From June–October 2014 the Health Quality & Safety Commission worked with Waikato and Lakes district health boards (DHBs) and Southern Cross Auckland Surgical Centre on a proof of concept project, testing approaches to improve teamwork and communication in operating theatres.
The proof of concept allowed the Commission to test ways of introducing the clinical tools and behavioural change that work for New Zealand hospitals. Drawing from international experience and the advice of an expert advisory group, a package of interventions was developed, made up of the following evidence-based components:
- surgical team briefings
- paperless surgical safety checklist (based on the WHO Checklist, modified for the New Zealand context)
- supporting communication tools, such as ISBAR (identify, situation, background, assessment, recommendation) and closed loop feedback.
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.
Frequently asked questions about the proof of concept project
Q. Who took part in the proof of concept project?
Theatre teams at Waikato DHB, Lakes DHB and Southern Cross Auckland took part.
Q. What was the aim of the project?
A. To improve patient safety by reducing patient harm in the operating theatre. The project tested evidence-based interventions and international approaches to the process of implementing surgical team briefings, the World Health Organization Surgical Safety Checklist, and debriefings, with public and private hospital surgical teams.
Q. How long did the proof of concept project run for?
A. The project ran over two phases from June 2014 to October 2014.
Q. Which tools were tested?
- The proof of concept included tools and guidance on how to take a planned and measured approach to introducing the three clinical process interventions (briefing, WHO Surgical Safety Checklist, and de-briefing).
- Each of the three process interventions was backed with an evidence summary, measures and a ‘how to guide’ – for example a ‘paperless’ WHO Surgical Safety Checklist was tested.
- An electronic observational measurement tool was developed to measure team engagement with each of the three process interventions.
- A behavioural toolkit including evidence and ‘how to’ advice was also produced to encourage surgical teams to use a range of tools to improve behaviour/culture in applying the three process interventions – for example using SBAR and the ‘Two Challenge Rule’.
- The two toolkits were supported by an improvement methodology based on international best practice to support surgical teams using the de-briefing to create new and innovative ways of driving improvement – ie, making changes to process and ways of working. The process uses the Plan-Do-Study-Act cycle of improvement.
Q. Was the proof of concept evaluated?
A. Yes. The proof of concept was evaluated and the final report is on our website.