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New operating room training to improve teamwork

Fuseworks Media
Fuseworks Media

A realistic pilot training simulation for operating room staff designed to test and improve teamwork skills, has found many positive improvements result from the new communication training.

The teamwork training pilot, developed by researchers at the University of Auckland and the first such model for improving operating room teamwork, is being rolled out to the first district health boards around New Zealand with a second round planned to begin soon.

The pilot intervention known as MORSim (Multi-disciplinary Operating Room Simulation) was funded by Health Workforce NZ.

This year the Accident Compensation Corporation (ACC) agreed to fund the training project into all district health boards over the next five years with $4.8 million for the first 10 DHBs and a further $4.8 million in 2018.

"Unintended patient harm is a major contributor to poor outcomes for surgical patients and often reflects failures in teamwork," says lead researcher, Associate Professor Jennifer Weller from the University of Auckland, in a paper published today in the NZ Medical Journal.

"To address this we developed the MORSim intervention to improve teamwork in the operating room and piloted it with 20 operating room teams from two of New Zealand’s 20 district health boards."

Associate Professor Weller is the director of the Centre for Medical and Health Science Education at the University of Auckland.

The latest study describes the MORSim experience of participants in the pilot, details the challenges to implementing changes in clinical practice and offers suggestions for making the programme a success.

In an editorial, published today in the same issue of the NZ Medical Journal, the Head of Surgery at the University of Auckland, Professor Ian Bissett says one of the outcomes from the MORSim pilot of concern was that compared with other members of the surgical teams, none of the participating surgeons reported using new communication strategies despite this being a major part of the training.

In the NZMJ editorial he says "In general, we surgeons see ourselves as the leaders of the operating room teams, deciding who needs surgery and putting the patients on the lists. It would be expected that surgeons would have the most to gain by improving communication and teamwork in the operating room."

"Despite this, none of the interviewed surgeons volunteered that they had implemented the communication tools presented."

"We, as surgeons, need to recognise that we may not be as good at communication as we think that we are," says Professor Bissett. "If it can be demonstrated that this is a matter of patient safety one hopes it will stimulate us to be more engaged in the whole process."

"Modern operating requires the close cooperation of all operating room members who are each expert in their own field," he says. "The recent initiative by the RACS, ‘Let’s operate with respect’, was introduced in response to the revelation of widespread discrimination, bullying and sexual harassment in surgery."

"This has recognised that much of what has happened in the operating room has not demonstrated the mutual respect that is a foundation of teamwork. Addressing this can only improve the communication and culture of work in the operating room," says Professor Bissett.

He says the country-wide introduction of MORSim "requires careful assessment of communication skills, attitudes and clinical outcomes."

"We have an opportunity as a country to show that we can change communication and attitudes in operating room teams and that these changes translate into better clinical outcomes for patients," says Professor Bissett. "If this can be achieved it will provide a model that should be transferrable internationally. The MORSim team are to be applauded for taking on this challenge."

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