Organization Reduces Surgical Errors

One organization in Florida sought to reduce surgical errors and complications five years ago by improving communication in the operating room.  Leaders of the organization, Memorial Healthcare System, started by exploring Crew Resource Management (CRM), which is a management method used by the airline industry to reduce human error.  This method has now been used with success at other health systems.

CRM is meant to engage physicians and staff to improve and standardize their process in order to reduce errors.  All members of the OR team are encouraged to speak up if they feel any concerns.  The new standardized process that was introduced included a procedure for briefing prior to every OR procedure.  This briefing would ensure that the entire team including the surgeon and anesthesiologist knew the name of the patient, what type of procedure was to be performed, what equipment was needed, among other things.  Memorial Healthcare attempt to implement this was two years before the Surgical Safety Checklist was introduced by the World Health Organization.

Memorial Healthcare started by contracting with a consulting group called Lifewings, which trains organizations on CRM.  Lifewings began training Memorial Healthcare’s surgeons and OR staff.  Within a year the OR at one of Memorial Healthcare’s hospitals had successfully implemented CRM.  The process was then introduced and implemented in Memorial Healthcare’s five other ORs and periphery units.

CRM was implemented in four stages, training, observing, building tools, and maintaining.

• Training – educated physicians and OR staff on the implementation of CRM and its importance for patient care.  Staff members were also encouraged to start speaking up and to learn to recognize and verbalize red flags.  OR staff members were given an important role in ensuring the safe outcome for the patient.  A staff member could signal to the surgeon to stop what s/he is doing to discuss the concern of the staff member.
• Observing – Identified and eliminated distractions.  Additionally, items that should be discussed during pre-procedure briefings and debriefings were standardized.
• Building tools – Implementing team developed tools that reinforced initial CRM training.  Memorial Healthcare used posters, signs, as well as other guides that clearly communicated procedures and processes that were aimed at helping keep patients safe.
• Maintaining – Anesthesiologists had a key role in introducing the initiative to other sites since they worked across sites.  They could vouch for CRM because they had seen its initial success.  Currently the use of CRM is maintained through the training of new employees on CRM.

Following the implementation of CRM training, safety culture survey scores have showed an improved quality and safety, a reduction in untoward outcomes and sentinel events, and improved patient experience and satisfaction.  The satisfaction of physicians has also increased in all areas including patient safety, teamwork, perception of overall quality, place to practice, collaboration with nursing, and communication with the nursing staff.  Additionally, errors that would previously not been caught are now more likely to be uncovered.

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