Safer Australian Surgical Teamwork – Human Factors in Action

My blog, ‘In Safe Hands – Flying High’, described the importance of good communication and teamwork and the importance of these non-technical skills or human factors in ensuring patient safety.

Recently, I had the privilege of being involved in an initiative, ‘Safer Australian Surgical Teamwork’ (SAST) conducted through the Royal Australasian College of Surgeons (RACS) aimed at improving non-technical skills within surgical teams. RACS have conducted programs in non-technical skills for surgeons (NOTSS) for a number of years using the work of industrial psychologist, Rhona Flin from Aberdeen University. Flin’s work also involved identifying anaesthetic non-technical skills (ANTS) and scrub practitioner list of non-technical skills (SPLINTS).

Seeking to broaden the original NOTSS program and develop a program that included all members of the surgical team, RACS invited representation from ACORN, Australian College of Nursing (ACN) and Australian & New Zealand College of Anaesthetists (ANZCA) to participate in a working party to develop a series of human factors workshops conducted at selected rural centres around Australia.

I was honoured to be invited to represent ACORN alongside Elissa Shaw, with fellow perioperative nurses Vicky Warwick, Emma Woodhouse and Rona Tranberg representing ACN. The combined working party met at RACS HQ in Melbourne several times to develop the content and identify presenters for each workshop, organise venues and travel plans. As the whole program was government funded through Rural Health Continuing Education, the venues selected were Albany (WA), Darwin (NT), Bega (NSW) and Traralgon (Vic).

A team, the RACS Faculty, comprising of an anaesthetist, surgeon, one or two nurses and a RACS Project Manager facilitated each workshop.

The presentations, aimed at exploring team dynamics, reflected the non-technical skills identified by Flin’s work in each discipline – situation awareness, communication, teamwork, task management, decision making and leadership.

I presented ‘Situation Awareness’ in Traralgon and at two workshops in Darwin (photo shows  me with Vicky Warwick and NT ACORN Director, Sharon Harding) – quite a contrast in temperature and the sand flies saw me coming in NT causing a very uncomfortable week as I desperately tried to find a relief for the itchy bites! I did find it interesting (and at times challenging) to present to interdisciplinary groups, I wasn’t sure how the surgeons and anaesthetists in particular would react to the content, but there were some great experiences shared which added to the richness of discussions. There was some amusing banter between the disciplines, along with some robust discussion and overall I came away energised by the openness of the groups to embrace new ideas and strategies for improving their local teamwork. I also had the chance to meet new people, caught up with old nursing buddies and enjoyed working with such a committed group of surgeons, anaesthetists and perioperative colleagues, all of whom gave their time voluntarily to participate in this exciting project.Vicky Warwick and Sharon Harding in Darwin

Participants in each centre were restricted to 15 to allow for plenty of interaction and ensure an even spread from each discipline. A combination of didactic sessions, group work, video scenarios, and observational assessments were greeted enthusiastically by all the participants. The evaluations were very positives with participants identifying the following ‘take home’ messages:
• greater team involvement in Time Out process
• get to know your team
• reduce distractions during important phases of surgery (‘sterile cockpit’)
• recognise fatigue amongst team members
• have confidence to speak up and contribute to patient safety

Hopefully the positive evaluations will lead to further funding and more workshops across the country. In particular, it is hoped that local champions for human factors can be identified, so that ‘in house’ human factors workshops can be conducted.

I invite you to view some of the websites related to human factors and keep an eye out for future workshops at your hospital.

Clinical Human Factors Group

Scrub Practitioners List of Non-Technical Skills (SPLINTS)

bye for now
Menna