Combining Systems and Teamwork Approaches to Enhance the Effectiveness of Safety Improvement Interventions in Surgery

McCulloch, Peter; Morgan, Lauren; New, Steve; Catchpole, Ken; Roberston, Eleanor; Hadi, Mohammed; Pickering, Sharon; Collins, Gary S.; Griffin, Damian R.

doi:10.1097/sla.0000000000001589

Cited by 49 publications

(56 citation statements)

References 30 publications

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“…As a corollary, combining safety interventions with very different mechanisms might have resulted in more synergistic or additive effects. CRM may well add value when combined with a systems improvement approach. In addition, the observed improvements might have resulted from a positive secular trend in surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Cluster randomized trial to evaluate the impact of team training on surgical outcomes

Duclos

Peix²,

Piriou

et al. 2016

British Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Cluster randomized trial to evaluate the impact of team training on surgical outcomes

Duclos

Peix²,

Piriou

et al. 2016

British Journal of Surgery

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“…Worldwide, patient safety programmes are designed to measure and improve safety in order to control risks and minimize potentially avoidable patient harm, by systems and teamwork approaches 34 . Supplementary to the legal frameworks and professional guidelines, the Dutch basic requirements for a hospital Safety Management System (SMS) are nationally established and described in the Dutch Technical Agreement (DTA) 35 .…”

Section: Discussionmentioning

confidence: 99%

Development of the Surgical Patient safety Observation Tool (SPOT)

et al. 2018

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BackgroundA Surgical Patient safety Observation Tool (SPOT) was developed and tested in a multicentre observational pilot study. The tool enables monitoring and benchmarking perioperative safety performance across departments and hospitals, covering international patient safety goals.MethodsNineteen perioperative patient safety observation topics were selected from Dutch perioperative patient safety guidelines, which also cover international patient safety goals. All items that measured these selected topics were then extracted from available local observation checklists of the participating hospitals. Experts individually prioritized the best measurement items per topic in an initial written Delphi round. The second (face to face) Delphi round resulted in consensus on the content of SPOT, after which the measurable elements (MEs) per topic were defined. Finally, the tool was piloted in eight hospitals for measurability, applicability, improvement potential, discriminatory capacity and feasibility.ResultsThe pilot test showed good measurability for all 19 patient safety topics (range of 8–291 MEs among topics), with good applicability (median 97 (range 11·8–100) per cent). The overall improvement potential appeared to be good (median 89 (range 72·5–100) per cent), and at topic level the tool showed good discriminatory capacity (variation 27·5 per cent, range in compliance 72·5–100 per cent). Overall scores showed relatively little variation between the participating hospitals (variation 13 per cent, range in compliance 83–96 per cent). All eight auditors considered SPOT a straightforward and easy‐to‐use tracer tool.ConclusionA comprehensive tool to measure safety of care was developed and validated using a systematic, stepwise method, enabling hospitals to monitor, benchmark and improve perioperative safety performance.

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“…Also, we were unable to secure her permission to display de-identified charts of each anesthesiologist’s RA use over time. This technique has been shown to be effective by others in implementing provider behavioral change in other health-care settings (17). In addition, anesthesia personnel felt obligated to continuously monitor NAL delivered by continuous infusion, thus limiting the availability of personnel to provide NAL, especially during call hours.…”

Section: Discussionmentioning

confidence: 99%

Increasing Regional Anesthesia Use in a Serbian Teaching Hospital through an International Collaboration

Baysinger

Pujic

Veličković

et al. 2017

Front. Public Health

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Many low- and middle-income countries (LMICs) report low rates of regional anesthesia (RA) use for cesarean delivery (CD), despite its association with lower maternal major morbidity and mortality. Also, the prevalence of neuraxial analgesia for labor (NAL) is often low in LMICs. We report on the results of a collaboration in clinical education over a multi-year period between Kybele Inc., an international non-profit organization, and Klinicki Centar Vojvodine (CCV), a teaching hospital in Novi Sad, Serbia, to increase RA use for CD and NAL at CCV. From late 2011 through 2015, teams from Kybele participated in annual to biannual didactic conferences and week-long bedside teaching efforts involving obstetric and anesthesia staff from CCV and surrounding hospitals. Ongoing contact occurred at least weekly between Kybele and the host to discuss progress. De-identified quality improvement data on total deliveries, numbers of elective and non-elective CDs, number of vaginal deliveries, type of anesthesia for CD, and the number of NALs were collected. RA use for CD increased to 25% in year 2015 versus 14% in base year 2011 [odds ratio (OR): 2.05; 95% confidence interval (CI): 1.73,2.42; p < 0.001]. NAL increased to 10.5% of laboring women in 2015 versus 1.2% in 2011 (OR: 9.6; 95% CI: 7.2, 12.8; p < 0.001). Greater increases for RA use during non-elective CD were observed between 2011 and 2015 (1.4 versus 7.5% of total CD; OR: 5.52; 95% CI: 2.63, 8.41; p < 0.001) relative to elective CD (12.5 versus 17.5% of total CD; OR: 1.48; 95% CI: 1.23, 1.77; p < 0.001). Overall, RA for CD increased during the 4 year collaboration but was not as great as reported in other countries with similar health-care demographics utilizing a similar program. Detailed descriptions of program interventions and barriers to change at CCV are presented.

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Combining Systems and Teamwork Approaches to Enhance the Effectiveness of Safety Improvement Interventions in Surgery

Abstract: Safety interventions combining teamwork training and systems rationalization are more effective than those adopting either approach alone. This has important implications for safety improvement strategies in hospitals.

Cited by 49 publications

References 30 publications

Cluster randomized trial to evaluate the impact of team training on surgical outcomes

Cluster randomized trial to evaluate the impact of team training on surgical outcomes

Development of the Surgical Patient safety Observation Tool (SPOT)

Increasing Regional Anesthesia Use in a Serbian Teaching Hospital through an International Collaboration

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