Perioperative Harm programme proof of concept moves to next phase

4 Mar 2015 | Safe Surgery NZ

The Health Quality & Safety Commission spent 2014 working with Waikato and Lakes District Health Boards (DHBs) and Southern Cross Auckland on a proof of concept project, testing approaches to improve teamwork and communication in operating theatres.

The next phase of the programme focuses on rolling out the learnings from the project to the sector.

Over the next 16 months the Commission will be:

  • retiring the current quality and safety marker (QSM) at the end of the 2014–15 financial year (DHBs should have heard about this through the recent guidance about the annual and regional plan processes)
  • rolling out a package of teamwork and communication quality improvement interventions to DHBs in a staggered approach
  • establishing a new QSM measuring surgical teams’ engagement with the teamwork and communication tools, which will most likely be collected through local observational audit.

The package of interventions is made up of the following evidence-based components:

  • briefing
  • all three parts of the checklist, modified to be used in paperless form, as a poster on the operating theatre wall
  • debriefing.

These interventions were trialled during the proof of concept project, with positive results. Participants reported efficiency gains as a result of using briefing and debriefing, increased buy-in to, and more appropriate use of, the paperless checklist and improved teamwork and communication in surgical teams.

Local teams can choose how to implement the interventions within certain parameters, eg, trial within one or two operating theatres at first before expanding across the hospital or focus on one speciality before moving to others. Lessons learned during each improvement cycle will be shared via multiple communication channels eg, regional workshops/learning sessions, newsletters, webinars/teleconferences. The Commission will provide quality improvement advice through on-site implementation support, phone calls and email. Each DHB will need trained observational auditors – training for this role will be provided by the Commission, as well as making available an app to make data collection and submission easier.

The programme’s focus for 2015–16 will be supporting DHBs to take up the interventions, and prepare to report against the new QSM from the beginning of 2016–17.

The Commission has developed a web-based app for use by DHBs to make data collection easier. The app makes data available in real-time, which can be used to inform the local change project as it rolls out, as well as collecting information for the new QSM.

Rollout process

The Commission intends to undertake a three-phase roll-out of the teamwork and communication interventions to all DHBs. All DHBs are expected to have started implementation of the bundle before the start of the 2016–17 financial year.

Table showing the rollout process of the teamwork & communication interventions.

We aim to recruit seven DHBs for cohort one, up to seven for cohort two and the remainder for cohort three. Ideally the first cohort will include the sites that were involved in the original trial of the interventions and they will support the other DHBs to implement the changes. Cohort one participants will be asked to support subsequent DHBs to implement the interventions. The Commission will ensure there is at least connection with, and ideally support, from the regional quality and safety steering groups.

A request for expressions of interest will be sent out in mid-March to DHB chief executives, directors of surgery (or equivalent), quality and risk managers and the DHB’s nominated reducing perioperative harm champion. The Commission has spent the last week of Feb/first week of March calling all of the champions to confirm that they are still the appropriate people to contact and, potentially, lead this work.

For more information contact emma.forbes@hqsc.govt.nz.

Last updated 04/03/2015