In 2007, system senior leadership determined that team training was needed to enhance teamwork and communication across the health system, and TeamSTEPPS was identified as a solution to create transformational change by fostering a culture of safety. Northwell became an early adopter of TeamSTEPPS with training and implementation beginning in the pilot hospital. In 2008, Northwell Health senior leadership decided to implement Team STEPPS systemwide and allocated resources. TeamSTEPPS has been implemented in all Northwell hospitals, long-term care facilities and ambulatory settings. To sustain TeamSTEPPS, the health system embedded it into its organizational matrix and professional practice model. TeamSTEPPS was viewed as a way to operationalize Northwell’s values of collaboration, leadership and safety.


  • Northwell Health is New York’s largest private employer and health care provider, with 21 hospitals and about 900 outpatient facilities.
  • There are more than 12,000 credentialed physicians, including about 5,400 employed doctors and nearly 4,500 members of Northwell Health Physician Partners.
  • There are about 19,000 nurses and more than 5,600 volunteers.

Approach & Goals

  • Building a sustainable culture of safety as the foundation for the organization to guide daily practice, optimizing teamwork and ongoing engagement of the health care team.
  • Creating a culture committed to a zero tolerance for errors.
  • Creating an empowering environment to speak up and influence actions to facilitate safety.

Actions Taken

  • A corporate-level team with expertise in research and evidence-based practice, education and process improvement was formed to lead the TeamSTEPPS implementation.
  • One of the system community hospitals volunteered to be the pilot site for TeamSTEPPS. The corporate team partnered with the executive leadership of the pilot hospital to plan training, implementation and sustainment, and to customize our Collaborative Care Council (CCC) infrastructure to function as change teams at the unit/ department level. This infrastructure would remain in place permanently. The Hospital Survey on Patient Safety Culture (HSOPSC) was administered to the hospital staff prior to training to assess the staff perception of the organization’s culture of safety and to serve as a baseline for future measurement of culture change post-TeamSTEPPS implementation.
  • The training approach include the following: a two-day TeamSTEPPS Master Training course for all hospital leadership and for those chosen to train the staff; a four-hour Fundamentals course for clinical staff providing direct patient care; and a two-hour Essentials course for all nonclinical staff. The trainings were interdisciplinary, which included physicians who were employed by the hospital. Training the attendings and the voluntary staff needed more flexibility and creativity, so were done at dinner meetings, grand rounds, etc. Unit/department teams were trained together by Master Trainers from the units/departments. Storytelling was a methodology used to create a shared mental model with the teams.
  • A timeline for rapid, systematic and structured implementation across the health system was developed. The training approach, CCC infrastructure, implementation and sustainment process from the pilot hospital were standardized and spread. The HSOPSC was administered to all sites prior to training and implementation.

Positive Outcomes

  • The rollout was completed at the pilot hospital in 2008. When the HSOPSC was repeated in 2013, they were above the national benchmark in 11 out of 12 domains. Recently in 2022, HSOPSC was repeated at the pilot hospital and they were above the national benchmark in all domains.
  • Systemwide safety culture survey results have shown significant improvement in multiple dimensions over the years. Not only did Northwell create a culture of safety, but it also has sustained TeamSTEPPS for more than 15 years. TeamSTEPPS is “routinized” or part of the system’s DNA; it is how we practice and do business.


  • Establish a permanent structure for change and sustainment.
  • Standardize the implementation process.
  • Train everyone, including leaders and managers, so they can be coaches to staff once roll-out is complete.
  • Ensure that trainings are interprofessional and teams attend together whenever possible.
  • To sustain TeamSTEPPS, it should be anchored into multiple aspects of the organization (e.g., orientation, policies, simulation, etc.).