Objective: To evaluate the effectiveness of the implementation of a TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) program at an Australian mental health facility. Design, setting and participants: TeamSTEPPS is an evidence‐based teamwork training system developed in the United States. Five health care sites in South Australia implemented TeamSTEPPS using a train‐the‐trainer model over an 8‐month intervention period commencing January 2008 and concluding September 2008. A team of senior clinical staff was formed at each site to drive the improvement process. Independent researchers used direct observation and questionnaire surveys to evaluate the effectiveness of the implementation in three outcome areas: observed team behaviours; staff attitudes and opinions; and clinical performance and outcome. The results reported here focus on one site, an inpatient mental health facility. Main outcome measures: Team knowledge, skills and attitudes; patient safety culture; incident reporting rates; seclusion rates; observation for the frequency of use of TeamSTEPPS tools. Results: Outcomes included restructuring of multidisciplinary meetings and the introduction of structured communication tools. The evaluation of patient safety culture and of staff knowledge, skills and attitudes (KSA) to teamwork and communication indicated a significant improvement in two dimensions of patient safety culture (frequency of event reporting, and organisational learning) and a 6.8% increase in the total KSA score. Clinical outcomes included reduced rates of seclusion. Conclusion: TeamSTEPPS implementation had a substantial impact on patient safety culture, teamwork and communication at an Australian mental health facility. It encouraged a culture of learning from patient safety incidents and making continuous improvements.

Patients who have had their jaws irradiated as part of management of head and neck malignancy are at risk of osteoradionecrosis (ORN) following tooth extraction. Thirty-seven patients with a history of irradiation to the jaws were managed during a four year period. Twenty-nine patients received hyperbaric oxygen therapy (HBO) consisting of 20 treatments before surgery and ten treatments a f t e r. Only one (4 per cent) developed ORN. Seven patients who did not have HBO and one who did (15 per cent) developed ORN. The need for prophylactic treatment with HBO is discussed. It is recommended that prophylactic HBO is used prior to surgery for irradiated facial bones.Key words: Osteoradionecrosis, hyperbaric oxygen, surgery.(Received for publication July 1998. Accepted September 1998.) i rr a d i ated bone, which fails to heal without intervention'.3 The usual first presentation is pain with subsequent exposure of bone into the mouth. This m ay progress to wide exposure of bone both i n t o the mouth and through the skin. M o r e advanced stages are associated with constant pain, s e q u e s t r at i o n , p at h o l o gic fracture, m a l o d o u r , deformity and discharge. 4 Radiology is not usually helpful in the early stages of ORN 5 and even in its advanced stages does not necessarily relate to the imaging features.6 Described r a d i o graphic features range from normal appearance, to localized areas of osteolysis to extensive osteolysis, sequestra and fracture. Extraction sockets will often remain visible for more than twelve months after surgery.Computerized tomography (CT) is more valuable in determining the boundaries between norm a l and non-viable bone.5 Nuclear medicine scans, usually with technetium 99, will delineate between vascularized and inflamed areas versus non-viable s e g m e n t s. 7 Magnetic resonance imaging has a limited role.Concepts of the pathogenesis of ORN have undergone change over the last decade. For much of this century ORN was considered primarily an infection,that is,the irradiated bone was injured and became infected. 8 Common traumatic events which breached the overlying mucosa and thus allowed ingress of bacteria were biopsies, cancer surgery, tooth extraction and denture irritation.Hence treatment of ORN followed the classical principles of infection management; removal of the cause, debridement, drainage and antibiotics.This concept was challenged by Marx in the early 1980s. He presented the view that ORN was p ri m a rily a non-healing wound secondary to endarteritis.1 The effect of irradiation on the bone Introduction Osteoradionecrosis (ORN) of the facial bones, particularly of the mandible, is a known serious complication of therapeutic radiotherapy for head and neck cancer. ORN is painful, debilitating and frequently refractory to treat m e n t .

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Differences between safety specialists' and workforce groups' beliefs about how to improve patient safety may impede the successful implementation of patient-safety programmes.