Combining systems and teamwork interventions improves patient safety

Editor's Note

Patient safety approaches that combine teamwork training and systems interventions are more effective than either approach alone, this study finds.

The study involved 4-month safety improvement interventions in 5 UK hospitals using teamwork training (TT); systems redesign and standardization (SOP); Lean quality improvement; SOP plus TT; or Lean plus TT.

The results showed:

• TT improved nontechnical skills and World Health Organization (WHO) checklist compliance, but not technical performance.
• Systems interventions (SOP and Lean) improved nontechnical skills and technical performance, but improved WHO compliance less.
• Combined interventions (SOP plus TT and Lean plus TT) improved all performance measures except WHO time-out attempts.
• Single approaches (TT, SOP, or Lean) improved WHO compliance less and failed to improve technical performance.

Importance: Patient safety improvement interventions usually address either work systems or team culture. We do not know which is more effective, or whether combining approaches is beneficial. Objective: To compare improvement in surgical team performance after interventions addressing teamwork culture, work systems, or both.