A number of different initiatives were subsequently introduced to refocus attention on patient safety. These included mandating minimum nurse-to-patient ratios, reducing working hours, care bundles that improve patient outcomes, safety checklists, advances to the science of simulation and teamwork training.
Team-based approaches are particularly significant, as inconsistencies in treatment have often been attributed to high turnovers in staff. Trials are currently underway to measure the success of:
- Simulation - ranging from simple bench-top models to task simulators, virtual reality simulators and simulated operating or labour suites for training and assessment of entire clinical teams.
- Standardisation – creating a consistent means of assessing core skills and performance.
- Team training – involving three core activities - leading (over years), managing (over months) and coaching (daily)
- CPT - establishing routines on a long-term basis, objective standards and checklists.
Healthcare as a team objective
Both industries share common issues. Both operate in an environment characterised by stress, heavy workloads, often high-risk situations and high stakes decision-making with very consequential errors.
This team-based training recognises that humans have limited capabilities and that, when human limitation meets environmental complexity and constant stress, errors become inevitable.
As teams, rather than individuals, deliver healthcare success is dependent on the quality and effectiveness of communication, as well as monitoring and co-ordination, within the team. If the clinical environment, team effectiveness or individual clinicians compromise these, concentration will be diverted and safety and efficiency will be affected detrimentally.
What makes an effective team?
With these obvious and objectively measureable success factors, it is relatively easy to reflect whether the team has achieved its goals.
Other factors, which are often overlooked, include the happiness of the team, their commitment to team goals and their ability to pull together as to improve performance together.
Team training – when and how?
Neily and colleagues carried out a clinical study across 108 hospitals in the USA looking at the impact of team training. It documented an overall 18% reduction in post-operative mortality in the intervention hospitals.
But the only way to achieve these levels of success is through systematic team training.
There needs to be a shift from training on real patients to simulation-based training where actual team members train together in a simulated operating theatre environment. Here they can rehearse and perfect effective responses to catastrophic and/or rare crises and introduce novel interventions such as the World Health Organisation (WHO) checklist.
Improving and standardising assessment
The BJA recommends that regulations are in place to ensure that assessments are fair and reliable, that valid feedback is provided in an effective and sensitive manner. It also suggests that faculty and trainers should undertake extensive training, demonstrate a minimum level of proficiency, and hold an accreditation to apply these measures in practice.
Finally, it recommends that healthcare provider selection should be based on evidence of appropriately validated tasks, and the concept of assessment/selection of the centres should be introduced across specialities, including acute care, surgery and anaesthesia.