Changes in surgical team performance and safety climate attitudes following expansion of perioperative services: a repeated-measures study
Brigid M. Gillespie A B C E , Emma Harbeck C , Evelyn Kang C , Catherine Steel D , Nicole Fairweather D and Wendy Chaboyer CA School of Nursing and Midwifery, Griffith University, Gold Coast campus, Qld, 4222, Australia.
B Gold Coast University Hospital and Health Service, 1 Hospital Blvd, Southport Qld, 4215, Australia.
C National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast campus, Qld, 4222, Australia. Email: e.kang@griffith.edu.au; w.chaboyer@griffith.edu.au; e.harbeck@griffith.edu.au
D Division of Surgery, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia. Email: Catherine.Steel@health.qld.gov.au; nfairweather.asa@gmail.com
E Corresponding author. Email: b.gillespie@griffith.edu.au
Australian Health Review 42(6) 703-708 https://doi.org/10.1071/AH17079
Submitted: 13 March 2017 Accepted: 19 June 2017 Published: 10 August 2017
Abstract
Objective The aim of the present study was to describe process changes in surgical team performance and team members’ attitudes to safety culture following hospital relocation and expansion of perioperative services.
Methods The study was a naturalistic study using structured observations and surveys to assess non-technical skills (NTS; i.e. communication, teamwork, situational awareness, decision making and leadership) in surgery. This interrupted time series design used mixed-linear regression models to examine the effect of phase (before and after hospital relocation) on surgical teams’ NTS and their processes that may affect performance. Differences in self-reported teamwork and safety climate attitudes were also examined.
Results In all, 186 procedures (100 before and 81 after hospital relocation) were observed across teams working in general, paediatric, orthopaedic and thoracic surgeries. Interobserver agreement ranged from 86% to 95%. An effect of phase was found, indicating that there were significant improvements after relocation in the use of NTS by the teams observed (P = 0.020; 95% confidence interval 1.9–4.7).
Conclusions The improvements seen in surgical teams’ NTS performance and safety culture attitudes may be related to the move to a new state-of-the-art perioperative department.
What is known about the topic? Patient safety in surgery relies on optimal team performance, underpinned by effective NTS.
What does this paper add? The NTS of surgical teams may be improved through ergonomic innovations that promote teams’ shared mental models.
What are the implications for practitioners? Effective multidisciplinary teamwork relies on a combination of NTS and ergonomic factors, which inherently contribute to team performance and safety climate attitudes.
Additional keywords: culture, hospital expansion, human factors, non-technical skills, patient safety, ergonomics.
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