Background: Positive deviance (PD) seminars, which have shown excellent results in improving the quality of surgical practices, use individual performance feedback to identify team members who outperform their peers; the strategies from those with exemplary performance are used to improve team members' practices. Our study aimed to use the PD approach with arthroplasty surgeons and nurses to identify multi disciplinary strategies and recommendations to improve operating room (OR) efficiency. Methods:We recruited 5 surgeons who performed high-volume primary arthroplasty and had participated in 4-joint rooms since 2012, and 29 nurses who had participated in 4-joint rooms and in at least 16 cases in our data set. Three 1-hour PD sessions were held in February and March 2021: 1 with surgeons, 1 with nurses, and 1 with both surgeons and nurses to select recommendations for implementation. The sessions were led by a member of the nonorthopedic surgical faculty who was familiar with the subjects discussed and with PD seminars. To determine the success of the recommendations, we compared OR efficiency before and after implementation. We defined success as performance of 4 joint procedures within 8 hours.Results: Eleven recommendations were recorded from the session with nurses and 7 from the session with surgeons, of which 11 were selected for implementation. During the month after implementation, there were great improvements across all time intervals of surgical procedures, with the greatest improvements seen in mean anesthesia preparation time in the room (4.51 min [26.3%]), mean procedure duration (9.75 min [14.0%]) and mean anesthesia finish time (5.78 min [44.0%]) (all p < 0.001). The total time saved per day was 49.84 minutes; this led to a success rate of 69.0%, a relative increase of 73.8% from our 2012-2020 success rate of 39.7% (p < 0.001). Conclusion:The recommendations and increased motivation owing to the individualized feedback reduced time spent per case, allowing more days to finish on time. Positive deviance seminars offer an inexpensive, efficient and collegial means for process improvement in the OR. Contexte :Les séminaires de déviance positive (DP), une approche qui a déjà donné d'excellents résultats en termes d'amélioration de la qualité des pratiques chirurgicales, recourent à la rétroaction sur le rendement individuel pour identifier les membres des équipes dont le rendement excède celui de leurs pairs; les stratégies associées à tout rendement exemplaire servent à améliorer les pratiques des membres des équipes. Notre étude visait à utiliser la DP comme approche pour les chirurgiennes et chirurgiens et le personnel infirmier spécialisés en arthroplastie afin d'identifier des stratégies et des recommandations multidisciplinaires pour améliorer l'efficience des blocs opératoires (BO). Méthodes : Nous avons recruté 5 spécialistes dont le volume d'interventions pour arthroplastie primaire était élevé et qui oeuvraient dans des blocs à 4 interventions chirurgicales depuis 2012, et 29 membres du pers...
Background Smoking among young adults is often associated with social contexts and alcohol use. While many countries, including New Zealand, have prohibited smoking inside licensed premises, outdoor areas have enabled smoking and alcohol co-use to persist. We examined whether and how outdoor bar areas facilitate and normalise young adult smoking, and explored potential policy implications. Methods We conducted in-depth interviews with 22 young adults who had recently smoked in a New Zealand bar or nightclub and investigated how physical design attributes (atmospherics) influenced experiences of smoking in outside bar settings. We used qualitative description to identify recurring accounts of the outdoor bar environment and thematic analysis to explore how participants experienced the bar in relation to smoking. Results Participants valued outdoor smoking areas that were comfortable and relaxing, and saw attributes such as seating, tables, heating, protection from inclement weather, and minimal crowding, as important. We identified four themes; these explained how participants used smoking to gain respite and make social connections, showed how bar settings enabled them to manage smoking’s stigma, and identified potential policy measures that would decouple smoking and alcohol co-use. Conclusions Evidence bar environments facilitate and normalise smoking among young adults questions whether smokefree policies should be expanded to include all bar areas. Introducing more comprehensive smokefree outdoor policies could reduce the influence of design attributes that foster smoking while also reframing smoking as outside normal social practice. Implications Bar environments contain many stimuli that cue and reinforce smoking, and integrate smoking into social experiences. Expanding smokefree bar settings to include outdoor areas would reduce exposure to these stimuli, decrease opportunities for casual smoking, help maintain young people’s smokefree status, and support longer-term goals of sustained reductions in smoking prevalence.
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