Improving patient safety in the operating theatre – teamwork and communication

The Health Quality & Safety Commission’s Reducing Perioperative Harm programme is working to help hospitals improve teamwork and communication in the operating theatre.

We know that the message is an easy one to express – but both New Zealand and international evidence tells us that this one of the most difficult challenges that can be set in the hospital system because it requires a change in team culture.

The goal of the programme is to develop the tools to make culture change possible and to encourage support for culture change by executive leadership teams within district health boards (DHBs).

The role of DHB Chairs, Chief Executives, Directors of Nursing, Chief Medical Officers and Executive Managers is crucial – change must be supported from the organisations leadership to be effective. To communicate this message the chair of the Perioperative Harm Advisory Group, Mr Ian Civil, is presenting at hospital grand rounds throughout the country during July, August and September.

His message is clear – 25 percent of operating theatre communications have been found to fail because of inappropriate timing, inaccurate or missing content or a failure to resolve issues. Over 35 percent of operating theatre teams have been shown to have visible effects of tension in the team, inefficiency, waste of resources, delay or procedural error linked to poor communication.

To combat this we need to develop a culture of collective leadership – a challenging concept that requires excellent communication and teamwork that is supported by prompts and guidelines and training in a truly multidisciplinary environment.

As a programme we need DHB leaders to visibly support their operating theatre teams and improvement leaders as they work towards change.

The programme is focusing on ways to improve patient safety and quality of care through the effective use of:

• a briefing before each operating list
• use of all three stages of the World Health Organization surgical checklist for each patient
• a debriefing at the completion of each operating list.

However, these are just tools – the real impact for patients and hospitals will come from operating theatre teams working effectively together. Internationally the key success criteria for the implementation of briefings, surgical safety checklist, de-briefing within a hospital are:

• acknowledgment of the complex nature of the task
• ensuring strong and visible executive leadership
• develop and support clinical champions
• planned and staged implementation
• knowing when and where to seek help.

The Reducing Perioperative Harm programme has a range of supporting tools and resources including a three-part surgical checklist video, the grand round presentation by Ian Civil, and evidence reviews and improvement tools to support improved teamwork and communication in the operating theatre.