Combining Systems and Teamwork Approaches to Enhance the Effectiveness of Safety Improvement Interventions in Surgery: The Safer Delivery of Surgical Services (S3) Program.
Ann Surg
; 265(1): 90-96, 2017 01.
Article
en En
| MEDLINE
| ID: mdl-28009731
ABSTRACT
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 surgeryPARTICIPANTS:
All operating theatres staff, including surgeons, nurses, anaesthetists, and othersINTERVENTIONS:
4-month safety improvement interventions, using teamwork training (TT), systems redesign and standardization (SOP), Lean quality improvement, SOPâ+âTT combination, or Leanâ+âTT combination. MAIN OUTCOMES ANDMEASURES:
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.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Grupo de Atención al Paciente
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Cultura Organizacional
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Competencia Clínica
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Procedimientos Quirúrgicos Electivos
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Errores Médicos
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Mejoramiento de la Calidad
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Seguridad del Paciente
Tipo de estudio:
Evaluation_studies
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Observational_studies
/
Prognostic_studies
Límite:
Humans
País/Región como asunto:
Europa
Idioma:
En
Revista:
Ann Surg
Año:
2017
Tipo del documento:
Article
País de afiliación:
Reino Unido