mation about their patients with their teams and make sure that their teams are ready to help them. The TeamSTEPPS program helps team members commu- nicate with each other and makes every- one feel safe to speak up. An OR with- out a well-used checklist is an OR with a team that does not know what to do. A surgeon without team members who will speak up is essentially alone. A single provider cannot watch

everything all the time. Surgeons need help when performing surgery. Some- body needs to carefully give anesthe- sia, someone else needs to assist the physician and the nurses need to watch the whole room. The surgery team needs to work together and talk to each other. TeamSTEPPS teaches staff to speak up, provide them with the lan- guage to be heard and communicate more efficiently and effectively.

Fortunately, for our patients, most of the time things work out even when people do not communicate effec- tively. Not always, however. Some ASCs have worked hard on their communication skills and find that their staff is stable and the members of their team feel safe and respected. In other ASCs, where communication problems exist, there is often large staff turnover and unhappy staff. The TeamSTEPPS program can

work in all ASCs, small and large. It is easier to bring TeamSTEPPS to a small ASC because the staff is smaller and, therefore, more easily manage- able. The larger ASCs require a more complicated plan, but success is still possible, particularly when the sur- geon leadership and the ASC board stand behind the program.

AHRQ packaged TeamSTEPPS in a series of modules that can be used to train staff. There are trainers who can be hired or your ASC could do a train- the-trainer course at an ASCA meet- ing. There are short scripts and tools to teach your staff language to speak up, materials that address how to do a checklist more effectively and prac- tical exercises. Any ASC can use a TeamSTEPPS program that has been specially designed for them and be successful at improving the teamwork and communication in their ASC. I will share more on TeamSTEPPS during my session at ASCA 2018. Hope to see you there.

William Berry is the chief medical officer at Ariadne Labs in Boston, Massachusetts. Write him at

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