Five years ago, leadership at Memorial Healthcare System in Hollywood, Fla., set their sites on reducing surgical errors and complications by improving communication in the operating room.
While the organization didn't have any major deficiencies in this area, the health system had long prided itself on patient safety as a primary focus of the institution and sought a way to further ensure safety at the organization, explains Joseph Loskove, MD, chief of anesthesia for the hospital and the healthcare system and a regional medical director in the anesthesia division of Sheridan Healthcare, a national anesthesia services provider.
Several leaders of the organization began to explore Crew Resource Management, a management method to reduce human error used by the airline industry, which had, at the time, been used with success at a few pioneering health systems including Vanderbilt University Medical Center.
In 2007, Memorial Healthcare contracted with a consulting group called Lifewings, which trains healthcare organizations on CRM, and began training Memorial's surgeons and OR staff on the new initiative. CRM engages physicians and staff in process improvement and standardization to reduce errors, and encourages all members of the OR team to speak up if they have a concern. The new standardized process introduced included a pre-procedure briefing before each OR procedure to ensure the surgeon, anesthesiologist and staff confirmed the name of the patient, type of procedure, equipment needed, etc. While this is an accepted best practice today, Memorial Healthcare attempted to make this commonplace two years before the World Health Organization introduced its Surgical Safety Checklist.
While the CRM system and its mandatory "time out," did face some initial pushback from surgeons, within a year, the OR at flagship Memorial Regional Hospital had successfully implemented CRM. From there, the process was introduced to the system's five other ORs and periphery units, including cardiac cath labs and ICUs. Memorial Healthcare's successful implementation of CRM took place in four stages, which allowed the system to test and improve its implementation and win over reluctant physicians in the process.
1. Training. The first stage, training, sought to educate physicians and staff on how to implement CRM and why it was so important for patient care. Staff members were also trained to speak up, learning to recognize and verbalize red flags.
"There was a fair amount of pushback, but [with education] most people recognized the amount of value in it," says Dr. Loskove, "And as illustrated by our safety surveys, overall perceptions of patient safety in the OR saw increases up to 41.4 percent after CRM's implementation in 2007."
Now, any staff member in the OR has an important voice in ensuring a safe outcome for the patient by voicing his or her concern by saying, "Delta," which signals the surgeon to stop what he or she is doing and discuss the staff member's concern.
2. Observing. The implementation of CRM involved observing processes currently in place and then improving and standardizing them. Distractions were identified so they could be eliminated. The group then standardized the items that should be discussed during pre-procedure briefings and debriefings.
"It gives us a framework for conversation," Dr. Loskove says, explaining that a significant culture change has occurred at the health system, and he believes it has resulted in fewer errors and improved patient safety.
3. Building tools. Once the best practices were standardized, Memorial Healthcare's CRM implementation team developed tools to reinforce the initial CRM training. They put posters, signs and other guides in place to clearly communicate procedures and processes that aim to help keep patients safe.
"What I've really found most valuable about it is it forces everyone to stop what they're doing and pay attention to the plan," says Dr. Loskove.
4. Maintaining. After CRM's initial success at Memorial Regional, CRM training was deployed at other OR sites. During this stage, the anesthesiologists played a key role in introducing the initiative, as they worked across sites and had seen its initial success. Now that CRM is used at multiple sites, its use is maintained by training new employees in those units on CRM. By 2011, over 4,397 physicians and hospital staff members had been CRM-trained.
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While the organization didn't have any major deficiencies in this area, the health system had long prided itself on patient safety as a primary focus of the institution and sought a way to further ensure safety at the organization, explains Joseph Loskove, MD, chief of anesthesia for the hospital and the healthcare system and a regional medical director in the anesthesia division of Sheridan Healthcare, a national anesthesia services provider.
Several leaders of the organization began to explore Crew Resource Management, a management method to reduce human error used by the airline industry, which had, at the time, been used with success at a few pioneering health systems including Vanderbilt University Medical Center.
In 2007, Memorial Healthcare contracted with a consulting group called Lifewings, which trains healthcare organizations on CRM, and began training Memorial's surgeons and OR staff on the new initiative. CRM engages physicians and staff in process improvement and standardization to reduce errors, and encourages all members of the OR team to speak up if they have a concern. The new standardized process introduced included a pre-procedure briefing before each OR procedure to ensure the surgeon, anesthesiologist and staff confirmed the name of the patient, type of procedure, equipment needed, etc. While this is an accepted best practice today, Memorial Healthcare attempted to make this commonplace two years before the World Health Organization introduced its Surgical Safety Checklist.
While the CRM system and its mandatory "time out," did face some initial pushback from surgeons, within a year, the OR at flagship Memorial Regional Hospital had successfully implemented CRM. From there, the process was introduced to the system's five other ORs and periphery units, including cardiac cath labs and ICUs. Memorial Healthcare's successful implementation of CRM took place in four stages, which allowed the system to test and improve its implementation and win over reluctant physicians in the process.
1. Training. The first stage, training, sought to educate physicians and staff on how to implement CRM and why it was so important for patient care. Staff members were also trained to speak up, learning to recognize and verbalize red flags.
"There was a fair amount of pushback, but [with education] most people recognized the amount of value in it," says Dr. Loskove, "And as illustrated by our safety surveys, overall perceptions of patient safety in the OR saw increases up to 41.4 percent after CRM's implementation in 2007."
Now, any staff member in the OR has an important voice in ensuring a safe outcome for the patient by voicing his or her concern by saying, "Delta," which signals the surgeon to stop what he or she is doing and discuss the staff member's concern.
2. Observing. The implementation of CRM involved observing processes currently in place and then improving and standardizing them. Distractions were identified so they could be eliminated. The group then standardized the items that should be discussed during pre-procedure briefings and debriefings.
"It gives us a framework for conversation," Dr. Loskove says, explaining that a significant culture change has occurred at the health system, and he believes it has resulted in fewer errors and improved patient safety.
3. Building tools. Once the best practices were standardized, Memorial Healthcare's CRM implementation team developed tools to reinforce the initial CRM training. They put posters, signs and other guides in place to clearly communicate procedures and processes that aim to help keep patients safe.
"What I've really found most valuable about it is it forces everyone to stop what they're doing and pay attention to the plan," says Dr. Loskove.
4. Maintaining. After CRM's initial success at Memorial Regional, CRM training was deployed at other OR sites. During this stage, the anesthesiologists played a key role in introducing the initiative, as they worked across sites and had seen its initial success. Now that CRM is used at multiple sites, its use is maintained by training new employees in those units on CRM. By 2011, over 4,397 physicians and hospital staff members had been CRM-trained.
The impact
As evidenced through safety culture survey scores a year following the implementation of CRM training, Memorial's outcomes have included improved quality and safety, reduced untoward outcomes and sentinel events, and improved patient experience and satisfaction. Physician satisfaction also increased substantially in every category, including perception of overall quality, place to practice, patient safety, teamwork, collaboration with nursing and communication with nursing. Communication openness, for instance, increased at one Memorial hospital OR by 48.1 percent and at another hospital OR by 40.5 percent. Dr. Loskove says he personally has experienced several situations where CRM and a scripted briefing uncovered errors that would not have been recognized before the introduction of CRM.More Articles on Reducing Medical Errors:
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