Thrive at Work case study: SWANS
Redesigning work to improve communication and efficiency in Perth hospitals
How 3-5 minutes a day could save Perth hospitals millions.
The SWANS (Surgical Work Team Advanced Non-Technical Skills) project is a research initiative that investigates how non-technical skills (e.g. decision making, communication) affect surgical, staff, and cost outcomes.
The research was funded by the Western Australia Department of Health to understand the impact of multi-professional team briefings on hospital outcomes. This case study outlines the diagnosis, intervention and organisational outcomes resulting from SWANS research1.
Australian studies have shown that 22 percent of surgeries experience an “adverse event”. Of these events, it is estimated that 48% are preventable, and of these, 70% are the result of communication failure.
As well as being important for reducing risks to patient safety, communication is also important for efficiency, employee job satisfaction and engagement, and team tension.
Yet preventing communication breakdowns in surgical teams can be a challenge for several reasons.
First, the teams are multi-professional, involving nurses, surgeons, anaethistists. Having a diversity of knowledge and experience is necessary, and allows treatment to be informed by a diverse group of specialised professionals. However, when not managed effectively, multidisciplinary teams can be susceptible to communication breakdowns as each discipline can have different ways of communicating.
Second, many teams lack stability. It is not always guaranteed that surgical team members will have worked together in the past. In fact, sometimes team members may not even know each other’s names before the surgery. Lack of familiarity can make it more difficult to know their own and others’ roles, and make more difficult to predict each other’s behaviour.
Third, there are quite strong hierarchies in surgical teams, and differences in power. Strong hierarchies can make it difficult for the lower power groups to feel able to speak up.
Researchers at the University of Western Australia were engaged to assist in the evaluation of an intervention to address the problem of communication failures during surgery. The team observed operating room behaviour, conducted surveys and interviews with surgical staff and analysed organisational data related to efficiency at four major hospitals in Western Australia.
After consultation with relevant stakeholders, multi-professional briefings were introduced to three WA hospitals. Multi-professional briefings are 3-5 minute meetings before the start of an operating list. The meetings are held before the first patient is brought into theatre and involve all team members working in the operating theatre, including surgeons, nurses, technicians and anaesthesiologists.
There are two key aims of multi-professional briefings. First, they act to facilitate information sharing by allowing all team members to discuss their professional opinions, develop contingency plans in the event of surgical complications and determine their role in the team, all of which reduce ambiguity. In this way, briefings ensure all team members are on the same page, working to a common goal and are aware of how to get there.
The second function of multi-professional briefings is to open communication channels among team members. This is particularly important for teams who have not previously worked together. Breaking down communication barriers helps team members feel more comfortable raising concerns, which allows problems to be identified and resolved more efficiently. Briefings set the tone for the day and contribute to a culture of collaboration and team work.
‘Briefings personally changed my perspective on being a surgeon as before I felt just like a contract labourer doing my job, but briefings helped me to express and connect with my workplace a lot better.’ (Surgeon)
A clear and structured briefing procedure was introduced to assist the process.
Data indicates that these 3-5 minute multi-professional briefings are associated with several positive outcomes. These include:
- Increased operating theatre efficiency: fewer delays in theatre turn around, less time wasted waiting for appropriate equipment to become available, and less time between anaesthetising the patient to completing the surgery.
- Economic efficiencies: the efficiency gains provided by briefings has the potential for significant financial advantages. Based on highly conservative figures used in the research, it is estimated that if the program was adopted by all surgical teams in Western Australia, the efficiencies would equate to $3,257,375.84 saved annually.
- Patient safety: safety communication between surgical staff enhanced the effectiveness of briefings. This in turn, resulted in improved safety outcomes for patients
- Theatre staff engagement: the introduction of briefings lead to a significant increase in inter-professional communication. In addition, the quality of briefings and staff engagement were related, with staff reporting higher levels of engagement when participating in higher quality briefings.
‘This project has significantly contributed to an improved culture of communication in theatre in our hospital. The briefings definitely improve efficiency, avoid problems and improve the work of the team.’ (Anaesthetist Consultant)
These findings show that investing just 3-5 minutes a day can have significant and wide-reaching outcomes, including financial, patient care and staff satisfaction. Though briefings may not be appropriate for all organisations, the SWANS case demonstrates the significant impact that small, targeted and achievable interventions can have on organisational benefits.
Based on highly conservative figures used in the research, it is estimated that if the program was adopted by all surgical teams in Western Australia, the efficiencies would equate to $3,257,375.84 saved annually.
Parker, S. K., Rammohan, A., Griffin, M., Flemming, A. F. S., Hamdorf, J., Leung, Y., … Yam, C. (2018). Success in the operating theatre: Multidisciplinary pre-operative briefings for efficiency, patient safety, and staff engagement. Australia.