Evaluation of the effect of multidisciplinary simulation-based team training on patients, staff and organisations: protocol for a stepped-wedge cluster-mixed methods study of a national, insurer-funded initiative for surgical teams in New Zealand public hospitals

Abstract

IntroductionNetworkZ is a national, insurer-funded multidisciplinary simulation-based team-training programme for all New Zealand surgical teams. NetworkZ is delivered in situ, using full-body commercial simulators integrated with bespoke surgical models. Rolled out nationally over 4 years, the programme builds local capacity through instructor training and provision of simulation resources. We aim to improve surgical patient outcomes by improving teamwork through regular simulation-based multidisciplinary training in all New Zealand hospitals.Methods and analysisOur primary hypothesis is that surgical patient outcomes will improve following NetworkZ. Our secondary hypotheses are that teamwork processes will improve, and treatment injury claims will decline. In addition, we will explore factors that influence implementation and sustainability of NetworkZ and identify organisational changes following its introduction. The study uses a stepped-wedge cluster design. The intervention will roll out at yearly intervals to four cohorts of five District Health Boards. Allocation to cohort was purposive for year 1, and subsequently randomised. The primary outcome measure is Days Alive and Out of Hospital at 90 days using patient data from an existing national administrative database. Secondary outcomes measures will include analysis of postoperative complications and treatment injury claims, surveys of teamwork and safety culture, in-theatre observations and stakeholder interviews.Ethics and disseminationWe believe this is the first surgical team training intervention to be implemented on a national scale, and a unique opportunity to evaluate a nation-wide team-training intervention for healthcare teams. By using a pre-existing large administrative data set, we have the potential to demonstrate a difference to surgical patient outcomes. This will be of interest to those working in the field of healthcare teamwork, quality improvement and patient safety. New Zealand Health and Disability Ethic Committee approval (#16/NTB/143).Trial registration numberAustralian and New Zealand Clinical Trials Registry ID ACTRN12617000017325 and the Universal Trial Number is U1111-1189-3992.

Psychometric properties of the Chinese version of the TeamSTEPPS teamwork perceptions questionnaire to measure teamwork perceptions of Chinese residents: a cross-sectional study

“…[7][8][9][10][11] As there is a great need in improving patient safety and healthcare quality, team training has been widely recognised to enhance teamwork. [12][13][14][15] However, health professionals today are not competent in teamwork, and team training has not attracted the attention of medical institutions. [16][17][18] The Chinese Hospital Association has reported that adverse patient events consumes extensive medical resources every year in Chinese healthcare institutions.…”

Analysis of medication errors during anaesthesia in the first 4000 incidents reported to webAIRS

“…However, they also provide testimony to the challenges faced in anaesthesia: anaesthetists are often required to undertake parallel processing in relation to current, previous and impending patients, while also teaching, continuously assessing dynamic clinical situations and at the same time interacting with surgeons and other staff. NetworkZ and the Effective Management of Anaesthetic Crises courses are examples of important initiatives to improve communication and the management of factors such as these during anaesthesia in general, 25,26 but perhaps more thought is needed on how to do this effectively in the context of medication management in particular. Many of the reported medication errors had no consequence.…”

“…The theme of communication failures comes through strongly in our data, and this can be addressed by training in teamwork and communication, in concert with promoting the importance of these skills within departments and institutions. 25,26,49 The problem of flushing residual medication from IV lines is simply a failure in technique, and (again anecdotally) has been addressed in some institutions by an interdepartmental focus on this point of practice and the use of checklists at handover to the PACU. Somewhat similar comments apply to wrong-sided regional blocks.…”

Latent Safety Threats and Countermeasures in the Operating Theater

“…Further detail about NetworkZ courses, debriefing, instructor training, and implementation strategy is available elsewhere. 14 …”

“…NetworkZ is a multidisciplinary simulation-based in situ team training program for operating theater staff in public hospitals throughout New Zealand. 14 Its primary objective is to improve patient safety by enhancing interprofessional communication and teamwork. During the in situ simulation scenarios, systems and situational factors that may threaten patient safety were also identified.…”