11 December 2015

Study to turn spotlight on teamwork in surgery

If you’ve ever been to hospital for an operation, chances are you won’t have given much thought to the camaraderie between the team members performing your procedure, let alone the sort of briefing they would have had prior to wheeling you into theatre.

But a team of WA researchers is – and that is probably just as well because according to the study’s principal investigator, organisational psychologist Sharon Parker, up to 70 per cent of adverse events during operations are the result of failings in communication and teamwork.

What’s more, while adverse events occur in 22 per cent of operations, almost half (48 per cent) are deemed “highly preventable”.

With the help of a State-funded Research Translation Project (RTP) grant Professor Parker, from the University of Western Australia’s School of Business, and fellow researchers are looking at how these failings can be overcome and will explore the potential of pre-operative interdisciplinary meetings to improve communication and team spirit within surgical teams. 

Professor Parker reveals that interdisciplinary meetings ahead of surgical lists are relatively rare in WA and Australia, with most pre-operative briefings – if they occur at all – doing so within disciplines.

“You’ve got surgeons talking to surgeons, anaesthetists talking to other anaesthetists and nurses talking to nurses but they’re not talking outside their disciplines and this can be a problem because many of the errors that occur in health do so at the barrier between one discipline and the other,” she explains.

“The medical environment is a very hierarchical environment and we need to get away from that – we want a climate that is psychologically safe so that if things start to go wrong during a procedure, people feel secure enough to voice their concerns.

“If a surgeon is about to chop off the wrong leg you’d like to think there will be somebody to speak up!”

Fieldwork for the Parker study will take place at Fiona Stanley Hospital where interdisciplinary pre-operative briefings are standard practice.

The team will explore the potential of such briefings to improve surgery efficiency, patient safety and staff satisfaction and engagement.

It will also use its findings to develop a template for the “optimal briefing format”.

Professor Parker said preliminary international research had shown that effective pre-operative briefings could enhance surgery efficiency by as much as 31 per cent, with similarly encouraging results being obtained from a pilot study at Kaleeya Hospital prior to its closure last year.

Such briefings could also give staff members the chance to clarify their roles in a procedure, identify equipment needs or even raise concerns about issues such as change in a patient’s condition.

“We’re probably only talking about an extra five minutes at the start of a surgery list but an effective briefing can potentially enable the surgery to proceed more smoothly and provide flow on benefits such as reduced operating time, less time under anaesthesia, lower risk of infection, reduced waiting times for patients, fewer cancellations and better use of staff and resources,” she said.

With the cost of surgery estimated at $120 to $180 per minute, Professor Parker says an efficiency improvement of just 10 per cent could lead to savings of more than $17 million per year at Fiona Stanley Hospital alone.

Professor Parker says the Kaleeya pilot also highlighted the potential of multi-disciplinary meetings to enhance staff morale, citing the feedback of one participant who reported: Briefings personally changed my perspective on being a surgeon.  Before I felt just like a contract labourer doing my job. Briefings helped me connect with my workplace a lot better.

Professor Parker said the new research would build on the Kaleeya pilot and compare the teamwork, communication and outcomes (such as efficiency, adverse events and staff engagement) of teams operating after pre-operative briefings, with those whose lists were performed without briefings.

She said the research was possible because despite briefings being standard at FSH, for various reasons they did not always take place.

As part of their project, the researchers will track surgical list times and compare anticipated times and schedules with actual list times. The quality of individual briefings – and the procedures that follow them – will also be monitored.

WA Health’s Chief Medical Officer Professor Gary Geelhoed said the project had the potential to provide important information for Western Australia’s health system, enabling it to enhance the efficiency of surgical lists, reduce costs, improve staff engagement and improve patient outcomes.

He said the project helped highlight the important collaborations taking place in health and medical research in Western Australia.

Professor Parker’s project is one of nine research projects awarded an RTP grant this year.  The RTP program funds research that is designed to improve patient outcomes yet at the same time enhance efficiency and cost effectiveness in WA’s public health system.

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