Attendees laugh, cry, learn at motivational general sessions: Sunday, March 30, to Thursday, April 3, 2008

AORN Journal, June, 2008

Attendees at the 55th AORN Congress General Sessions were frequently in tears, both from laughing and crying. In spite of the emotional punch of the sessions--or perhaps because of it--attendees connected with speakers and learned about inspiring leadership, promoting teamwork, and igniting passion for perioperative nursing.

NATIONWIDE HEALTH CARE NEEDS YOU!

We are headed toward a health care system that is information-rich and patient-focused, predicted Carolyn M. Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ). She discussed numerous 2008 AHRQ research projects and programs aimed at improving nationwide patient care during "Transparency, Transformation, and Value Creation: New Opportunities for Quality and Patient Safety Improvement." The catch, she says? "We need your input!"

The good news in today's health care market is that quality is, in fact, improving. The "less good news," Dr Clancy said, is the rate of improvement has started to slow. To combat this decline, the AHRQ is reaching out through various programs and initiatives for increased communication between patients and health care professionals. A current advertising campaign replete with scrubs-clad, singing hospital personnel urges patients to ask questions. Health care personnel should engage in "teachable moments," such as telling patients with heart disease that tobacco use significantly increases risk, Dr Clancy advised. "At the root of all of our safety issues are communication issues," she said. "[Communication] is really, really important."

One patient safety issue targeted recently in the media is wrong site surgery. Dr Clancy stressed this issue, saying wrong site surgeries occur 1,300 to 2,700 times per year in the United States, although there is very little empirical data on how to remedy the problem. In an effort to combat this and other patient safety issues, the AHRQ is working under the Patient Safety Act of 2005, which authorized the creation of Patient Safety Organizations (PSOs) to collect confidential information on patient safety events. By encouraging voluntary reporting of near misses, which are depersonalized for anonymity, patient safety can be improved.

Putting good information in people's hands is a key goal of the AHRQ, Dr Clancy said. The AHRQ Effective Health Care Program offers "current, unbiased evidence" that directly compares various health interventions, and the John M. Eisenberg Clinical Decisions and Communications Science Center offers descriptions in layman's terms. To simplify medical issues, the AHRQ web site gives patients the bottom line first, then more detailed evidence.

Compiling usable data under the umbrella of health information technology (IT) has been an agency priority since 2004 and is a current industry hot topic. The goal is to make health IT easier, because it will fundamentally change the industry, Dr Clancy noted, but for now, it is a difficult process.

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"The work before you is local," Dr Clancy advised, "we are not going to get you better health care until we get to the point that it's a team sport."

KIMBERLY RETZLAFF

ASSOCIATE EDITOR

SIMULATION TRAINING IMPROVES TEAMWORK

During "Transforming the OR Team Through Simulation Training," John Paige, MD, discussed the importance of teamwork in the OR. He introduced simulation training as a way to promote safer ORs through enhanced teamwork.

The perception of a team's communication is not viewed in the same way by all team members. To demonstrate the disconnect in perceptions, Dr Paige cited a study by Sexton et al. The study authors found that depending on which OR team member they asked, the perception of teamwork was different.

When asked to "rate the quality of teamwork and communication," different percentages of respondents reported high levels of teamwork with surgical consultants:

* surgical consultants--64%

* residents--73%

* anaesthesia residents--10%

* anaesthesia nurses--26%

* surgical nurses--28%

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According to Dr Paige, this disconnect illustrates the need for teamwork training.

"If there are conflicting ideas about the roles, then there must be a problem with the quality of communication," Dr Paige said. Team training can be effective for improving communication and promoting a team culture, which ultimately improves patient safety.

Dr Paige explained that highly reliable teams are able to perform effectively, reliably, and consistently every time. These teams embrace a culture of safety--placing safety as their primary priority--and are given the necessary resources to ensure safety. Highly reliable teams adapt to change, maintain open and flexible communication, and anticipate the needs of team members.

The goal of human factors engineering is to design systems that people can use safely and effectively and to help teams become highly reliable. Human factors engineers study human behavior to optimize the relationship between humans and systems. According to Dr Paige, several points are fundamental to the human factors theory: