Health Quality Improvement Using Instructional Communication and Teamwork Videos: An Outcome Study

Abstract

Many factors contribute to errors that occur during emergency Cesarean birth under general anesthesia. The Joint Commission of Accreditation of Health Care Organizations (JACO) reports that 70% of sentinel events in obstetric practice are attributable to errors in communication and teamwork. Our objective was to develop a video training module to address these deficiencies, and measure its effectiveness. A webbased learning resource was created using professionally made videos that depicted effective and non-effective communication/teamwork techniques in an obstetrical event. This resource could be accessed by a facilitator of small group sessions or by self directed learners. Obstetrical nurses watched this learning resource and were then debriefed by a facilitator to highlight examples of how human factors contribute to the evolution of adverse events. The knowledge and skills, as well as, perceptions of their own behaviors and of other health professionals in the team, were evaluated pre-and post intervention. The performance of a subgroup of participants in a high-fidelity simulation of an emergency Cesarean birth was assessed to measure the outcome of intervention. Ninety-five obstetrical nurses were given the pre-intervention questionnaires, and 52 completed the post-intervention questionnaires one year later. Participants had significantly higher scores post-intervention (M = 0.78, SD = 0.09) as compared to pre-intervention (M = 0.73, SD = 0.12; t(53) = −3.07, p <0.003, d = .47). Following intervention, participants were more conscious of the behaviors of those they worked with (t(51) = −4.99, p < 0.001, d = −0.66). Ten months after intervention, nurses indicated that they were able to identify challenges in teamwork and communication in their practice, and were more willing to speak up and be more assertive, and use strategies of conflict resolution and communication that they had learned. There was an improvement in performance of a sub-group of participant when assessed using a simulation scenario. The video web-based learning resource used in small group sessions effectively improved performance of obstetrical nurses as evaluated using questionnaires and high fidelity simulation. Future work will determine if the web-based version will be as effective in orienting new staff to the challenges of working in acute care obstetrical practice.