Patient Safety and Teamwork in Healthcare

This assignment delves into the critical role of teamwork and effective communication in enhancing patient safety within healthcare settings, with a particular emphasis on surgical procedures. It analyzes various research studies and reports that highlight the connection between teamwork dynamics, incident reporting systems, and improved patient outcomes. The assignment explores best practices for fostering collaboration among healthcare professionals and addresses the challenges encountered in achieving seamless teamwork.

Professional- practice development
Professional- practice development
1

Professional- practice development
Professional- practice development
Introduction
Health care system is one of the highly complex systems requiring interdependency
between people (Hood, 2014). Team work is highly crucial in all the hospital
departments including operation theatre to enhance patient treatment, care as well as
safety for patients/ clients. In a health care system, multitude of health- related services
are rendered to people in all care levels including operative services by closed knit of
multi-disciplinary personnels involving surgeons, OT nurses, circulating nurses, theatre
technicians as well as other health- personnels by working together as a panel,
cooperating and respecting each other, communicating effectively and appropriately
among themselves along with sharing resources (Basavanthappa, 2010).
Nearly 50% of the errors occur in the operation theatre of a hospital. Majority of them
occurs due to improper communication (Pronovost, 2006). Hood (2014) suggested that
the hospital errors could be prevented by rendering holistic care to the patients by
following appropriate communication style, promoting health-team work along with
functioning collaboratively with other healthcare personnels (Basavanthappa, 2010).
This post discusses about the importance of team work, communication with
collaboration in a health care system; particularly in an operation theatre along with
varied methods to avoid miscommunications by analyzing an incident that has occurred
in the operation theatre of a hospital in Saudi Arabia.
2

Professional- practice development
Event of incident
A 10 year old girl has undergone liver transplantation (recipient) surgery. The donor liver
extraction has hardly taken six hours to finish late by 4 pm and then recipient surgery
was started which was a highly complicated surgery. The surgeon has extracted the
native (diseased) liver which was kept by the OT nurse in formalin without following the
guidelines given by KSA for preserving specimens. Then, the surgeon has started to
anastamose the donor liver in the recipient’s peritoneum but found that the portal vein is
too short and was also could not be repaired. He was not clear about the surgical
guidelines of KSA and has confusedly asked the nurse to take the liver out of the
formalin and wash it thoroughly to graft a vein. The circulating nurse was also not clear
about the surgical guideline to be followed here. Meanwhile, a theatre practitioner has
refused their idea of taking the diseased liver out and getting a graft in it and has also
communicated with the surgeon to call the vascular team-members, but the surgeon
was not sure about it and hence has repeated to the consultant, which was refused by
him. The surgeons and OT nurses were highly exhausted.
A practitioner who gets rotation in vascular team and also has attended a course on
‘grafting vein’ has advised the surgeon to use an artificial vein graft instead of using
formalin preserved native liver vein graft, which is absolutely not recommended.
Altogether, there were greater miscommunication between the surgeons and the nurses
and the theatre practitioner, affecting the work quality adversely. More particularly, the
surgeon, OT and circulating nurses were not clear about the surgical guidelines of KSA.
The theatre practitioner has also tried to advise the surgeon to check the graft again,
3

Professional- practice development
which he has also agreed and checked it whereas the operation room in-charge has
mentioned that it is only the surgeon’s problem but not others problem which typically
suggests that there is no team work along with miscommunication among theatre
professionals.
The theatre practitioner has prevented a major mistake of taking vein graft from formalin
preserved native diseased liver by appropriate communication with appropriate person
(surgeon). Further she has also advised the surgeon to contact vascular team who is in
rotation as well as attended vein grafting classes and has tried to work as a team and
has promoted patient safety (prevented the occurrence of harm to the patient) and has
made an appropriate timely decision and/or suggestion. The surgery succeeded; patient
survived and the surgeon was highly thankful to the theatre practitioner.
This event is considered to be near miss or narrow escape as it is an unplanned event
that has not resulted in any illnesses, damages or injuries to the patient; but has
potential to do so (Jabir et al, 2013). A fortunate break in the chain of events has
prevented the patient from fatality (National Safety Council, 2013).
In-order to maintain confidentiality, pseudonyms Raihana is used to refer patient,
Mohammed is used to indicate surgeon; Fathima to refer OT nurse, Haifa for circulating
nurse and Habiba to refer theatre practitioner; during analysis and discussion of this
incident.
Health care is like a team- sport; with teams taking care of patients (Smith, 2010,
Manser, 2009). Health care teams function in an environment that encompasses
4

Professional- practice development
increased stress, heavy work-load and high decision- making situations that ends up
with consequential errors (Salas, 2007).
The human failures as compared to the technical failures impose greatest threat to the
health care system, which is more complex as well as hazardous system (Carayon,
2010). Particularly, human factors acts as a major contributor to health- care errors
affecting patient safety (Carayon, 2010, Sevdalis et al, 2012). Human error becomes
inevitable when the human limitations combine with organizational (hospital) as well as
environmental complexity along with production and natural experience of stress;
specifically while caring sick patients, human error becomes virtually inevitable (Bion,
2012).
According to WHO (2016), human factor involves organizational, environmental, job
(stress) factors, individual and group factors which influences work behavior that directly
affecting the safety and health of patient (Carayon, 2010). Hence following factors have
been used to show how it has affected the quality of the clinical-work performance in
health-care settings; particularity operation theatre.
Organizational factors
Fathima was a newly appointed OT nurse and has also received only 2- weeks of
orientation about the hospital and hence was not clear about the surgical guidelines of
KSA to be followed in an operation theatre (OT), particularly for a liver transplantation
surgery. Though she was having an experience of more than 5 years in this field, she
was unable to manage with Saudi Arabian culture (Bion, 2012). All the health team
5

Professional- practice development
members should be trained about cultural competency with trans-cultural care (Douglas,
2012). Nurses should receive sufficient training before caring a patient, particularly in
OT (Malik, 2010). Fathima has not received any training in communication techniques
based on Saudi culture. In addition to that, most of the healthcare personnels from
different parts of the world get placed in Saudi hospitals for caring Saudi patients who
are not oriented with their culture.
The OT nurses placed in Saudi Arabian hospitals encounters a greater number of
issues and challenges that forbids them from attaining their tasks; in- regard to
client/patient care in hospital areas. Moreover, an uncontrolled rise in the admission of
patients for surgeries without increasing the postings for newer staff nurses creates
severe staff shortages (Malik, 2010). This shortage has made Fathima to scrub for
Raihana’s liver transplantation surgery in-spite of her lesser experience in Saudi culture.
Additionally, Haifa who is a circulating nurse also stood confused because she is a
diploma nurse and she has assisted for surgeries other than major transplantation
surgeries. These all depicts that the hospital was in severe shortage of nurses and was
not able to combat with less experienced staffs. Further, the professional development
of the staff-nurses could result in quality improvement that in-turn could improve the
patient care services that is rendered by the organization (Douglas, 2012). Most of the
countries have upgraded the nursing education level to at-least bachelor degree
whereas most of the staff nurses hold only diploma nursing in Saudi which might create
a negative impact on the delivery of patient cares as like Haifa (Bion, 2014).
An organizational climate indicates the organizational perception in regard to the
existing feelings with values of the organization (Basavanthappa, 2010). A trustful
6

Professional- practice development
feelings, belongingness, esteem with loyalty should exist in an organization to establish
an appropriate team work (CHSRF, 2006). But, as Fathima is not oriented to the
principles and guidelines of KSA, she doesn’t developed trustful relationships with other
theatre professionals and hence has not developed sense of belongingness which has
prohibited her from communicating with others (Douglas, 2012). Additionally, when an
organizational climate is positive in a hospital setting, it can promote higher quality care
with increased motivation between theatre professionals towards promoting the
outcomes. But, there is no positive climate for Fathima as everyone is new and others
have not communicated properly with her.
Individual factors
According to Anoosheh (2009), extreme work pressure, fatigue along with absence of
welfare services act as main impeding factors for communication between nurses,
patients and other professionals (Bion, 2014). Because of these issues along with poor
coordination, poor communication, lack of appropriate training in Saudi culture, the
donor surgery has got delayed to about 6 hours. This has also delayed the recipient
surgery to start at 4 pm which has exhausted Fathima as well as other theatre
professionals which in-turn has reduced her positive interaction with Mohammad and
others.
Most of the preservation chemicals are environmentally hazardous. Particular rules and
regulations were formulated by KSA to avoid harm (SCOT, 2014). Hence, KSA
guidelines have to be followed strictly while handling with formalin immersed native
liver. As per KSA guidelines, it is strictly prohibited to graft a vein from formalin-
immersed liver which is highly dangerous. Because of poor knowledge about KSA
7

Professional- practice development
guidelines for formalin immersed specimen along with poor communication among OT
members has made them to be confused. Hence, all the OT members should be
adequately trained about the KSA guidelines (Phillips, 2016).
Effective teamwork will have positive effect on patient safety (Hood, 2014). But, Fathima
doesn’t have any help from her colleagues. She stood confused when Mohammad
asked about the guideline of taking graft vein from native liver. Haifa has not clearly
communicated the guidelines to Mohammad, even though she knows the guideline of
KSA thoroughly (Basavanthappa, 2010). She lacked courage and empowerment to
communicate with the physician. Moreover, Habiba, the theatre practitioner too has not
communicated the guidelines appropriately and hence has delayed the surgery causing
exhaustion of Mohammad and Fathima (human factor), thus impeding the quality of
service provided (Douglas, 2012).
Ultimately, a practitioner who was skilled in vein grafting and had sufficient rotations in
vascular surgeries has communicated clearly to Mohammad. This shows that adequate
rotation of OT staffs with surplus amount of training in vascular field has made him to be
confident with his skill, which has given him adequate courage to communicate
effectively. His proficiency has saved the life of the patient which shows that organizing
conference, workshops and seminars and allowing the practitioner in rotation to other
medical and surgical areas helps them to gain adequate knowledge and skills about the
particular therapy or procedure (Alahmadi, 2009).
Team working in OT necessitates sharing of organizational goals as well as specific
roles with every team member (Zamanzadeh, 2014). The OT supervisors are
responsible for promoting positive culture among OT members, good communications,
8

Professional- practice development
effective leadership skills, understanding varied roles, assisting subordinates, giving
feedback and ultimately coordination (West, 2012, Anoosheh, 2009). It is evident in this
event that the OT supervisor has not taken any responsibility about subordinates and
was not an effective leader.
Quality Improvement Initiatives
Quality improvement initiatives functions to enhance health-care delivery by identifying
health issues, developing, implementing as well as evaluating the corrective actions and
to determine its efficiency (NIHCE, 2015). Most health organizations implement quality
improvement to reduce costs; enhance efficiency and to provide best quality care
(Basavanthappa, 2010). PDSA is a straight-forward and an iterative approach to
improve quality in a health care organization. In relation to this event, it is evident that
adequate amount of staffs were not recruited and most of the nurses available were
only diploma nurses. Hence, sufficient rotation of operation theatre staff must be
implemented to achieve improvement with development (Hood, 2014). Adequate
awareness has to be created among OT nurses by rotating their posting areas. In-order
to improve the quality in OT process, PDSA (Plan, Do, Study, Act) model is followed
here:
Plan
The motive is to promote the awareness about surgical skills among OT staffs in 15
surgical specialty hospitals, particularly in liver transplantation areas by placing them in
rotation.
9

Professional- practice development
Do
Valid measuring tool should be used to determine the awareness among 50 OT staffs;
in-regard to surgical skills; with a time period of 4 months in 15 specialty hospitals,
including transplantation units. All the OT staffs should be informed about the purposes
of tool. Every OT nurses should be rotated in all surgical theatres within four months so
as to gain experience in all the specialty areas. The OT in-charges should be
responsible for supervising OT staffs
Study
The outcomes should be collected, measured and compared with the predicted/
expected outcomes that are framed in plan phase. It should be looked for unintended
consequences, successes as well as failures.
Act
Based on the differences noted, corrective actions should be taken.
Recommendations
Awareness should be created among the OT staffs by placing them in rotations. They
should be trained about the importance of team spirit, communication, coordination and
cooperation within professionals. They should be insisted on their responsibility,
accountability and autonomy (Plaza, 2015). The staffs should be trained about the non-
verbal communication skills along with the importance of individual’s speech, behavior,
body language, etc (Basavanthappa, 2010).
Communication with health-team influences the working relationships, job satisfaction
and promotes patient safety in all areas including OT (Manser, 2009). Moreover,
diploma nurses should be slowly upgraded to bachelor’s level to enhance patient
10

Professional- practice development
treatment, safety and care. Providing orientation and training them with communication
skills based on Saudi culture can avoid errors. Providing in-service and continuous
education programs and motivating to attend workshops and conferences can improve
communication skills and in-turn team work which is crucial in a healthcare setting
(Hood, 2014).
Higher qualification with professional enhancement of the staff-nurses could ultimately
result in improved patient services that are rendered in the hospital, particularly in OT
and also to enhance quality- of- patient care rendered by the staff-nurses. Nurses in
Saudi Arabia should be encouraged to conduct adequate researches to promote
evidence- based nursing practice so as to provide best quality care. OT supervisors
should be responsible for proper “briefings” of surgical checklist in OT. The 2 OT
phases of sign-in & time-out should be completed before the beginning of surgery
(Haynes, 2009). The Saudi or WHO surgical checklist should be employed to minimize
perioperative mortality (Neily, 2010).
Conclusion
Overall, poor communication, lack of effective collaboration, poor team cooperation,
lack of organization, lack of adequate staffs, poor orientation and absence of team spirit
has affected the patient adversely which could have endangered the life of the patient, if
the vascular practitioner hasn’t helped. Hence as given by Hull (2011), Global OT
team’s performance should be thoroughly assessed by every organizations that
includes communication, cooperation and back-up behavior, coordination, leadership
and team monitoring system with situation awareness (Russ, 2012). Patient safety is a
11

Professional- practice development
global challenge and hence knowledge with skills from multiple areas, including human
and organization factors should be accounted.
References
[online] Available at http://www.scot.gov.sa/pdf/ok/Directory_of_the_
Regulations_of_Organ_Transplantation.pdf [Accessed 11/11/17]
Alahmadi, H. 2009. Factors affecting performance of hospital nurses in Riyadh.
International Journal of Health Care Quality Assurance, 22(1), pp. 40-54.
Anoosheh, M., Zarkhah, S., Faghihzadeh, S. & Vaismoradi, M. 2009. Nurse–patient
communication barriers in Iranian nursing. International Nursing Review, 56, pp.243–
249.
Basavanthappa. 2010. Nursing Administration. [online] Available at
https://books.google.co.in/books?isbn=8171796710 [Accessed 11/11/17]
Bion, J.F et al. 2010. Human factors in the management of the critically ill patient. Br J
Anaesth, 105, pp. 26–33
Carayon, P. 2010. Patient Safety: The Role of Human Factors and Systems
Engineering. Stud Health Technol Inform, 153, pp. 23–46 [Accessed 11/11/17]
CHSRF. (2006). Teamwork in healthcare: promoting effective teamwork in healthcare in
Canada. Policy synthesis and recommendations- In Teamwork in healthcare: promoting
effective teamwork in healthcare in Canada: Canadian Health Services Research
Foundation. Policy synthesis and recommendations.
Directory Of The Regulations Of Organ Transplantation In The Kingdom Of Saudi
Arabia.
12

Professional- practice development
Douglas, C. 2012. Potter and Perry’s Fundamentals of Nursing- Australian version. (4th
edition). Elsevier: St. Louis, Missouri
Haynes, A.B et al. 2009. A surgical safety checklist to reduce morbidity and mortality in
a global population. N Engl J Med, 360, pp.491–9. 6.
Hood, L.J. (2014). Leddy & Pepper’s conceptual bases of professional nursing. (8th ed.).
Philadelphia, PA: Wolters KLuwer Health/ Lippincott Williams & Wilkins.
Hull, L et al. 2011. Observational teamwork assessment for surgery (OTAS): content
validation and tool refinement. J Am Coll Surg, 212, pp. 234–43
Jabir, M., Abdul-Salam, I., Suheil, D. M., Al-Hilli, W., Abul-Hassan, S., Al-Zuheiri, A., &
Souza, J. P. 2013. Maternal near miss and quality of maternal health care in Baghdad,
Iraq. BMC pregnancy and childbirth 13(1), 11.
Malik, M. R., Alam, A. Y., Mir, A. S., Malik, G. M., & Abbas, S. M. 2010. Attitudes and
perceived barriers of tertiary level health professionals towards incident reporting in
Pakistan. North American Journal of Medical Sciences 2(2), 100.
Manser, T. (2009). Teamwork and patient safety in dynamic domains of healthcare: a
review of the literature: Acta Anaesthesiologica Scandinavica. 53 (2): 143-151.
National Institute for health and care excellence (NIHCE). 2015. National Institute for
health and care excellence [online] Available at http//www.journalslibrary. nihr.ac.uk/
[Accessed 11/11/17]
National Safety Council. 2013. National Safety Council. U.S. Department of Labor.
[online] Available at http://www.nsc.org/WorkplaceTrainingDocuments/Near-Miss-
Reporting-Systems.pdf [Accessed 11/11/17]
13

Professional- practice development
Neily, J et al. 2010. Association between implementation of a medical team training
program and surgical mortality. JAMA, 304, pp. 1693–700
Phillips, N. 2016. Berry & Kohn's Operating Room Technique. [online] Available at
https://books.google.co.in/books?isbn=0323399274 [Accessed 11/11/17]
Plaza, F.C. 2015. The importance of teamwork in the operating rooms. Rev Colomb
Anestesiol, 43, pp.1–2.
Pronovost, P.J et al. 2006. Toward learning from patient safety reporting systems. J Crit
Care, 21, pp. 305–15
Russ, S et al. 2012. Observational teamwork assessment for surgery: feasibility of
clinical and nonclinical assessor calibration with short-term training. Ann Surg, 255, pp.
804–9
Salas, E et al. 2007. Managing teams managing crises: principles of teamwork to
improve patient safety in the emergency room and beyond. Theor Issues Ergon Sci, 8,
pp. 381–94
Saudi Centre for organ Transplantation (SCOT). 2014. Kingdom Of Saudi Arabia Saudi
Health Council
Smith, A.F et al. 2010. Interaction between anesthetists, their patients, and the
anesthesia team. Br J Anaesth, 105, pp. 60–8
West, M.A. 2012. Effective Teamwork—Practical Lessons from Organizational
Research. Chichester: BPS Blackwell
WHO. 2016. Technical Series on Safer Primary Care. [online] Available at
http://apps.who.int/iris/bitstream/10665/252273/1/9789241511612-eng.pdf [Accessed
11/11/17]
14

Professional- practice development
Zamanzadeh, V., Rassouli, M., Abbaszadeh, A., Nikanfar, A., Alavi-Majd, H., &
Ghahramanian, A. 2014. Factors influencing communication between the patients with
cancer and their nurses in oncology wards. Indian Journal of Palliative Care, 20(1),
pp.12.
15