Date of Award

January 2022

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)


Yale University School of Nursing

First Advisor

Mary Ann Camilleri


Quality improvement, a concept implemented by Florence Nightingale in the 19th century, is now deeply embedded in United States healthcare policy from licensure to payment models (Nightingale, 1863). The culture of safety and the emphasis on process improvement is engrained in high reliability organizations, fostering an environment of collective mindfulness and collective enactment to prevent error. To achieve high quality, healthcare organizations must bridge the core competencies of communication, collaboration, and problem solving taught in pre-licensure and translate them in inter-professional practice using evidence-based approaches. Nurses and nursing leaders must be equipped with the right problem-solving tools to drive efficiency, quality improvement, conflict resolution, and collaboration needed to support a high performing organization. TeamSTEPPS® developed by the Department of Defense and the Agency for Healthcare Research and Quality, is an evidence-based curriculum, aimed at fostering teamwork and collaboration (King et al., 2008). This quality improvement initiative adopted TeamSTEPPS® and implemented a virtual, self-guided pilot training program focused on 4 modules (TRICARE Management Activity, 2008). The pilot training program was implemented across 3 inpatient units and specifically targeted clinical nursing leaders in an academic medical center. The Kirkpatrick’s model was used to evaluate knowledge-skills-attitudes gained by participants of the training program (Kirkpatrick, 1967). Each participant completed a pretest prior to completing the virtual training and an immediate and 4-to-5-week posttest. The results of the 4 multiple choice questions and 15 to 17 4-point Likert scale questions were analyzed through descriptive statistics. Of the 10 participants who completed the pretest, 4 completed the immediate posttest (40% response rate) and 5 completed the 4-to-5-week posttest (50% response rate). The findings did not demonstrate significant improvement in knowledge gained and behavior applied from the pilot training program. Results indicated future considerations to augment the curriculum to address conflict engagement. Results indicated slight improvement in learning and behavior tied to standardized methods in sharing information. The COVID-10 pandemic and a shift in organization priorities and strategy resulted in limitations around participation. As the organization and health care community ascends from the pandemic and other organizational priorities, nursing leaders will be reenergized and engaged. Future scalability includes consideration to add a simulation lab to the curriculum design and implement the training program across all adult inpatient units in the organization, promoting participation and common language across all clinical nursing leaders.


This is an Open Access Thesis.

Open Access

This Article is Open Access