Team stripes framework

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Team Stripes is a five-stage framework that helps multidisciplinary teams identify their own safety priorities and act on them. It uses data, observation and structured team conversation to surface what to focus on next.

The framework is designed to be led by the clinical unit, not imposed from outside. Every unit has its own context, identity and culture, and the Stripes give teams a shared method to step back, look at how they work together, and agree on improvements that fit their setting.

An introduction to the framework

Build stronger teamwork and communication at the point of care.

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Learn how Hornsby Hospital Adult Mental Health Unit used Team Stripes to improve multidisciplinary teamwork and communication.

Before you start

Most Team Stripes journeys take 6 to 18 months, from engagement through to testing, embedding and sustaining improvements. The Discovery phase alone can take up to 6 weeks. Timelines may be shorter if your team has run improvement work before, or longer if the change is complex or involves several services.

Define the problem, not the solution

The real problem is often hard to pinpoint. Use local data and a literature review to focus on what to address, rather than jumping to what to do.

Examples of problems Team Stripes can help with:

  • Patients and families say they are not included in decisions about their care.
  • Care coordination is fragmented.
  • The multidisciplinary team works in silos.
  • Communication processes such as safety huddles and team rounds are not valued, or happen ad hoc, missing chances to reduce risk.
  • A serious adverse event linked to teamwork and communication.

Avoid these common pitfalls:

  • Choosing a problem the team is not interested in.
  • Jumping to a solution before investigating the cause.
  • Picking a process that is currently in transition, such as moving from a manual to an electronic system.
  • Selecting a problem outside your sphere of influence.

Engagement

Engagement is where the team commits to using Team Stripes. All improvement requires change, and change is not always welcomed. Projects can lose momentum if there is significant resistance from those most affected.

Include point-of-care staff from the start. They are the people whose work the framework will most affect.

A unit readiness assessment helps you confirm the team is ready for change, surface current concerns about communication or safety, and plan how to address resistance.

Engaging leadership early

Improvement work begins after Discovery, but you need executive leadership support in place before that. Executive support gives the project organisational backing and aligns it with the values and priorities of your service, your local health district and NSW Health.

Communicate the change you want to address early. Each group you engage will have different needs and motivations, so tailor your approach.

Examples of engagement activities

  • Use unit and department channels such as team meetings and shift crossovers to share short, regular updates.
  • Identify nursing, medical, pharmacy and allied health champions to advocate for the work and support the team on the floor.
  • Create a visual display board or fact sheet with education, information and data about Team Stripes.
  • Add a standing agenda item or short presentation to regular meetings.
  • Use posters, lanyards and computer screensavers to keep the project visible.

Data to support your case

Work with your Clinical Governance Unit or local safety improvement lead to confirm sampling and data sources. There is also value in examining what works well, because that helps the team identify and replicate its strengths.

Examine your unit's:

  • incident data, including Serious Adverse Event Review (SAER) data
  • average length of stay
  • patient compliments and complaints
  • staff turnover and sick leave.

Stripe 1. Discovery

Discovery is where the team gathers data and analyses it together. The aim is to self-identify gaps in care and build the evidence base for the team's improvement priorities.

Collect baseline data

Use a mix of methods:

  • a safety culture measurement tool, such as the Safety Attitudes Questionnaire (SAQ)
  • patient experience surveys
  • family and carer experience surveys
  • structured clinical observations
  • staff and patient stories
  • a literature search to identify relevant evidence.

Staff and patient stories give rich insight. They help show impact during evaluation, surface unintended consequences, highlight innovation, and support quantitative data.

Working with the data

Synthesise the data into a short, accessible summary for the point-of-care team. Keep it brief enough to leave time for discussion.

Your feedback session should:

  • summarise the date the team shared through surveys and stories
  • include other relevant data such as incidents, observations and patient and carer feedback
  • leave plenty of time for a team discussion
  • end with an agreement of at least one priority area for safety improvement work.

Plan your action

Within three weeks of the feedback session, give the leadership team a written summary report to share with the clinical team.

The team is given an agreed an agreed amount of time to consider and clarify the report before action planning begins. Most reports identify more than one possible improvement area, so improvement coaching helps the team choose a single priority. Trying to change everything at once is the most tempting and least sustainable option.

Including the point-of-care team in this learning process helps them feel heard. It also builds a shared sense of purpose that underpins a resilient workforce.

Stripe 2. Coaching for teams

This stage prepares your team for autonomy in future improvement work. It introduces improvement coaching and brings your team’s attention to safety fundamentals.

Improvement coaching

Skill improvement coaching keeps teams focused and motivated to meet their aims. The coach guides the team through the rest of the Stripes and supports continuous learning beyond the project.

An improvement coach needs:

  • skills in communication and facilitation
  • knowledge of improvement science methodology and hot to apply it practically
  • experience leading their own improvement science project.

Coaches usually have additional training in this area. The best way to build coaching skills is to apply them early and often. See Safety and Quality Essentials Pathway for more information on coaching and upskilling teams.

Coaching models can help structure conversations and help people arrive at their own insights, which builds trust, surfaces strengths and opens new possibilities. Over time, the team leads its own improvement work with gentle support from the coach.

Coaching also helps the teamwork through resistance. When barriers arise, the coach helps identify them, and sometimes this means difficult conversations to resolve conflicts and restore team function.

Safety fundamentals for teams

See build and embed safety culture for safety fundamental tools to support teams in everyday practice.  If your team already applying these tools, use Stripe 2 to evaluate how they are working. Look at what is embedded, what has slipped, and what could be strengthened.

Stripe 3. Improvement priorities

This stripe guides you through starting your improvement work. ams using Team Stripes work on different priorities, so use topic-specific toolkits where relevant. For example, the last days of life toolkit or the medication reconciliation toolkit.

An improvement brief outlines your project, helps secure support and aligns the work with your health service’s priorities.

A strong brief covers:

  • the problem you are solving
  • why it matters to patients, families staff and the community
  • the data that shows the problem exists
  • how long the project will take
  • how you will achieve and sustain the improvement.

Stay in touch with your Clinical Governance Unit at every stage. They can link you with local quality improvement experts and keep your project on track. You can also reach out to colleagues at other health services to learn from their projects.

A sponsor offers guidance, helps you access resources and removes barriers. Choose someone who is:

  • senior enough for the cope of your project (for example, a nurse unit manager versus an executive director)
  • not working directly on the improvement
  • available for regular updates.

Governance gives your project a reporting line and operational accountability. Your sponsor will help you set this up at the right level.

  • For ward or unit projects: build reporting into existing huddle, team meetings, or education sessions
  • For health service, local health district or speciality health network projects: report through your clinical practice improvement unit and other relevant groups.

Governance is separate from your project team. Your project team carries out day-to-day work.

Build an interdisciplinary team with the right mix of expertise and interest. Include:

  • a team leader
  • a quality improvement advisor or expert
  • junior and senior staff from every part of the process you are changing
  • a consumer representative (or interview or survey consumers).

The team leader organises meetings, delegates tasks and acts as the voice of the project. The team’s role is to:

  • review current communication and teamwork processes, such as safety huddles and multidisciplinary team rounds
  • identify and recruit clinical champions
  • set goals
  • design, test and evaluate change ideas
  • share results and findings.

Agree early on what is in scope and what is out of scope. Projects that grow beyond their original focus tend to lose direction and fail.

The Quality Improvement Data System (QIDS) brings data from multiple sources into one place. A shared space on QIDS lets your team work on the same improvement priority in one location.

See Improvement tools for improvement science methodology.

Stripe 4. Continuous learning

A learning environment asks two questions: what have we learned, and what can we improve now?

Around 12 to 18 months after start-up, repeat your Discovery phase data collection. This shows you the new current state and whether your changes have held.

Family of measures

One measure alone cannot tell you whether an improvement has happened. Use one or two measures from each of the three categories below.

For each measure, define the numerator, the denominator and an operational definition. This keeps your data consistent.

Outcome measures track the overall impact of your project. They align closely with your aim statement. Examples:

  • baseline and 12-month Safety Attitudes Questionnaire (SAQ) scores
  • reduced incidents, particularly those linked to communication breakdown
  • executive satisfaction
  • staff retention and satisfaction.

Process measures track whether each step of your process is working as planned. They link your changes to your outcomes. Examples:

  • percentage of team members who completed the SAQ
  • number of Safety Fundamentals commenced
  • number of action plan items completed on time
  • number of staff trained in improvement science.

Balancing measures check whether an improvement in one part of the system is causing problems elsewhere. For example, if your aim is to reduce inpatient length of stay, also:

  • monitor readmission rates to make sure they do not rise
  • check that patient experience does not decline.

Planning your data collection

Plan what you collect, where you record it and who is responsible.

  • Review any baseline or historical data.
  • Agree who collects each measure, when, where and how.
  • Choose the most efficient way to access the data.
  • Decide how you will present the data and only collect what you will use.
  • Record data in a spreadsheet or, ideally, QIDS.
  • Assign each measure to a specific team member.
  • Talk to staff and patients about their experience during testing.
  • Keep collecting data after the project ends to confirm the improvement holds.

Quality matters more than quantity. Collect consecutive samples (for example, the first five patients each week) or random samples. Your local quality improvement advisor can help you decide what fits your project.

Presenting your data

Run charts are the most common way to display improvement data. A run chart is a line graph that shows data over time. Use it to:

  • tell the story of your project
  • show stakeholders what has changed
  • mark where you tested change ideas using annotations.

You can also use histograms or statistical process control (SPC) charts depending on your data. For guidance on choosing and interpreting charts, see our quality improvement tools

Knowing when an improvement is happening

Real improvement shows up as a pattern over time, not a single result. Probability-based rules help you spot non-random changes in your data.

See safety intelligence data tools for details on data type, minimum data points and the probability-based rules. Your local quality advisor can also help.

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