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Combining systems and teamwork approaches to enhance the effectiveness of safety improvement interventions in surgery
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McCulloch, Peter, Morgan, Lauren, New, Steve, Catchpole, Ken, Roberston, Eleanor, Hadi, Mohammed, Pickering, Sharon, Collins, Gary and Griffin, Damian R. (2017) Combining systems and teamwork approaches to enhance the effectiveness of safety improvement interventions in surgery. Annals of Surgery, 265 (1). pp. 90-96. doi:10.1097/SLA.0000000000001589 ISSN 0003-4932.
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Official URL: http://dx.doi.org/10.1097/SLA.0000000000001589
Abstract
Importance: Patient safety improvement interventions usually address either work systems or team culture. We do not know which is more effective, or whether combining approaches is beneficial.
Objective: To compare improvement in surgical team performance after interventions addressing teamwork culture, work systems, or both.
Design: Suite of 5 identical controlled before-after intervention studies, with preplanned analysis of pooled data for indirect comparisons of strategies.
Setting: Operating theatres in 5 UK hospitals performing elective orthopedic, plastic, or vascular surgery
Participants: All operating theatres staff, including surgeons, nurses, anaesthetists, and others
Interventions: 4-month safety improvement interventions, using teamwork training (TT), systems redesign and standardization (SOP), Lean quality improvement, SOP + TT combination, or Lean + TT combination.
Main Outcomes and Measures: Team technical and nontechnical performance and World Health Organization (WHO) checklist compliance, measured for 3 months before and after intervention using validated scales. Pooled data analysis of before-after change in active and control groups, comparing combined versus single and systems versus teamwork interventions, using 2-way ANOVA.
Results: We studied 453 operations, (255 intervention, 198 control). TT improved nontechnical skills and WHO compliance (P < 0.001), but not technical performance; systems interventions (Lean & SOP, 2 & 3) improved nontechnical skills and technical performance (P < 0.001) but improved WHO compliance less. Combined interventions (4 & 5) improved all performance measures except WHO time-out attempts, whereas single approaches (1 & 2 & 3) improved WHO compliance less (P < 0.001) and failed to improve technical performance.
Conclusions & Relevance: 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.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||
| Journal or Publication Title: | Annals of Surgery | ||||
| Publisher: | Lippincott Williams & Wilkins | ||||
| ISSN: | 0003-4932 | ||||
| Official Date: | January 2017 | ||||
| Dates: |
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| Volume: | 265 | ||||
| Number: | 1 | ||||
| Page Range: | pp. 90-96 | ||||
| DOI: | 10.1097/SLA.0000000000001589 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access | ||||
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