invaluable to the team and team huddles were occurring daily.

Fast forward, six months later, and we still had to champion the huddles, they were the most difficult to keep implemented due to everyone being extremely busy in the mornings in prepping to begin cases.

Fast forward one year later, communication was improved and teamwork was improved. Debriefings were continued with the addition of a paper version in the event the physician had to leave immediately after surgery. Huddles were still happening 80% of the time and SBAR was happening 100% of the time.


I think this project was well worth the manhours spent with its implementation. I had planned to revisit the training at least annually. For the foundational team, it would contribute a deeper understanding and for newer team members, it would help reinforce their training from orientation.

Garner the buy-in from your leadership and governing board to implement teamwork and communication training. Most people do not have any formalized training in either and both are paramount to patient safety and patient outcomes. I have included links below to my project and to our ASC where you can find additional information and guidance.

My Thoughts

Finally, if something like this was provided to all team members as a required orientation, would this improve overall teamwork and communication and ultimately, patient safety? I aim to make teamwork and communication within ASCs a staple, just like the OSHA training and HIPAA training.

There is another offering from AHRQ, that was adopted in Florida for 2025 and that is the Patient Safety Culture Survey. This has the same premise for measuring your team’s perception of the culture within your center and provides interventions to correct deficits and bolster patient safety.

Give something like this a try in your center and let me know how it goes. I would love to hear from you. Additionally, I have two programs describing the implementation and change processes that may aid in your endeavor. Check out for more information. I do believe this will be a strong future focus as CMS begins measuring more and more of our center’s data.

Additionally, here is a link to my project for duplication:

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