Rona Patey

Anaesthetists' attitudes to teamwork and safety.

Summary A questionnaire survey was conducted with 222 anaesthetists from 11 Scottish hospitals to measure their attitudes towards human and organisational factors that can have an impact on effective team performance and consequently on patient safety. A customised version of the Operating Room Management Attitude Questionnaire (ORMAQ) was used. This measures attitudes to leadership, communication, teamwork, stress and fatigue, work values, human error and organisational climate. The respondents generally demonstrated positive attitudes towards the interpersonal aspects of their work, such as team behaviours and they recognised the importance of communication skills, such as assertiveness. However, the results suggest that some anaesthetists do not fully appreciate the debilitating effects of stress and fatigue on performance. Their responses were comparable with (and slightly more favourable than) those reported in previous ORMAQ surveys of anaesthetists and surgeons in other countries.

Rating non-technical skills: developing a behavioural marker system for use in anaesthesia

Studies of performance in medicine are often based on observation. Videotape provides a valuable tool for recording events from both real environments and simulators. When analysing observational data it is important that robust tools are used, particularly when investigating non-technical (cognitive and social) skills. This paper describes the method used to identify the key non-technical skills required in anaesthesia and to develop a behavioural marker system for their measurement. A prototype taxonomy was designed on the basis of a literature review; an examination of existing marker systems; cognitive task analysis interviews; an iterative development process involving workshops; and cross-checking in theatre. The resulting anaesthetists’ non-technical skills (ANTS) system comprises four skill categories (task management, team working, situation awareness, and decision making) that divide into 15 elements, each with example behaviours. Preliminary evaluation using ratings of videotaped scenarios indicated that the skills were observable and could be rated with reasonable agreement.

Patient safety: helping medical students understand error in healthcare

Objective: To change the culture of healthcare organisations and improve patient safety, new professionals need to be taught about adverse events and how to trap and mitigate against errors. A literature review did not reveal any patient safety courses in the core undergraduate medical curriculum. Therefore a new module was designed and piloted. Design: A 5-h evidence-based module on understanding error in healthcare was designed with a preliminary evaluation using self-report questionnaires. Setting: A UK medical school. Participants: 110 final year students. Measurements and main results: Participants completed two questionnaires: the first questionnaire was designed to measure students’ self-ratings of knowledge, attitudes and behaviour in relation to patient safety and medical error, and was administered before and approximately 1 year after the module; the second formative questionnaire on the teaching process and how it could be improved was administered after completion of the module. Conclusions: Before attending the module, the students reported they had little understanding of patient safety matters. One year later, only knowledge and the perceived personal control over safety had improved. The students rated the teaching process highly and found the module valuable. Longitudinal follow-up is required to provide more information on the lasting impact of the module.

“There is a chain of Chinese whispers …”: empirical data support the call to formally teach handover to prequalification doctors

Background: Changing patterns of work in the hospital setting mean different teams look after the same group of patients over the course of any given day. Shift handovers, or hand/sign-off, can give rise to miscommunication of critical information, a patient safety issue. How can we best prepare new doctors for handover? Methods: This was a qualitative, focus-group study, exploring the views of doctors (Foundation Year, Senior House Officers, Registrars and Consultants) and night nurse practitioners, in Aberdeen, UK. Results: Five focus groups were carried out with 21 participants. Using framework analysis, five main themes relevant to the task of effectively handing over, and how to best teach handover, emerged. These were: definition of handover; experience of handover as a junior doctor; perceptions of junior doctors’ handover skills and attitudes; systems factors, and their interaction with individual factors; and the “what” and the “how” of teaching handover. Conclusions: New doctors feel unprepared for handover and are seen as poor at handing over. Certain skills are required for effective handover, but professional attitudes are also critical. The skills identified reflect those suggested in policy documents based on expert panel views. Poor systems are a barrier to effective learning and practice. Our empirical approach adds to existing knowledge by highlighting that handover is not solely a skills-based task; there are complex interactions between individual and systems factors; and junior doctors should be prepared for handover prequalification. These data can be used to plan optimal handover teaching for medical students.

Improving patient safety through training in non-technical skills

As in aviation, education should occur early in the core curriculum

Team Communication During Patient Handover From the Operating Room: More Than Facts and Figures

Objective: This study was aimed at examining team communication during postoperative handover and its relationship to clinicians’ self-ratings of handover quality. Background: Adverse events can often be traced back to inadequate communication during patient handover. Research and improvement efforts have mostly focused on the information transfer function of patient handover. However, the specific mechanisms between handover communication processes among teams of transferring and receiving clinicians and handover quality are poorly understood. Method: We conducted a prospective, cross-sectional observation study using a taxonomy for handover behaviors developed on the basis of established approaches for analyzing teamwork in health care. Immediately after the observation, transferring and receiving clinicians rated the quality of the handover using a structured tool for handover quality assessment. Handover communication during 117 handovers in three postoperative settings and its relationship to clinicians’ self-ratings of handover quality were analyzed with the use of correlation analyses and analyses of variance. Results: We identified significantly different patterns of handover communication between clinical settings and across handover roles. Assessments provided during handover were related to higher ratings of handover quality overall and to all four dimensions of handover quality identified in this study. If assessment was lacking, we observed compensatory information seeking by the receiving team. Conclusion: Handover quality is more than the correct, complete transmission of patient information. Assessments, including predictions or anticipated problems, are critical to the quality of postoperative handover. Application: The identification of communication behaviors related to high-quality handovers is necessary to effectively support the design and evaluation of handover improvement efforts.

Year 1 medical undergraduates knowledge of and attitudes to medical error

Context  To improve patient safety, medical students should be taught about human error and the factors influencing adverse events. The optimal evaluation of new curricula for patient safety requires tools for baseline measurement of medical students’ attitudes and knowledge.

Supporting transitions in medical career pathways: the role of simulation-based education

Transitions, or periods of change, in medical career pathways can be challenging episodes, requiring the transitioning clinician to take on new roles and responsibilities, adapt to new cultural dynamics, change behaviour patterns, and successfully manage uncertainty. These intensive learning periods present risks to patient safety. Simulation-based education (SBE) is a pedagogic approach that allows clinicians to practise their technical and non-technical skills in a safe environment to increase preparedness for practice. In this commentary, we present the potential uses, strengths, and limitations of SBE for supporting transitions across medical career pathways, discussing educational utility, outcome and process evaluation, and cost and value, and introduce a new perspective on considering the gains from SBE. We provide case-study examples of the application of SBE to illustrate these points and stimulate discussion.