Combining systems and teamwork approaches to enhance the effectiveness of safety improvement interventions in surgery: the safer delivery of surgical services (S3) …
P McCulloch, L Morgan, S New, K Catchpole… - Annals of …, 2017 - journals.lww.com
Annals of surgery, 2017•journals.lww.com
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 …
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 …
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.
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