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Staff perception of the culture of safety in addition to other barriers were identified as potential contributors to inconsistent performance of debriefing procedures at a Southern California medical center hospital, 12-suite, surgical department. The Joint Commission (TJC) has identified ineffective communication as a critical contributor to events related to patient safety regarding healthcare. Evidence shows a standardized process for debriefing based on staff input can improve the commitment to performing debriefings. This quality improvement project aimed to improve the consistency in use of the debriefing process in the operating room (OR) through assessments of barriers, the perceptions of what constitutes a culture of safety, and proposed revisions to the standardized process to performance of debriefings in order to improve consistency and accuracy. The surgical safety checklist (SSC) is a tool to assist with decreasing errors and improving teamwork and communication in the OR and procedural areas. The debriefing process is an essential element of the SSC that contributes to a culture of effective communication and patient safety. There is evidence to support that when the debriefing process is integrated properly such as use as part of the SSC, it contributes to a culture of effective communication which in turn has been shown to be a vital part of an OR culture where patient safety is understood and a top priority (Donnelly, 2017). In this quality improvement project, forty-two (42) of the total 81 (52%) staff at the medical center participated in voluntary completion of survey assessments selected to iv identify their perceptions of what makes a culture of safety and confidence around performing debriefings. Demographic practice and role related data was also collected which revealed an experienced staff with 61.7% having 11 or more years of experience in the OR setting. Key results from a modified version of the Safety Assessment Questionnaire (SAQ) revealed only 45.24% of the staff “strongly agreed” that debriefings were a common practice currently in the OR while the remaining 55.76% of responses ranged from ‘strongly disagree’ to ‘slightly agree’. Additionally, responses to all five of the questions in the validated tool known as the Confidence Scale (Grundy, 1993) ranged from 44.19 to 63.64% of the time in which staff indicated they were not absolutely certain they were performing the debriefing process correctly or efficiently. Assessment tool results indicated that identification of cultural and care process barriers and facilitators related to safety prior to implementation of the current debriefing process had not occurred which was validated by staff’s lack of awareness of the link between inconsistent and inaccurate performance in the debriefing process and its relationship to their perception of a culture of safety. Based on the findings, recommendations were made to the leadership at the hospital to focus on revising the organization’s reporting methods for adverse events by staff so as to include awareness of the link between reporting and a “true” culture of safety. Additionally, greater examination of the organizational culture of safety specifically, why staff felt they did not have the confidence to consistently perform the debriefing, is recommended before implementing any changes to the current debriefing process in order to ensure greater success with the change process. |
