Lessons from the airline industry were used to make members of an operating theatre team more aware of the way they work. Aircrews have a framework of how to work with each other, which allows them to question staff further up the hierarchy. This promotes passenger safety – it is not about ‘who is right’ but ‘what is right’.
The theatre team worked with psychologists from QinetiQ’s Centre for Human Sciences’ organisational effectiveness group. Formerly part of the Ministry of Defence, this organisation is experienced in managing team debriefing sessions. Together they worked on a toolkit of 15 different debriefing techniques.
Theatre staff in one theatre block have now started running regular team self-review sessions. The overall performance – including patient safety, workload and staff stress levels – will be compared with
another theatre block that is not using team debriefs.
The five-to ten-minute briefing session at the start of a theatre list is conducted by the surgeon or the anaesthetist. It concentrates on the technical aspects of the work and involves talking about the patients on the list and ensuring that the staff know each other and their roles. An A4 laminated sheet is used as a prompt card. The briefing enables the team to:
• introduce each other – teams often have a core set of members and a number of others who enter and exit the team structure; • discuss the plans for the day, the order of the list in theatres or the
order of the patients at the beginning of outpatients etc; • discuss specific anticipated problems;
• discuss issues such as overbooking or time-related issues; • share values and beliefs.
It also enhances the debriefing at the end of the day, list or clinic. The debriefing sessions can be led by any member of the team. They conduct a non-judgemental debrief to look at team cooperation, communication, equipment use and dispute resolution. A series of flash cards are used as triggers and help give the briefing a structure. An important element of the debrief is that any issues identified can be converted into practical modifications to alter the way the team
works and packaged so that the lessons learned can be shared with other teams in the same department.
The reporting of ‘near misses’ in the operating theatre was also adapted from the airline industry. Royal Cornwall Hospitals NHS Trust is planning to add the reporting of what they call ‘close calls’ to the reporting of patient safety incidents.
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