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PLoS One. 2015 Sep 18;10(9):e0138490. doi: 10.1371/journal.pone.0138490. eCollection 2015.

Quality Improvement in Surgery Combining Lean Improvement Methods with Teamwork Training: A Controlled Before-After Study.

Author information

1
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
2
Saïd Business School, University of Oxford, Oxford, United Kingdom.
3
Warwick Medical School, University of Coventry and Warwick, Warwick, United Kingdom.
4
Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom.
5
Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Red de Investigación de Servicios Sanitarios en Cronicidad (REDISSEC), Madrid, Spain.

Abstract

BACKGROUND:

To investigate the effectiveness of combining teamwork training and lean process improvement, two distinct approaches to improving surgical safety. We conducted a controlled interrupted time series study in a specialist UK Orthopaedic hospital incorporating a plastic surgery team (which received the intervention) and an Orthopaedic theatre team acting as a control.

STUDY DESIGN:

We used a 3 month intervention with 3 months data collection period before and after it. A combined teamwork training and lean process improvement intervention was delivered by an experienced specialist team. Before and after the intervention we evaluated team non-technical skills using NOTECHS II, technical performance using the glitch rate and WHO checklist compliance using a simple 3 point scale. We recorded complication rate, readmission rate and length of hospital stay data for 6 months before and after the intervention.

RESULTS:

In the active group, but not the control group, full compliance with WHO Time Out (T/O) increased from 14 to 71% (p = 0.032), Sign Out attempt rate (S/O) increased from 0% to 50% (p<0.001) and Oxford NOTECHS II scores increased after the intervention (P = 0.058). Glitch rate decreased in the active group and increased in the control group (p = 0.001). Complications and length of stay appeared to rise in the control group and fall in the active group.

CONCLUSIONS:

Combining teamwork training and systems improvement enhanced both technical and non-technical operating team process measures, and were associated with a trend to better safety outcome measures in a controlled study comparison. We suggest that approaches which address both system and culture dimensions of safety may prove valuable in reducing risks to patients.

PMID:
26381643
PMCID:
PMC4575036
DOI:
10.1371/journal.pone.0138490
[Indexed for MEDLINE]
Free PMC Article

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