Similarities in Surgical Errors in USA & UK: What Might These Stats and Nurse Feedback Reveal about People Skills?

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Beth Boynton, RN, MS

 

Check out these statistics from the USA and UK and see if you can see any interesting similarities.  And while you do, keep in mind the top three categories of root causes of Sentinel Events from 2010 through 2012 according to the Joint Commission are: Leadership, Human Factors, and Communication.

In May of 2013, Nicola Beckford of the BBC reported that 750 patients were victims of serious and preventable mistakes in England’s hospitals during the previous four years.  Their investigation, Freedom of Information requests to the National Health Service (NHS) trusts found that the majority of these errors fell into four categories:

  • 322 cases of foreign objects left inside patients during operation.
  • 214 cases of surgery on the wrong body part.
  • 73 cases of tubes, which are used for feeding patients or for medication, being inserted into patients’ lungs.
  • 58 cases of wrong implants or prostheses being fitted.

In the USA, the Joint Commission (TJC), reported data involving “sentinel events”, (unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof), revealing interesting statistics that suggest some similar issues.

The top four of most frequently reviewed sentinel event categories reviewed by TJC;

In 2010:

  • Unintended retention of a foreign body.
  • Delay in treatment.
  • Wrong-patient, wrong-site, wrong procedure.
  • Op/post-op complication.

Then in 2011:

  • Unintended retention of a foreign body
  • Wrong-patient, wrong-site, wrong procedure
  • Delay in treatment
  • Op/post-op complication

And in 2012:

  • Unintended retention of a foreign body.
  • Wrong-patient, wrong-site, wrong procedure
  • Delay in treatment
  • Suicide

What is Going On in the Operating Room?

More clues to the answer can be found in sharing some consulting work provided for a chapter of the American Organization of PeriOperative Registered Nurses (AORN) a couple of years ago.  In preparation for assertiveness training, I asked their educational committee to share most common communication challenges that nurses faced.  Their answers, as follows, are quite revealing:

  1. Your teammate purposefully holds back information about a surgery to make you look bad in front of the surgeon.
  2. The surgeon yelling that s/he “wants somebody in here that knows whey they are doing”.
  3. Other team members saying negative things about you in front of you and not including you in the conversation.
  4. Surgeon refuses to wait for “time-outs” or “count” at the end of a procedure, (especially when counts are incorrect), and ignores or becomes angry when the nurse requests the surgeon consider the information presented.

In my opinion, these scenarios reveal layers of interwoven relationship patterns and deficits in ‘people skills’. Some of this toxic dynamic may be deliberate hostility and some more innocent lack of awareness about how individual behaviors impact others.  Add this to a lack of skill in self-reflection and assertiveness/ownership and the complexity of interactions and safety-related ramifications begins to emerge.  A work culture and leadership that tolerates such behavior is also likely to be part of the picture.

In addition to leadership and culture change initiatives, healthcare professionals need training and practice in “People Skills”.  These are the kind of behaviors we need and must cultivate!

  1. A teammate purposefully reminds a colleague that the OR schedule was changed again because of an equipment failure during an emergency surgery on nights.
  2. The surgeon, stressed because of a patient’s declining condition and the number of questions the scrub nurse seemed to have stated, “These are important questions, but not the right time.  Please get the nurse manager to sub for you stat. You step back and watch.  We’ll debrief later”.
  3. A team members says, “If you have constructive feedback, I’m happy to hear it, but talking about me as if I’m not in the room is rude” and a bystander colleague adds, “She’s right. I’m not going to participate in this toxic conversation.”
  4. Surgeon  takes a deep breath.  “Thank you for insisting I address the missing sponges”.

What do you think accounts for these OR stats?

Medical Improv Builds People Skills! 

beth@bethboynton.com

603-319-8283

 

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3 Responses to Similarities in Surgical Errors in USA & UK: What Might These Stats and Nurse Feedback Reveal about People Skills?

  1. Pingback: An Unpleasant Metaphor helps Explain Concerns about Cameras in the Operating Room

  2. Love your people skills suggestions, Beth. I want to thank you for an excellent post, pointing out some very important information. I wish everyone in healthcare could read your articles like this! And that everyone in healthcare felt their best (happiest and healthiest self) so that these types of behaviors wouldn’t even happen in the first place. Enjoy your day!

    • Thanks, Elizabeth! Always great to hear from you and I appreciate your insights and feedback. Wow, just imagine happy and healthy healthcare professionals! We deserve to be and it is within our grasp. Thank you for all of your work in that direction!

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