The Highly Reliable Surgical Team - Essay Example

Partial fulfillment of the requirements for the degree of Bachelor of Arts Surgical Safety and the Highly Reliable Surgical Team by Randall Rentschler 36617 Blanca Ave Madera, Ca. 93636 Tom Schindler Dr.Breck Harris Organizational Leadership 32 May 27, 2009 Abstract Patient safety is more than a local hospital, state government, and national political mandate. It can also be viewed as a worldwide concern. In late 1999 the Institute of Medicine released its report "To Err Is Human: Building a Safer Health System". According to estimates from the Agency for Healthcare Research and Quality, the cost (gleamed from research in 2001-2002) of preventable medical errors that occur during or after surgery is nearly $1.5 billion a year. (Medical News Today, 2008) The World Health Organization (WHO) also seems to understand the safety concerns and the cost associated with intra-operative error. They have in concert, along with their "Safe Surgery Saves Lives Challenge" developed a surgical checklist (World Health Organization, 2009) as part of a global push to improve surgical patient safety and outcomes. Table of Contents Abstractii The Highly Reliable Surgical Team1 Purpose of the Thesis3 Setting of the Problem3 History and Background of the Problem7 Scope of the Thesis8 Importance/Significance of the Thesis8 Definition of Terms10 Chapter I: HRST Intention The main goals are: improve safety of surgical patients undergoing procedures at Kaiser Permanente, Fresno and improvement of surgical safety attitudes of both physicians and OR staff resulting in an environment that will decrease risk to patients undergoing surgical intervention and further maintain a "no never events" record. Purpose of the Thesis The purpose of this thesis is to develop alternative methods to ensure 100% compliance with the use of a surgical briefing; exceeding the requirements of Joint Commission's "Universal Protocol" (The Joint Commission , 2009) by OR staff members and physicians utilizing the surgery department at Kaiser Permanente Fresno, California. Setting of the Problem Although surgical safety is more than a local challenge, only addressing individual behaviors and habits at a local level can raise the threshold to decrease significant surgical mishaps. Kaiser Permanente OR staff and surgeons are comprised of very well seasoned and experienced caregivers. As new concepts come to light, it can be challenging for those individuals to perceive the benefit of incorporating what is viewed as unnecessary, time consuming and laborious steps to prevent errors when they may not have had any personal history of such errors. Kaiser Permanente is a very complex, highly structured healthcare system and as such, has a high degree of formalization within the organization. This is can be seen demonstrated throughout the local, regional, national offices and medical centers. In addition Kaiser Permanente is comprised of three distinct businesses: Kaiser Foundation Hospitals and their subsidiaries (KFH), and the Kaiser Foundation Health Plan (KFHP) which are both not for profit corporations. The Permanente Medical Group (TPMG) which consists of eight separate physician groups, is a for profit enterprise. Kaiser Permanente has 37 Medical Centers and 400 medical offices nationally. Northern California is their largest region, which accounts for 20 Medical Centers. Kaiser Permanente Fresno has 5 distinct medical office buildings (MOB) located between Selma and Oakhurst California. The Fresno Medical Center has a complement of 169 licensed beds, 8 surgical suites with an additional 2 labor and delivery suites. The facility provides both inpatient and ambulatory surgical care, which is facilitated by 200 physicians, 500 plus nurses, along with 80 medical support staff, servicing 108,000 members. There is currently a goal to integrate and adopt all regional job descriptions at the local levels. There are national, regional, as well as local policy and procedures covering many aspects of the organization. These are in addition to multiple complex union contracts. These contracts dictate norms and expectations for both management and covered employees. This begins to demonstrate how complex the system is spatially, has well as the how complex the organizational chart is both horizontally and vertically even at the local level (see Appendix A). The staff hierarchy and intra-departmental structure demonstrates that some surgeons still believe in the "Captain of the Ship" doctrine. "Essentially, this doctrine holds that the surgeon's mere presence in the OR makes him or her legally responsible for everything that happens there, regardless of whether he or she has any ability to control the actions of others" (Murphy, 2001, p. 48). On the other hand, other surgeons see the nurse and scrub technologists more as peers and part of a cohesive team. In reality, the RNs have responsibility for the care delivered in the surgical suite; they are the patient advocates. The RN is required to oversee and direct the care of the surgical technologist, nursing assistance or other non-licensed staff as mandated by the Nurse Practice Act in California. The Kaiser system has much more individual control over the medical staff. There is a more defined hierarchy and authority as physicians can be seen as employees in some regards. This is a much different model when compared to the private practice providers who could be compared to independent private contractors. This is more common in non-Kaiser healthcare environments and practitioners many times are privileged in more than one facility. The Kaiser model lends itself to improved participation with surgical safety and the national patient safety goal mandates. The legitimate physician leadership in the department stems from a physician leader who oversees the various surgical chiefs who then oversee the surgical specialties. This is similar in structure, to some extent, to the nursing leadership where a department manager reports up to an area service director who reports up to the chief nursing officer (See appendix Z). This results in increases in the influence and communication that both structures benefit from. History and Background of the Problem There are over 700 surgical interventions per month, in a wide variety of specialties, which contribute to the relevant and real circumstances of this thesis. There are over 150 different levels of participation, with different education levels and experience. Each of these individuals brings their own intense personality while providing high levels of safe patient care. The interface is complicated by the need to meet regional financial and efficiency metrics. This also must be accomplished while meeting patient's expectations and adherence to the team's three goals: Service: " Our cause is health. Our passion is service. We're here to make lives better." Mission: "The Kaiser Permanente Medical Center-Fresno seeks to satisfy the health care needs of our members by providing accessible, affordable, comprehensive services of high quality." Lastly, Vision: "Kaiser Permanente Medical Center-Fresno will be the model for health care delivery by setting the standard for quality, service, and affordability within the communities we serve." This means that the surgical team can be diverse itself with relativistic influences, but is brought together by the common goal of the medical center's vision. Because of the high number of surgeries performed per year by the facility, making sure the surgical team understands each other's needs and differences is key to developing a reliable team. While different personalities can come into play and cause conflict, where health as well as life and death can be concerned, it is extremely important to ensure that the team can work together both efficiently and effectively to meet their goals. Scope of the Thesis The thesis will be limited to Kaiser Permanente Fresno Surgical Department and the associated professional staff. The thesis will be conducted concurrently within the Fresno Pacific University Organizational Leadership "Cohort 32" class time lines. Importance/significance of the Thesis Surgical safety within the organization is paramount. If surgical safety is not practiced, a wide variety of repercussions can occur, including disease and infection for the patient. In order to provide the best surgical service necessary, it is important to make sure that the surgical team has been taught and trained to successfully interact and function as a team. A minor misunderstanding can result in an extreme side effect for a patient. Therefore, the surgical team must make sure that it has proper communication skills, as well as the ability to effectively interact in order to meet the goals and guidelines of each procedure performed. The importance of a successful, communicative, motivated surgical team in a hospital environment cannot be overlooked; failure to meet safety requirements can have dire consequences leading to sever medical issues for the patient. Therefore, the team must be trained to work as an effective safety unit, and as a whole, while taking into account the individual needs and differences of each individual member. Communication is especially vital to this process, as good communication ensures an effective and complete surgery by the team. Definitions of Terms HRST........Highly Reliable Surgical Team KFH.........Kaiser Foundation Hospital KFHP........Kaiser Foundation Health Plan MOB.........Medical Office Building OR..........Operating Room RFO.........Retained Foreign Object RN..........Registered Nurse SCIP........Surgical Care Improvement Project TPMG........The Permanente Medical Group WHO.........World Health Organization Reference: Institute of Medician. (1999, November). The National Academies Press. (J. M. Linda T Kohn, Editor) Retrieved May 17, 2009, from To Err is Human: http://www.iom..edu/Object.file/Master/4/117/ToE rr-8pager.pdf Leape, L. L. (2000, March 18). PubMed Central. Retrieved May 17, 2009, from BMJ:British Medical Journal: http://pubmedcentral.inh.gov/articalrender.fcgia rtid=1117747 Partners LLC. (2008, March). Improving Paient Safety and Quality Care. 1.2. Memphis , Tennessee, USA. News Today. (2008, July 29). Retrieved May 17, 2009, from MediLexicon International limited: ttp;//www.medicalnewtoday.com/articles/11637.php Murphy, E. K. (2001). Captian of the Ship. AORN , 74 (4), 525. Quality Interagency Coordination task force. (1998). Quality Interagency Coordination QuIC task force. Retrieved May 17, 2009, from QuIC: http://www.quic.gov/index The Joint Commission . (2009, May 12). The Joint Commission. Retrieved May 12, 2009, from Universal Protocol for Prevention for preventing wrong site, wrong procedure, wrong person surgery: http;//www.JointComission.org/PatientSafety/Unvers alProtocol/ U.S. Department of Health and Human Services. (2009, March 27). Patients' Bill of Rights Too Tough to Read. Retrieved May 17, 2009, from womenshealth.gov: http://www.womenshealth.gov/news/English /624592.htm World Health Organization. (2009). World Health Organization. Retrieved May 13, 2009, from WHO / Safe Surgery Saves Lives: http://who.int/patientsafety/safesurgery/en Appendix A Read More