The Operating Theatre Journal July 2022

Table Five Five – NHS England – NHS responses England to Human responses Factors question. to Human Factors question.
Region
Discussion
The literature to support a greater understanding of how human
factors affect the use of the safer surgery checklist is still emerging.
The review to date is not intended to be exhaustive but allowed
the researcher to think of and to begin framing further questions,
identify some of the contextual issues and plan for further doctoral
level investigations. The use of a simple audit was borne out of our
curiosity to see to what extent human factors is influencing the use of
the safer surgery checklist, especially in these unprecedented times
of a large elective surgical backlog.
Sensitivity: Internal
Number
of
Trusts
Contextually we can anticipate that never events in the NHS and
indeed in healthcare globally will continue to remain a constant
yet stubborn patient safety concern, in part as a result of workload
stress, staff shortages, and the fast pace required to deliver health
care partly caused by the COVID-19 pandemic and possibly the war
in Ukraine. Surgery takes place within optimum conditions, and part
of those conditions is having a theatre team equipped and ready to
question one another, openly and honestly without fear of reprisal.
Whilst it was not an intention to undertake comparison, there was
very little literature on what ‘culture’ in the operating theatre means,
and how we best tackle it to further improve team working, thus
operating in as safer environment as possible. In reality, this is more
complex, and requires further research. Interestingly to note that four
out of the seven regions stated staff attitude as the biggest human
factor when it comes to compliance of the safer surgery checklist.
This was the second category by only a mere 2% when compared to
NHS England.
If NHS England is split into three, The North, South and Midlands
there are clear differing human factors affecting the completion of
the safer surgery checklist.
The North – Culture, The South - Staff Attitude and the Midlands –
Leadership.
Conclusion
Responses
by region
Percentage
of
responses
by region
Number of
responses
by 25 th
March
2022
Number of
responses
by 1 st April
2022
Number of
responses
by 8 th April
2022
Number of
responses
by 15 th
April 2022
Number of
responses
by 22 nd
April 2022
London 22 41% 4 1 2 2 0
Southwest 15 53% 2 5 0 1 0
Southeast 20 55% 3 3 2 2 1
Midlands 21 38% 6 0 1 1 0
East 15 27% 1 2 0 1 0
Northwest 22 41% 4 1 2 1 1
Northeast & 21 39% 3 2 0 2 1
Yorkshire
Total 136 23(17%) 14(10%) 7(5%) 10(7%) 3(2%)
In summary, today’s NHS and infact global health systems are under
extreme pressure to deliver elective activity, due to the huge
increases in waiting list times caused by the COVID-19 pandemic
and possibly the war in Ukraine. It is certain and unavoidable that
theatre teams will be under pressure to finish the operating lists and
avoid cancellations. This can’t happen at the expense of increasing
risk along the patients pathway. We must ensure that the system is
not ‘set up to fail’ by hospital management and all/any problems are
recognised and tackled at source. Healthcare is complex and relies
on ‘people’ not to fail, to work as part of both a multi-disciplinary
and inter-disciplinary team and to effectively communicate. Kalantari
et al. (2021) study concluded by saying the current tools contain
assessments of all operating room team members mostly in the
domains of situational awareness, leadership, communication and
teamwork.
Even though it is not part of this literature review or thesis, we must
consider as part of the review/research, institutional/organisational
factors that may contribute to never events, not just in the operating
theatres, but wards, clinics and other treatment areas. Greenberg et
al. (2007) and Griffen et al. (2007, both cited in Nugent et al., 2013)
studies have shown that the majority of surgical errors occur outside
of the operating room, before or after surgery. The operating theatre
environment is an area of conflicting aims and goals between the
multi-disciplinary and inter-disciplinary teams and the organisation.
Conflict may arise from when the organisations quality improvement,
finance and transformation teams want to maximise efficiency and
productivity without fully considering the potential impact on the
wider teams. Moss et al. (2013, cited in Koleva, 2020) raised another
important issue for consideration, reduction of ‘turn-around’ times
and cost cutting, which may impact on safety. The findings from Moss
et al. (2013) study have never been so pertinent in the NHS, given the
huge backlog of elective procedures requiring surgery and the impact
this has on the economy, patients life expectancy and quality of life.
Parker et al. (2011) and Waeschle et al. (2015, both cited in Koleva,
2020) suggest that the origins of surgical error were found in unsafe
culture, outdated structural environments and equipment, nonexistence
of clinical standards and leadership, poor practice and
low personnel density. A study by Moppett and Moppett (2016, cited
in Koleva, 2020) examined 742 surgical ‘never events’ within 158
Trusts between April 2011 and March 2013. There were 12.1 million
operations performed in 3200 operating rooms. 504 ‘never events’
were reported. The findings reported was 28% cases of wrong site
surgery, wrong implant/prosthesis was 14% cases and retained
surgical objects accounted for 58% of the never events reported.
The study yielded the positive correlation between caseload and
‘never events’. This is an interesting point, as the findings previously
mentioned by NHS Resolution (2021) reported between the 1st April
2015 to 31st March 2020 totalled 389 claims, that were paid out for
retained foreign objects post-surgery, a combination of 90% were
either surgical instruments or swabs.
7
NHS England (2012, cited in Koleva, 2020) suggested that it is the
governing and political opinion that repeated ‘never events’ illustrate
a failure of the organisational leadership, predominantly clinical
leadership to consider patient safety seriously. This statement is still
true a decade later, the audit from across NHS England has highlighted
that the main human factors as to why the safer surgery checklist is
still not fully adhered to are leadership, culture and staff attitude.
The literature review yielded very little in terms of culture. Additional
research needs to be undertaken into this topic surrounding operating
theatres. No further clarification or explanation was given by the
respondents in terms of how or why they perceive culture as being
the biggest contributor, as to why the safer surgery checklist does not
get completed.
The safer surgery checklist on its own does not offer quality and
safety. This is the teams role. The checklist is one piece of the jigsaw,
the other pieces need to fit to complete the picture. These are
communication, resources, human factors and time.
Figure one one – The – The pieces pieces needed needed for safe for surgery. safe surgery.
Human factors
Leadership
TEAMWORK
Resources
Communication
The next diagram is an overview from the findings of the literature
reviews from the safer surgery checklist, LocSSIPs and Human Factors.
Champions
Staff
Compliance
The diagram feedback on page thirty is an overview from the findings Audit of & Review the literature
LocSSIPs
2015
reviews from the safer surgery checklist, LocSSIPs and Human Factors.
Empowerment
of teams
Implementation
Teamwork
Leadership
Situation
Awareness
Sensitivity: Internal
Local
champions
Communication
Leadership
Education and
Learning
Human
Factors / Nontechnical
skills
Continual
Education
NatSSIPs and
WHO
Checklist
2009
Training
Monitoring of
Sharing of
incidents/lessons
learnt
S S Checklist
per speciality
Culture
Barriers
Open & Honest
Customised
Continued on next page
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Time
Attitudes t
Blame-free
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