None listed
Conditions
Brief summary
This project evaluates the effectiveness of the NetworkZ training intervention for operating room (OR) staff in all DHBs in New Zealand (NZ). The aim of the intervention is to improve outcomes for surgical patients, and improve teamwork in the OR. Our primary hypothesis is that NetworkZ will lead to improved scores for Days Alive and out of Hospital (DAOH) at 90 days. The NetworkZ training is for staff in general, orthopaedic, urological, plastics, and ENT/ORL surgery in all DHBs in New Zealand. Each training session will be provided by accredited instructors to multidisciplinary teams of about 10 staff. The training comprises realistic simulations of challenging surgical cases, debriefs of the cases, and discussions of specific teamwork and communication strategies. The training focusses on shared mental models, structured communication, and mutual respect and trust. The NetworkZ training will be rolled out through all NZ DHBs in four cohorts of five DHBs over a period of five years. We will conduct a concurrent evaluation throughout using a stepped wedge cluster research design. This design will allow us to compare pre- and post-intervention cohorts, and enhance our capacity to separate training effects from long term trends and changes in the DHBs. Staff interviews will seek to identify factors that assist or inhibit the implementation of NetworkZ training in the different DHBs. Primary Outcome Measure: Days Alive and Out of Hospital (at 90 days). This looks at patients who are alive AND the number of days they are out of hospital, in the 90 days following surgery. We will also analyse mortality, and days out of hospital separately. The data for this analysis will be drawn from the NMDS. Secondary Outcome Measures: Post-surgical complications from the NMDS.Number and costs of post-surgical treatment injury claims, from ACC data base. Safety Climate pre-post intervention survey using the Surgical Culture Safety Survey developed and validated by the Harvard School of Public Health. Teamwork perceptions pre-post intervention survey, using a tool we have custom-designed to measure NetworkZ training processes. The quality of implementation of the Safe Surgery Checklist pre-post intervention, measured by the WHOBARS observation instrument, which we have previously developed and validated. The number and proportion of OR staff trained in the DHBs. Interview data exploring the organisational implementation process in the DHBs and how staff apply the training in their OR work. (Framework Analysis).
Interventions
NetworkZ is team-training intervention designed to improve information sharing between team members, improve communication strategies and develop mutual respect and trust between Operating Room (OR) staff.
The educational framework used is the Salas Model of effective teams. Whole operating room teams participate in immersive, simulated surgical cases where the challenges to teamwork and communication are amplified in order to demand optimal processes and expose deficiencies. Each simulation is
NetworkZ is team-training intervention designed to improve information sharing between team members, improve communication strategies and develop mutual respect and trust between Operating Room (OR) staff. The educational framework used is the Salas Model of effective teams. Whole operating room teams participate in immersive, simulated surgical cases where the challenges to teamwork and communication are amplified in order to demand optimal processes and expose deficiencies. Each simulation is followed by a structured debrief, led by trained and accredited simulation instructors, exploring reactions, clarifying scenario details to ensure a shared understanding of what happened, exploring what actually happened and why, and drawing lessons on communication and teamwork to apply to clinical practice. The debrief lasts approximately 45 minutes. Simulation based training is supported by communication skills training comprising four separate 30 minute workshops on the principles of teamwork and shared mental model; speaking up; closed loop communication; and structured recap. Workshops include videos, slide presentations and small group discussion. The communication skills training is delivered by trained and accredited NetworkZ instructors at the DHB. The simulator used is a 3G Laerdal Simman, set in a simulated or real operating room environment, and integrated with realistic custom-designed surgical models of trauma or pathology requiring a specific clinical response. All patient notes, laboratory investigations, equipment, drugs, fluids and consumables such as surgical drapes, gowns, gloves and masks will be provided as in a real theatre case. The simulated cases will be modelled on real life cases, and include up to 25 different surgical scenarios in the disciplines of general surgery, ENT/ORL, urology, plastics and orthopaedics. A full team training intervention comprises 1 full day of simulations, debriefs and discussion. In each day, there will be 4-5 simulations and debriefs. Simulations will be chosen from the 25 available scenarios based on the participants attending the session. As nursing, technician and anaesthesia staff work across all of the surgical disciplines portrayed in the scenarios. choice of scenario will be based on the discipline of the surgeon or surgeons attending any particular course, also ensuring that participants have not previously been exposed to that scenario. The intervention will be delivered at each District Health Board (DHB) in New Zealand and may be run either in existing operating theatres or in a purpose built simulation facility. The intervention will be progressively rolled out across all 20 DHBs over a 5 year time frame, in four cohorts with five DHBs in each. Cohorts are matched for DHB size. Cohort 1 training commenced on 3 March 2017. Cohort 2, 3, and 4 training will commence at 12 month intervals between 2018 and 2020. The intended start date for each new cohort is 1 February. In practice there may some delays in the start date in each cohort. Delivery of the intervention is by trained, accredited instructors. The Project team will deliver the initial courses at each DHB and train local staff as instructors through a structured training programme with ongoing monitoring and support. Course quality will be monitored and assured through a central accreditation process, instructor networks and instructor exchange. The NetworkZ team training days will be ongoing on a regular basis in each DHB, with an expectation that all OR staff will participate in a full course at least once every five years. We aim to train the majority of NZ OR staff during the course of this project and estimate that this will be over 6000 operating theatre staff. The intervention will run from 3 March 2017, beginning in Cohort 1, and will continue until the training is running in all four Cohorts (i.e. all DHBs in New Zealand). The pre-intervention period will be defined as the period of 12 months prior to the commencement of training in that Cohort. The implementation period will be 15 months following the commencement of training in that Cohort. The post-intervention period will be 12 months following the implementation period in that Cohort. Our primary outcome measure, Days Alive and out of Hospital will be measure at 90 days post surgery for all patients undergoing surgery in New Zealand public hospitals. The measurement will be from 12 months prior to the intervention in Cohort 1 to 12 months after the implementation period in Cohort 4 (plus 90 days for surgical case data). Because of the 90 day post-surgery follow-up we will continue to collect data for each DHB for 90 days after the measurement period has ended
Sponsors
Professor Jennifer Weller
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Healthy volunteers
Yes
Inclusion criteria
Eligibility for the training and staff surveys and observations: All staff working in ORs to provide general, orthopaedic, urological, plastics, and ENT/ORL surgery in NZ. The main staff groups who will be included are: surgeons, surgical trainees, anaesthetists, anaesthetic trainees, anaesthetic technicians, anaesthetic technician trainees, and theatre nurses. We will also include some staff who have a managerial interest in the implementation of NetworkZ training in their DHB, including directors of surgery, directors of nursing, and quality managers. Eligibility for patient outcome measure: all patients having surgical procedures with anaesthesia that are listed in the procedural codes of the Health Quality and Safety Commission (HQSC) Perioperative Mortality Review Committee (PMRC), involve the previously defined surgical disciplines and are operated on in a public hospital operating room in New Zealand
Exclusion criteria
Exclusion criteria for training and evaluation: Some junior medical staff that have not commenced specialised training in anaesthesia or surgery, such as house officers, may be present in the teams that we observe and rate, but we will not seek to gather survey information from them in relation to our two staff safety culture surveys. The same will apply to Health Care Assistants, who may or may not be involved in OR work. Exclusion criteria for surgical cases: minor procedures (i.e. patients who had their operation under local infiltration only).
Outcome results
None listed