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      Improving teamwork and communication in the operating room by introducing the theatre cap challenge

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          Abstract

          Objective

          One of the steps of the Surgical Safety Checklist is for the team members to introduce themselves. The objective of this study was to implement a tool to help remember and use each other’s names and roles in the operating theatre.

          Methods

          This study was part of a pilot study in which a video and medical data recorder was implemented in one operating theatre and used as a tool for postoperative multidisciplinary debriefings. During these debriefings, name recall was evaluated. Following the implementation of the medical data recorder, this study was started by introducing the theatre cap challenge, meaning the use of name (including role) stickers on the surgical cap in the operating theatre.

          Findings

          In total, 41% (n = 40 out of 98) of the operating theatre members were able to recall all the names of their team at the team briefings. On average 44.8% (n = 103) was wearing the name sticker.

          Conclusions

          The time-out stage of the Surgical Safety Checklist might be inadequate for correctly remembering and using your operating theatre team members’ names. For this, the theatre cap challenge may help.

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          Most cited references18

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          A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

          New England Journal of Medicine, 360(5), 491-499
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            The human factor: the critical importance of effective teamwork and communication in providing safe care.

            Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.
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              Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies

              Background Identifying characteristics associated with struggling healthcare organisations may help inform improvement. Thus, we systematically reviewed the literature to: (1) Identify organisational factors associated with struggling healthcare organisations and (2) Summarise these factors into actionable domains. Methods Systematic review of qualitative studies that evaluated organisational characteristics of healthcare organisations that were struggling as defined by below-average patient outcomes (eg, mortality) or quality of care metrics (eg, Patient Safety Indicators). Searches were conducted in MEDLINE (via Ovid), EMBASE, Cochrane Library, CINAHL, and Web of Science from database inception through February 8 2018. Qualitative data were analysed using framework-based synthesis and summarised into key domains. Study quality was evaluated using the Critical Appraisal Skills Program tool. Results Thirty studies (33 articles) from multiple countries and settings (eg, acute care, outpatient) with a diverse range of interviewees (eg, nurses, leadership, staff) were included in the final analysis. Five domains characterised struggling healthcare organisations: poor organisational culture (limited ownership, not collaborative, hierarchical, with disconnected leadership), inadequate infrastructure (limited quality improvement, staffing, information technology or resources), lack of a cohesive mission (mission conflicts with other missions, is externally motivated, poorly defined or promotes mediocrity), system shocks (ie, events such as leadership turnover, new electronic health record system or organisational scandals that detract from daily operations), and dysfunctional external relations with other hospitals, stakeholders, or governing bodies. Conclusions Struggling healthcare organisations share characteristics that may affect their ability to provide optimal care. Understanding and identifying these characteristics may provide a first step to helping low performers address organisational challenges to improvement. Systematic review registration PROSPERO: CRD42017067367.
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                Author and article information

                Journal
                J Perioper Pract
                J Perioper Pract
                PPJ
                spppj
                Journal of Perioperative Practice
                SAGE Publications (Sage UK: London, England )
                1750-4589
                2515-7949
                10 January 2022
                January 2022
                : 32
                : 1-2
                : 4-9
                Affiliations
                [1 ]Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
                [2 ]Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
                [3 ]Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
                [4 ]Department of Anesthesiology, Ringgold 2205, Royal Prince Alfred Hospital; , Ringgold 2205, universityRoyal Prince Alfred Hospital; , Sydney, Australia
                Author notes
                [*]Marlies P Schijven, Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. Email: m.p.schijven@ 123456amsterdamumc.nl
                Author information
                https://orcid.org/0000-0002-5468-9371
                Article
                10.1177_17504589211046723
                10.1177/17504589211046723
                8750134
                35001734
                3467dd45-22c0-443b-bd3c-924d66507712
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Categories
                Original Articles
                Custom metadata
                ts2
                January/February 2022

                operating room,surgical safety,quality improvement,teamwork,surgical safety checklist,closed-loop communication,name stickers

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