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Quality improvement in surgery combining lean improvement methods with teamwork training : a controlled before-after study
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Robertson, Eleanor, Morgan, Lauren, New, Steve, Pickering, Sharon, Hadi, Mohammed, Collins, Gary, Rivero Arias, Oliver, Griffin, Damian R. and McCulloch, Peter (2015) Quality improvement in surgery combining lean improvement methods with teamwork training : a controlled before-after study. PLoS One, 10 (9). e0138490. doi:10.1371/journal.pone.0138490 ISSN 1932-6203.
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Official URL: http://dx.doi.org/10.1371/journal.pone.0138490
Abstract
Background
To investigate the effectiveness of combining teamwork training and lean process improvement, two distinct approaches to improving surgical safety. We conducted a controlled interrupted time series study in a specialist UK Orthopaedic hospital incorporating a plastic surgery team (which received the intervention) and an Orthopaedic theatre team acting as a control.
Study Design
We used a 3 month intervention with 3 months data collection period before and after it. A combined teamwork training and lean process improvement intervention was delivered by an experienced specialist team. Before and after the intervention we evaluated team non-technical skills using NOTECHS II, technical performance using the glitch rate and WHO checklist compliance using a simple 3 point scale. We recorded complication rate, readmission rate and length of hospital stay data for 6 months before and after the intervention.
Results
In the active group, but not the control group, full compliance with WHO Time Out (T/O) increased from 14 to 71% (p = 0.032), Sign Out attempt rate (S/O) increased from 0% to 50% (p<0.001) and Oxford NOTECHS II scores increased after the intervention (P = 0.058). Glitch rate decreased in the active group and increased in the control group (p = 0.001). Complications and length of stay appeared to rise in the control group and fall in the active group.
Conclusions
Combining teamwork training and systems improvement enhanced both technical and non-technical operating team process measures, and were associated with a trend to better safety outcome measures in a controlled study comparison. We suggest that approaches which address both system and culture dimensions of safety may prove valuable in reducing risks to patients.
Item Type: | Journal Article | ||||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||
Journal or Publication Title: | PLoS One | ||||||||
Publisher: | Public Library of Science | ||||||||
ISSN: | 1932-6203 | ||||||||
Official Date: | 2015 | ||||||||
Dates: |
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Volume: | 10 | ||||||||
Number: | 9 | ||||||||
Article Number: | e0138490 | ||||||||
DOI: | 10.1371/journal.pone.0138490 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
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