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Lessons From Flight Crews Can Help Surgical Teams Work Better
Date:10/19/2010

mistakes cited in that report occurred due to simple errors in judgment or because surgical teams had failed to perform standard pre-operation checks.

The Michigan study focused on a training program that includes two months of planning and preparation with each hospital's surgical staff and a day-long instruction session. At the time of its implementation, Bagian was chief patient safety officer for the Veterans Health Administration's National Center for Patient Safety.

The training emphasizes the importance of teamwork and effective communications; encourages surgeons, anesthesiologists, nurses and technicians to challenge one another if they notice safety lapses; and encourages the use of checklists to guide discussions that include preoperative briefings and postoperative debriefings.

Like NASA, operating rooms tend to be hierarchical, with the surgeon at the top. This structure means other operation room staff are sometimes hesitant to speak up, Bagian said.

"When you look at problems and adverse events in health care, most of them have as one of their major causative factors a failure of communication," Bagian said. "Based on my background in aviation and NASA, it always was stunning to me that in health care we were very casual and not rigorous in the way we communicated."

According to Bagian, prior research has also shown that physicians tend to rate themselves as good communicators, even though the rest of the OR staff doesn't necessarily agree.

Lots of workers can relate, no doubt. "The bosses think communication is great, people down the line think it's not as good," Bagian said.

To alleviate that type of disconnect, Bagian recommends briefings and debriefings, in which operating room staff get together for a few moments before a surgery to discuss concerns, anticipate challenges, and make sure they have the right tools and supplies.

Post-op debriefings were a learning tool that helped opera
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