Journal article
Combining Systems and Teamwork Approaches to Enhance the Effectiveness of Safety Improvement Interventions in Surgery: The Safer Delivery of Surgical Services (S3) Program.
- Abstract:
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Importance: Patient safety improvement interventions usually address either work systems or team culture. We do not know which is more effective, or whether combining approaches is beneficial.
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.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Authors
- Publisher:
- Lippincott, Williams & Wilkins
- Journal:
- Annals of Surgery More from this journal
- Volume:
- 265
- Issue:
- 1
- Pages:
- 90-96
- Publication date:
- 2017-01-01
- Acceptance date:
- 2017-01-01
- DOI:
- EISSN:
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1528-1140
- ISSN:
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0003-4932
- Language:
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English
- Keywords:
- Pubs id:
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pubs:668687
- UUID:
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uuid:08e5462d-094f-419d-9f4e-6645d5319637
- Local pid:
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pubs:668687
- Source identifiers:
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668687
- Deposit date:
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2017-04-25
Terms of use
- Copyright holder:
- Wolters Kluwer Health
- Copyright date:
- 2017
- Notes:
- Copyright © 2017 Wolters Kluwer Health, Inc.
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