GOALS: identified principles, behaviors, and systems needed to improve surgical communication and leadership supporting a highly reliable and sustainable culture of safety.
Premise:
1. Well-designed policies and procedures should support both reliability as well as resilience through adaptation.
2. The surgical team is fluid- membership may vary based on the immediate situation of the patient. Secondarily there is the necessity for changing situational leadership based on domain expertise. It is expected that the surgeon will be the leader in the absence of necessary team adaptation based on situation and expertise.
3. Surgical teams must be reliable during routine events and resilient during stressful events.
4. Communication depends on a shared mental model.
5. Administrative leadership must support all efforts in these models.
To foster the optimal performance and well-being of all team members they culture must account for the individual, the team and the situation/system.
1. Recommendations regarding individuals:
a. Education in personal resilience begin in medical school and continue thru training.
b. Research on fatigue management be supported at the federal level (including performance variability due to fatigue, stress recognition among providers, effect of new care transitions to patient care, effect of introduced changes on providers.
c. MOC and research support devoted to provider resilience
2. Recommendations regarding teams:
a. Basic teamwork skills applicable to patient care beginning in undergraduate medical education.
That persists throughout postgraduate training.
b. MOC dedicated to advanced teamwork training
c. Surgical Team training with formal programmatic implementation led locally by surgical team leaders. This should be accompanied by reassessment and reinforcement devoted towards internalizing teamwork behaviors into unit culture and maintain sustainability.
3. Recommendations regarding Clinician-patient communication skill building:
a. Training on communication skills in undergraduate medical education with reinforcement using simulation and feedback as in GME.
b. MOC to ensure skills components in communication are reinforced.
4. Regarding the system:
a. All institutions embrace a restorative Just Culture model including a Second Victim support system.
b. All healthcare institutions should recognize that behavior is contextually bound and measurement techniques should assess “work as done” as opposed to “work as imagined” and applied to optimize both provider performance and well-being.
5. Creation of Performance Standards and Certificate Creation in Patient Safety curriculum.
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