Surgical safety, today and tomorrow
By Carina Stanton, MA
Senior News Editor/Writer
BEAVER CREEK, COLO. – The stunning backdrop of the Rocky Mountains, paired with the relative seclusion of Beaver Creek, provided the setting for AORN’s 2008 Executive Symposium on Surgical Safety. The event, held July 13-15 at the Park Hyatt Beaver Creek, was an opportunity for more than 125 professionals from multiple healthcare-related disciplines to join together for a summit on the current state of surgical safety and a look at where the future might lead. Themes of leadership in the operating room resonated with those who attended. “I truly believe that leadership in the next 10 years is not going to be a function of technical gizmos and technical expertise as much as it is better understanding human interactions, human relationships, developing a better basis for respect for our peers and colleagues and co-professionals,” said attendee John W. Overton, Jr., MD, a retired cardiothoracic surgeon who now focuses on surgical and aviation risk and safety management for Meridian Consulting, Inc. The eight sessions that made up the Executive Symposium covered material that spanned the topics of leadership and the creation of effective change within the OR. Even though those topics may seem outwardly technical, Overton said the presenters were able to show how the human element is an effective piece of surgical safety. “This meeting covered a lot of material, but I felt it dealt heavily and effectively with the human components of patient safety in the healthcare environment, and was particularly focused on the operating room environment and the perioperative environment,” Overton said. “It was an outstanding course.” Linda Knox, RN, MS, MS, CNOR, CNS, perioperative clinical nurse specialist at Oregon Health & Science University (OHSU) in Portland, Ore., enjoyed the experience because it gave her a chance to see what professionals are doing elsewhere. Her facility is unique in that it is the only health and science specialty school in Oregon. Because of the topography of where OHSU is built, OR staff work in five separate buildings. “My highlight was just seeing the collaboration that is possible in institutions and accomplishments that can really occur on very thorny issues,” Knox said. “It just gives us some great ideas that we might take and modify in our OR.” The biggest challenge going home, she added, was simply in being able to synthesize all the information to share with her peers. “It’s almost sensory overload,” Knox said. “I have to go back and sort through everything and figure out how to present it in a coherent fashion to my peers and colleagues back at work to figure out what we can do with all this information.” Much of the attendees’ time during the symposium was dedicated to learning from the speakers’ experiences. The apparent enthusiasm of the audience didn’t go unnoticed. “I came to this meeting hopefully to help inspire the attendees about leadership and about the great leaders we have and the requirements of leaders we have going forward,” said Charles R. Denham, MD, Chairman of the Texas Medical Institute of Technology. “I came away from this audience being inspired, because they are great leaders and they’re interested in going back with the things that they know can improve patient care. So I came to inspire and I was inspired.” Denham’s session, “Effective Leadership and Its Impact on Patient Safety,” looked at the essence of leadership and how it applies to patient safety. While much is known about what healthcare professionals need to do to improve safety, and know how to do it, he said the missing element to industry-wide change is effective leadership at all levels of a medical institution. “I truly believe that our nurses are the unsung heroes of healthcare, and the crisis that we’re heading into will be solved and will be overcome in no small measure due to our nurses,” Denham said. “I think it’s important that we invest in the resources to train them, educate them and put them in positions of leadership to be able to really deliver against that crisis.”
The Surgical Care Improvement Project: Improving Safety from Leadership to the Front Line In the opening keynote, Bratzler discussed recent developments in the Surgical Care Improvement Project and looked at where the project is going in the future. Bratzler discussed SCIP and how far it has come since 2003, and showed how the project has continued to hone its performance measures. While developing a sound process of care is part of the goal, he said, there is also the matter of taking care of patients’ needs. “Patients don’t go to a hospital for a good process of care, they want a good outcome,” Bratzler said.
John Paige, MD Chauvin and Paige showed that change comes not merely through a new set of rules, but through establishing a process and culture of change within a facility. Change follows stages, both at the individual level and on the organizational side. “Change is not an event, it’s a process,” Chauvin said. “It’s about continually getting better at what we do.” Paige highlighted Chauvin’s discussion on change by using his own System for Teamwork Effectiveness in Patient Safety (STEPS) project as an example. Through an AHRQ grant, Paige developed an immersive surgical simulation program that put OR teams to work in their own operating rooms. Through this type of simulation, OR teams were able to work on communication skills and anticipatory response to various situations in a real-life setting. “Training and improvement is a change process,” Paige said, “and that’s what we’re trying to do with the STEPS project.” There is an unknown potential for patient safety improvement through an effective and efficient system for identifying medical devices. Crowley discussed the FDA’s efforts to develop a system for identifying medical devices, and provided insight as to what it takes to do so. Currently there is no standardized identification for medical supplies or devices, such as surgical instruments, supplies or even domestic items like toothbrushes. This can make tracking an item that has been recalled or replaced somewhat difficult. “Everyone in the system comes up with their own way of doing things, so there’s no one way of finding something,” Crowley said. “We need a system that is going to consistently, unambiguously identify a device.” Congress signed into law in September 2007 a provision for which the FDA could begin to develop that identification system. Crowley said his group is looking at a three- to five-year implementation process, with a personal goal of having the final regulations in place in about two years. The future of patient safety is not simply going come through cutting-edge technology or new processes, but through effective leaders who can inspire their peers to improve. “It’s not going to be about basically getting the numbers, it’s going to be about the improvement,” Denham said. “And we aren’t going to have the improvement without the leaders.” Though the Centers for Medicare & Medicaid Services will implement a pay for performance program in October, it doesn’t account for the human element of patient safety. “There’s no reimbursement code for teamwork or for leadership,” Denham said. But that doesn’t mean that great change can be the result of caring leaders who work to make a difference.
Some of the greatest advancements in surgical safety have come through teamwork at all levels. Makary showed historical examples of how teamwork and leadership have made a difference in the surgical field. It is through conversation and collaboration that healthcare professionals can work together to improve patient outcomes. “There are conversations going on at this conference that are advancing patient safety far more than any journal article,” Makary said, “because you are talking with each other here.” Makary applauded the World Health Organization’s Patient Safety Checklist, and talked about how improved processes and tools at a universal level will lead to more advancements than issues such as pay for performance. “I think it’s an exciting time in healthcare, and I think we’re seeing discussions on the topic of patient safety that we’ve never seen before,” Makary said.
The Geisinger Experience – Quality in the OR Staff at Vanderbilt University Hospital in Nashville, Tenn., worked to build collaboration and a sense of partnership throughout the facility. The Geisinger Health System in northeastern and central Pennsylvania worked to bring in an electronic health record, along with “ProvenCare CABG,” an evidence-based practice system for acute surgical care. Members from both organizations showed how their efforts effected change. “Really we see this opportunity to further align our work with the World Health Organization Patient Safety Checklist that just came out,” Beauchamp said.
Influence is the most powerful tool possessed by a human being, Maxfield told attendees during the Symposium’s final session. Maxfield discussed his research for his latest title, “The Influencer,” and how certain techniques in leadership can have a profound effect. It is often a matter of finding vital behaviors within a culture that can be adjusted to build toward improvement. “The problem is we live in a quick-fix world looking for ‘silver bullet’ answers to complex problems,” Maxfield said. Creating change is a challenge, but with the right techniques from an “over-determined” individual, anything is possible. There isn’t always one answer to a problem, but a combination. Finding the right elements and motivating people to change is what really makes a difference. “It’s not which solution,” Maxfield said, “it’s how many you can combine together.” Read more news in AORN Connections. |
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