Quality Improvement in Surgery Combining Lean Improvement Methods with Teamwork Training: A Controlled Before-After Study.
BACKGROUND: To investigate the effectiveness of combining teamwork training and lean process improvement, two distinct approaches to improving surgical safety. We conducted a controlled interrupted time series study in a specialist UK Orthopaedic hospital incorporating a plastic surgery team (which...
| Main Authors: | , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
2015
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| _version_ | 1797099168295026688 |
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| author | Robertson, E Morgan, L New, S Pickering, S Hadi, M Collins, G Rivero Arias, O Griffin, D McCulloch, P |
| author_facet | Robertson, E Morgan, L New, S Pickering, S Hadi, M Collins, G Rivero Arias, O Griffin, D McCulloch, P |
| author_sort | Robertson, E |
| collection | OXFORD |
| description | BACKGROUND: To investigate the effectiveness of combining teamwork training and lean process improvement, two distinct approaches to improving surgical safety. We conducted a controlled interrupted time series study in a specialist UK Orthopaedic hospital incorporating a plastic surgery team (which received the intervention) and an Orthopaedic theatre team acting as a control. STUDY DESIGN: We used a 3 month intervention with 3 months data collection period before and after it. A combined teamwork training and lean process improvement intervention was delivered by an experienced specialist team. Before and after the intervention we evaluated team non-technical skills using NOTECHS II, technical performance using the glitch rate and WHO checklist compliance using a simple 3 point scale. We recorded complication rate, readmission rate and length of hospital stay data for 6 months before and after the intervention. RESULTS: In the active group, but not the control group, full compliance with WHO Time Out (T/O) increased from 14 to 71% (p = 0.032), Sign Out attempt rate (S/O) increased from 0% to 50% (p<0.001) and Oxford NOTECHS II scores increased after the intervention (P = 0.058). Glitch rate decreased in the active group and increased in the control group (p = 0.001). Complications and length of stay appeared to rise in the control group and fall in the active group. CONCLUSIONS: Combining teamwork training and systems improvement enhanced both technical and non-technical operating team process measures, and were associated with a trend to better safety outcome measures in a controlled study comparison. We suggest that approaches which address both system and culture dimensions of safety may prove valuable in reducing risks to patients. |
| first_indexed | 2024-03-07T05:19:50Z |
| format | Journal article |
| id | oxford-uuid:de828369-cdac-4c6b-b280-9c3a2f303692 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:19:50Z |
| publishDate | 2015 |
| record_format | dspace |
| spelling | oxford-uuid:de828369-cdac-4c6b-b280-9c3a2f3036922022-03-27T09:32:41ZQuality Improvement in Surgery Combining Lean Improvement Methods with Teamwork Training: A Controlled Before-After Study.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:de828369-cdac-4c6b-b280-9c3a2f303692EnglishSymplectic Elements at Oxford2015Robertson, EMorgan, LNew, SPickering, SHadi, MCollins, GRivero Arias, OGriffin, DMcCulloch, PBACKGROUND: To investigate the effectiveness of combining teamwork training and lean process improvement, two distinct approaches to improving surgical safety. We conducted a controlled interrupted time series study in a specialist UK Orthopaedic hospital incorporating a plastic surgery team (which received the intervention) and an Orthopaedic theatre team acting as a control. STUDY DESIGN: We used a 3 month intervention with 3 months data collection period before and after it. A combined teamwork training and lean process improvement intervention was delivered by an experienced specialist team. Before and after the intervention we evaluated team non-technical skills using NOTECHS II, technical performance using the glitch rate and WHO checklist compliance using a simple 3 point scale. We recorded complication rate, readmission rate and length of hospital stay data for 6 months before and after the intervention. RESULTS: In the active group, but not the control group, full compliance with WHO Time Out (T/O) increased from 14 to 71% (p = 0.032), Sign Out attempt rate (S/O) increased from 0% to 50% (p<0.001) and Oxford NOTECHS II scores increased after the intervention (P = 0.058). Glitch rate decreased in the active group and increased in the control group (p = 0.001). Complications and length of stay appeared to rise in the control group and fall in the active group. CONCLUSIONS: Combining teamwork training and systems improvement enhanced both technical and non-technical operating team process measures, and were associated with a trend to better safety outcome measures in a controlled study comparison. We suggest that approaches which address both system and culture dimensions of safety may prove valuable in reducing risks to patients. |
| spellingShingle | Robertson, E Morgan, L New, S Pickering, S Hadi, M Collins, G Rivero Arias, O Griffin, D McCulloch, P Quality Improvement in Surgery Combining Lean Improvement Methods with Teamwork Training: A Controlled Before-After Study. |
| title | Quality Improvement in Surgery Combining Lean Improvement Methods with Teamwork Training: A Controlled Before-After Study. |
| title_full | Quality Improvement in Surgery Combining Lean Improvement Methods with Teamwork Training: A Controlled Before-After Study. |
| title_fullStr | Quality Improvement in Surgery Combining Lean Improvement Methods with Teamwork Training: A Controlled Before-After Study. |
| title_full_unstemmed | Quality Improvement in Surgery Combining Lean Improvement Methods with Teamwork Training: A Controlled Before-After Study. |
| title_short | Quality Improvement in Surgery Combining Lean Improvement Methods with Teamwork Training: A Controlled Before-After Study. |
| title_sort | quality improvement in surgery combining lean improvement methods with teamwork training a controlled before after study |
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