The Human Factor (2004) shed light on the importance of teamwork and communication.7 Recommendations to reduce error included the use of the SBAR (situation, background, assessment, recommendation) tool and closed-loop communication tactics.
In 2006, the Agency for Healthcare Research and Quality (AHRQ) released Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). These insights were designed to serve as the national standard for team training in healthcare.8 Shortly after, in 2007, the Quality and Safety Education for Nurses (QSEN) Institute created the QSEN Competencies. The competencies can be applied in a multitude of settings to develop nurses with the knowledge, skills, and attitudes necessary to continuously improve the quality of healthcare.9
Each of these initiatives made evident the fact that the healthcare community had begun to respond to threats on patient safety.