Sara J Singer1, George Molina2, Zhonghe Li3, Wei Jiang4, Suliat Nurudeen5, Julia G Kite6, Lizabeth Edmondson7, Richard Foster8, Alex B Haynes2, William R Berry3. 1. Harvard TH Chan School of Public Health, Boston, MA; Harvard Medical School, Mongan Institute for Health Policy, Boston, MA; Massachusetts General Hospital, Boston, MA. Electronic address: ssinger@hsph.harvard.edu. 2. Ariadne Labs, Boston, MA; Massachusetts General Hospital, Boston, MA. 3. Harvard TH Chan School of Public Health, Boston, MA; Ariadne Labs, Boston, MA. 4. Brigham and Women's Hospital, Boston, MA. 5. Ariadne Labs, Boston, MA; Brigham and Women's Hospital, Boston, MA. 6. Harvard TH Chan School of Public Health, Boston, MA. 7. Ariadne Labs, Boston, MA. 8. South Carolina Hospital Association, Columbia, SC.
Abstract
BACKGROUND: Studies show that using surgical safety checklists (SSCs) reduces complications. Many believe SSCs accomplish this by enhancing teamwork, but evidence is limited. Our study sought to relate teamwork to checklist performance, understand how they relate, and determine conditions that affect this relationship. STUDY DESIGN: Using 2 validated tools for observing and coaching operating room teams, we evaluated the association between checklist performance with surgeon buy-in and 4 domains of surgical teamwork: clinical leadership, communication, coordination, and respect. Hospital staff in 10 South Carolina hospitals observed 207 procedures between April 2011 and January 2013. We calculated levels of checklist performance, buy-in, and measures of teamwork, and evaluated their relationship, controlling for patient and case characteristics. RESULTS: Few teams completed most or all SSC items. Teams more often completed items considered procedural "checks" than conversation "prompts." Surgeon buy-in, clinical leadership, communication, a summary measure of teamwork overall, and observers' teamwork ratings positively related to overall checklist completion (multivariable model estimates from 0.04, p < 0.05 for communication to 0.17, p < 0.01 for surgeon buy-in). All measures of teamwork and surgeon buy-in related positively to completing more conversation prompts; none related significantly to procedural checks (estimates from 0.10, p < 0.01 for communication to 0.27, p < 0.001 for surgeon buy-in). Patient age was significantly associated with completing the checklist and prompts (p < 0.05); only case duration was positively associated with performing more checks (p < 0.10). CONCLUSIONS: Surgeon buy-in and surgical teamwork characterized by shared clinical leadership, open communication, active coordination, and mutual respect were critical in prompting case-related conversations, but not in completing procedural checks. Findings highlight the importance of surgeon engagement and high-quality, consistent teamwork for promoting checklist use and ensuring a safe surgical environment.
BACKGROUND: Studies show that using surgical safety checklists (SSCs) reduces complications. Many believe SSCs accomplish this by enhancing teamwork, but evidence is limited. Our study sought to relate teamwork to checklist performance, understand how they relate, and determine conditions that affect this relationship. STUDY DESIGN: Using 2 validated tools for observing and coaching operating room teams, we evaluated the association between checklist performance with surgeon buy-in and 4 domains of surgical teamwork: clinical leadership, communication, coordination, and respect. Hospital staff in 10 South Carolina hospitals observed 207 procedures between April 2011 and January 2013. We calculated levels of checklist performance, buy-in, and measures of teamwork, and evaluated their relationship, controlling for patient and case characteristics. RESULTS: Few teams completed most or all SSC items. Teams more often completed items considered procedural "checks" than conversation "prompts." Surgeon buy-in, clinical leadership, communication, a summary measure of teamwork overall, and observers' teamwork ratings positively related to overall checklist completion (multivariable model estimates from 0.04, p < 0.05 for communication to 0.17, p < 0.01 for surgeon buy-in). All measures of teamwork and surgeon buy-in related positively to completing more conversation prompts; none related significantly to procedural checks (estimates from 0.10, p < 0.01 for communication to 0.27, p < 0.001 for surgeon buy-in). Patient age was significantly associated with completing the checklist and prompts (p < 0.05); only case duration was positively associated with performing more checks (p < 0.10). CONCLUSIONS: Surgeon buy-in and surgical teamwork characterized by shared clinical leadership, open communication, active coordination, and mutual respect were critical in prompting case-related conversations, but not in completing procedural checks. Findings highlight the importance of surgeon engagement and high-quality, consistent teamwork for promoting checklist use and ensuring a safe surgical environment.
Authors: Erin M Corsini; Jessica G Y Luc; Kyle G Mitchell; Nadine S Turner; Ara A Vaporciyan; Mara B Antonoff Journal: Surg Today Date: 2019-05-29 Impact factor: 2.549
Authors: Eli M Cahan; Henry C Cousins; Joshua T Steere; Nicole A Segovia; Matthew D Miller; Derek F Amanatullah Journal: Bone Joint J Date: 2021-02 Impact factor: 5.082
Authors: Mary E Brindle; Caraline McDiarmid; Kristin Short; Kathleen Miller; Ali MacRobie; Jennifer Y K Lam; Megan Brockel; Mehul V Raval; Alexandra Howlett; Kyong-Soon Lee; Martin Offringa; Kenneth Wong; David de Beer; Tomas Wester; Erik D Skarsgard; Paul W Wales; Annie Fecteau; Beth Haliburton; Susan M Goobie; Gregg Nelson Journal: World J Surg Date: 2020-08 Impact factor: 3.352
Authors: Jennifer M Weller; Tanisha Jowsey; Carmen Skilton; Derryn A Gargiulo; Oleg N Medvedev; Ian Civil; Jacqueline A Hannam; Simon J Mitchell; Jane Torrie; Alan F Merry Journal: BMJ Open Date: 2018-12-16 Impact factor: 2.692
Authors: Shehnaz Alidina; Gopal Menon; Steven J Staffa; Sakshie Alreja; David Barash; Erin Barringer; Monica Cainer; Isabelle Citron; Amanda DiMeo; Edwin Ernest; Laura Fitzgerald; Hiba Ghandour; Magdalena Gruendl; Audustino Hellar; Desmond T Jumbam; Adam Katoto; Lauren Kelly; Steve Kisakye; Salome Kuchukhidze; Tenzing Lama; William Lodge Ii; Erastus Maina; Fabian Massaga; Adelina Mazhiqi; John G Meara; Stella Mshana; Ian Nason; Chase Reynolds; Cheri Reynolds; Hannington Segirinya; Dorcas Simba; Victoria Smith; Christopher Strader; Meaghan Sydlowski; Leopold Tibyehabwa; Florian Tinuga; Alena Troxel; Mpoki Ulisubisya; John Varallo; Taylor Wurdeman; Noor Zanial; David Zurakowski; Ntuli Kapologwe; Sarah Maongezi Journal: Int J Qual Health Care Date: 2021-06-29 Impact factor: 2.038