​Initiatives that combine teamwork training and systems interventions are more effective than implementing either approach alone, according to a study published in the January 2017 Annals of Surgery [subscription required]. Most interventions to improve patient safety in surgery have taken two distinctly different approaches: providing training to improve teamwork and communication or approaching it through systems analysis. However, the authors said, no studies have addressed which of these approaches works best. The authors conducted five identically designed controlled before-and-after studies aimed at improving patient safety in the operating room. The four-month interventions involved all staff in the operating theater and used teamwork training (TT), systems redesign and standardization (SOP), Lean quality improvement, SOP and TT combined, and Lean and TT combined. In all, they reviewed 453 operations (255 with some sort of intervention, 198 control). The two combined interventions (SOP plus TT, Lean plus TT) improved performance in all measures except World Health Organization's (WHO) time-out attempts. TT alone improved nontechnical skills and WHO compliance but not technical performance. The two systems interventions (SOP, Lean) improved nontechnical skills and technical performance but saw less improvement in WHO compliance. Essentially, the TT led to improved attitudes among staff, the authors said, but did not empower them to change by building an understanding of systems improvement. The systems-based interventions had the opposite results. The findings make sense, the authors said, because safety in clinical settings relates to the three interacting dimensions of culture, system, and technology. "The combined interventions were more successful because they achieved both motivation and empowerment," the authors said.

HRC Recommends: Healthcare organizations are complex systems. System safety analysis is used to enhance safety by analyzing and identifying hazards and to design safety into the system so that hazards are eliminated or reduced. Teamwork training—when supported by a strong organizational culture of safety—can promote open communication among providers and reduced risk to patients. Risk managers may wish to investigate ways to offer team training and improve skills in systems analysis.