A human factors intervention in a hospital - evaluating the outcome of a TeamSTEPPS program in a surgical ward

Abstract

Background Patient safety in hospitals is being jeopardized, since too many patients experience adverse events. Most of these adverse events arise from human factors, such as inefficient teamwork and communication failures, and the incidence of adverse events is greatest in the surgical area. Previous research has shown the effect of team training on patient safety culture and on different areas of teamwork. Limited research has investigated teamwork in surgical wards. The aim of this study was to evaluate the professional and organizational outcomes of a team training intervention among healthcare professionals in a surgical ward after 6 and 12 months. Systems Engineering Initiative for Patient Safety 2.0 was used as a conceptual framework for the study. Methods This study had a pre-post design with measurements at baseline and after 6 and 12 months of intervention. The intervention was conducted in a urology and gastrointestinal surgery ward in Norway, and the study site was selected based on convenience and the leaders’ willingness to participate in the project. Survey data from healthcare professionals were used to evaluate the intervention. The organizational outcomes were measured by the unit-based sections of the Hospital Survey of Patient Safety Culture Questionnaire, and professional outcomes were measured by the TeamSTEPPS Teamwork Perceptions Questionnaire and the Collaboration and Satisfaction about Care Decisions in Teams Questionnaire. A paired t-test, a Wilcoxon signed-rank test, a generalized linear mixed model and linear regression analysis were used to analyze the data. Results After 6 months, improvements were found in organizational outcomes in two patient safety dimensions. After 12 months, improvements were found in both organizational and professional outcomes, and these improvements occurred in three patient safety culture dimensions and in three teamwork dimensions. Furthermore, the results showed that one of the significant improved teamwork dimensions “Mutual Support” was associated with the Patient Safety Grade, after 12 months of intervention. Conclusion These results demonstrate that the team training program had effect after 12 months of intervention. Future studies with larger sample sizes and stronger study designs are necessary to examine the causal effect of a team training intervention in this context. Trial registration number ISRCTN13997367 (retrospectively registered).

Longitudinal team training program in a Norwegian surgical ward: a qualitative study of nurses’ and physicians’ experiences with implementation

“…The participants experienced an impact of the team training program on the ward's patient safety culture in forms of a higher level of awareness about how to work together as a team and openly communicate within and between professional groups. This is also supported by both qualitative [14] and quantitative research results from studying the implementation of the current team training program [27,28]. Our study results further indicate that the implementation process maintained psychological safety at the ward, which, according to Edmondson [29], is needed to improve patient safety.…”

Use of the Hospital Survey of Patient Safety Culture in Norwegian Hospitals: A Systematic Review

“…Six studies involved interventions [ 24 , 25 , 26 , 27 , 28 , 29 ]. One of these intervention studies reported greater improvement than the others [ 25 ].…”

“…Other intervention studies also reported improvements, but these were generally weaker and reported a shorter intervention period. Aaberg et al [ 24 , 28 ] found improvement in three HSOPSC dimensions in their two studies: “Teamwork within unit”, “Manager expectations and actions promoting patient safety”, and “Communication openness”. Storm et al [ 27 ] focused their interventions at the interorganizational level.…”

“…Hence, organizations should never take the challenge of improving and changing patient safety culture lightly. The included intervention studies demonstrated that interventions most often improve very few of the HSOPSC dimensions [ 24 , 26 , 27 , 28 ]. Hence, interventions at the team and department levels will normally not improve all of the HSOPSC dimensions.…”

“…J. Anaesth. 10.1093/bja/aet005 Journal Article M. Storm; J. Schulz; K. Aase [ 27 ] 2018 Patient safety in transitional care of the elderly: Effects of a quasi-experimental interorganisational educational intervention BMJ Open 10.1136/bmjopen-2017-017852 Journal Article Oddveig Reiersdal Aaberg, Marie Louise Hall-Lord, Sissel Iren Eikeland Husebø & Randi Ballangrud [ 28 ] 2021 A human factors intervention in a hospital—evaluating the outcome of a TeamSTEPPS program in a surgical ward BMC Health Services Research volume 21, Journal Article P. G. Farup [ 33 ] 2015 Are measurements of patient safety culture and adverse events valid and reliable? Results from a cross sectional study BMC Health Serv.…”