1
|
Ching HL, Lau MS, Azmy IA, Hopper AD, Keuchel M, Gyökeres T, Kuvaev R, Macken EJ, Bhandari P, Thoufeeq M, Leclercq P, Rutter MD, Veitch AM, Bisschops R, Sanders DS. Performance measures for the SACRED team-centered approach to advanced gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2022; 54:712-722. [PMID: 35636453 DOI: 10.1055/a-1832-4232] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The European Society of Gastrointestinal Endoscopy and United European Gastroenterology have defined performance measures for upper and lower gastrointestinal, pancreaticobiliary, and small-bowel endoscopy. Quality indicators to guide endoscopists in the growing field of advanced endoscopy are also underway. We propose that equal attention is given to developing the entire advanced endoscopy team and not the individual endoscopist alone.We suggest that the practice of teams intending to deliver high quality advanced endoscopy is underpinned by six crucial principles concerning: selection, acceptance, complications, reconnaissance, envelopment, and documentation (SACRED).
Collapse
Affiliation(s)
- Hey-Long Ching
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Michelle S Lau
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Iman A Azmy
- Department of Breast Surgery, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
| | - Andrew D Hopper
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Martin Keuchel
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Tibor Gyökeres
- Department of Gastroenterology, Medical Center Hungarian Defence Forces, Budapest, Hungary
| | - Roman Kuvaev
- Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation.,Gastroenterology Department, Faculty of Additional Professional Education, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Elisabeth J Macken
- Division of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Mo Thoufeeq
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | | | - Matthew D Rutter
- North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK.,Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Andrew M Veitch
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, KU Leuven, Belgium
| | - David S Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| |
Collapse
|
2
|
Johnsen BH, Espevik R, Eid J, Østerås Ø, Jacobsen JK, Brattebø G. Coordinating Mechanisms Are More Important Than Team Processes for Geographically Dispersed Emergency Dispatch and Paramedic Teams. Front Psychol 2022; 13:754855. [PMID: 35356330 PMCID: PMC8959140 DOI: 10.3389/fpsyg.2022.754855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 02/09/2022] [Indexed: 11/18/2022] Open
Abstract
In recent decades there has been an increased emphasis on non-technical skills in medical teams. One promising approach that relates teamwork to medical efficiency is the theory of Shared Mental Models (SMM). The aim of the present study was to investigate the suitability of the Shared Mental Model approach for teamwork between operators in emergency medical communication centers and the first line ambulance personnel in real-life settings. These teams collaborate while working from geographically dispersed positions, which makes them distinct from the kinds of teams examined in most previous research on team effectiveness. A pressing issue is therefore whether current models on co-located teams are valid for medical distributed teams. A total of 240 participants from 80 emergency medical teams participated in the study. A team effectiveness model was proposed based on identified team coordinating mechanisms and the “Big five” team processes. Path analyses showed that SMM was positively associated with team effectiveness (i.e., performance satisfaction and situational awareness) and negatively related to mission complexity. Furthermore, the coordinating mechanisms of SMM and Closed Loop Communication was positively related to “Big five” team scores. However, no effects were found for the “Big five” team processes on effectiveness, which could indicate that the model needs to be adjusted for application to geographically dispersed teams. Possible implications for team training of distributed emergency response teams are discussed.
Collapse
Affiliation(s)
| | - Roar Espevik
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway.,Swedish Defence University, Stockholm, Sweden
| | - Jarle Eid
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Øyvind Østerås
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | | | - Guttorm Brattebø
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
3
|
Pomare C, Long JC, Churruca K, Ellis LA, Braithwaite J. Interprofessional collaboration in hospitals: a critical, broad-based review of the literature. J Interprof Care 2020; 34:509-519. [PMID: 31928245 DOI: 10.1080/13561820.2019.1702515] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Interprofessional collaboration (IPC) is a common term applied in the healthcare literature, with suggestions it contributes to improved quality and safety of patient care across the globe. Despite worldwide implementation of models of IPC, past systematic or meta-reviews on this topic have concluded that the evidence is mixed. However, these reviews are yet to adequately consider the qualitative and mixed-methods literature on this topic. In this critical review, we synthesize the outcomes and key findings of IPC in hospitals, taking a broader approach by including diverse study designs. A total of 4,776 abstracts were screened from three major databases (Medline, CINAHL, Embase). Thirty-four studies fulfilled inclusion criteria. Although outcomes and key findings (e.g., staff turnover, error rates) were mostly positive, there were inconsistencies in the results. The included studies reflected a variety of study designs and different methodological approaches. Overall, our review revealed moderate evidence that IPC can positively influence patient, staff and organizational factors in hospitals, and that inconsistent findings may be due to variation in context (e.g., the cohort of patients). Recommendations from the review are to incorporate qualitative- and mixed-methods approaches to studying IPC in healthcare and tailor evaluations of IPC outcomes specific to the context.
Collapse
Affiliation(s)
- Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| |
Collapse
|
4
|
Salwei ME, Carayon P, Hundt AS, Hoonakker P, Agrawal V, Kleinschmidt P, Stamm J, Wiegmann D, Patterson BW. Role network measures to assess healthcare team adaptation to complex situations: the case of venous thromboembolism prophylaxis. ERGONOMICS 2019; 62:864-879. [PMID: 30943873 PMCID: PMC7243844 DOI: 10.1080/00140139.2019.1603402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 06/04/2023]
Abstract
Hospitals are complex environments that rely on clinicians working together to provide appropriate care to patients. These clinical teams adapt their interactions to meet changing situational needs. Venous thromboembolism (VTE) prophylaxis is a complex process that occurs throughout a patient's hospitalisation, presenting five stages with different levels of complexity: admission, interruption, re-initiation, initiation, and transfer. The objective of our study is to understand how the VTE prophylaxis team adapts as the complexity in the process changes; we do this by using social network analysis (SNA) measures. We interviewed 45 clinicians representing 9 different cases, creating 43 role networks. The role networks were analysed using SNA measures to understand team changes between low and high complexity stages. When comparing low and high complexity stages, we found two team adaptation mechanisms: (1) relative increase in the number of people, team activities, and interactions within the team, or (2) relative increase in discussion among the team, reflected by an increase in reciprocity. Practitioner Summary: The reason for this study was to quantify team adaptation to complexity in a process using social network analysis (SNA). The VTE prophylaxis team adapted to complexity by two different mechanisms, by increasing the roles, activities, and interactions among the team or by increasing the two-way communication and discussion throughout the team. We demonstrated the ability for SNA to identify adaptation within a team.
Collapse
Affiliation(s)
- Megan E. Salwei
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, USA, 53706
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, USA, 53706
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, USA, 53706
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, USA, 53706
| | - Ann Schoofs Hundt
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, USA, 53706
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, USA, 53706
| | - Vaibhav Agrawal
- Geisinger Health System, 100 North Academy Avenue, Danville, USA, 17822
| | - Peter Kleinschmidt
- School of Medicine and Public Health, University of Wisconsin-Madison, 750 Highland Avenue, Madison, USA, 53726
| | - Jason Stamm
- Geisinger Health System, 100 North Academy Avenue, Danville, USA, 17822
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, USA, 53706
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, USA, 53706
| | - Brian W. Patterson
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, USA, 53706
- School of Medicine and Public Health, University of Wisconsin-Madison, 750 Highland Avenue, Madison, USA, 53726
| |
Collapse
|
5
|
Whitehair L, Hurley J, Provost S. Envisioning successful teamwork: An exploratory qualitative study of team processes used by nursing teams in a paediatric hospital unit. J Clin Nurs 2018; 27:4257-4269. [PMID: 29893436 DOI: 10.1111/jocn.14558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore how team processes support nursing teams in hospital units during every day work. BACKGROUND Due to their close proximity to patients, nurses are central to the process of maintaining patient safety. Globally, changes in models of care delivery by nurses, inclusive of team nursing are being considered. DESIGN AND METHODS This qualitative study used purposive sampling in a single hospital and participants were nurses employed to work on a paediatric unit. Data were collected using nonparticipant observation. Thematic analysis was used to analyse and code data to create themes. RESULTS Three clear themes emerged. Theme 1: "We are a close knit team"; Behaviours building a successful team - outlines expectations regarding how members are to behave when establishing, nurturing and managing a team. Theme 2: "Onto it"; Ways of interacting with each other - Identifies the expected pattern of relating within the team which contribute to shared understanding and actions. Theme 3: "No point in second guessing"; Maintaining a global view of the unit - focuses on the processes for monitoring and reporting signals that team performance is on course or breaking down and includes accepting responsibility to lead the team and team members having a widespread sensitivity to what needs to happen. CONCLUSION Essential to successful teamwork is the interplay and mutuality of team members and team leaders. RELEVANCE TO CLINICAL PRACTICE Leadership behaviours exhibited in this study provide useful insights to how informal and shared or distributed leadership of teams may be achieved. Without buy-in from team members, teams may not achieve successful desired outcomes. It is not sufficient for teams to rely on current successful outcomes, as they need to be on the look-out for new ways to ensure that they can anticipate possible risks or threats to the team before harm is done.
Collapse
Affiliation(s)
- Leeann Whitehair
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - John Hurley
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Steve Provost
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
| |
Collapse
|
6
|
Havinga J, Dekker S, Rae A. Everyday work investigations for safety. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2017. [DOI: 10.1080/1463922x.2017.1356394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jop Havinga
- School of Humanities, Griffith University, 170 Kessels Road, Brisbane, 4111, Queensland, Australia
| | - Sidney Dekker
- School of Humanities, Griffith University, 170 Kessels Road, Brisbane, 4111, Queensland, Australia
| | - Andrew Rae
- School of Humanities, Griffith University, 170 Kessels Road, Brisbane, 4111, Queensland, Australia
| |
Collapse
|
7
|
Werner NE, Foroughi CK, Baldwin C, Youmans R, Boehm-Davis DA. Associative activation during interrupted task performance: a mixed methods approach to understanding the overall quality effects of interruptions. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2017. [DOI: 10.1080/1463922x.2017.1284282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nicole E. Werner
- Department of Industrial and Systems Engineering, University of Wisconsin Madison, Madison, WI, USA
| | | | - Carryl Baldwin
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Robert Youmans
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | | |
Collapse
|
8
|
Apramian T, Cristancho S, Watling C, Ott M, Lingard L. "They Have to Adapt to Learn": Surgeons' Perspectives on the Role of Procedural Variation in Surgical Education. JOURNAL OF SURGICAL EDUCATION 2016; 73:339-47. [PMID: 26705062 PMCID: PMC5578763 DOI: 10.1016/j.jsurg.2015.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/30/2015] [Accepted: 10/28/2015] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Clinical research increasingly acknowledges the existence of significant procedural variation in surgical practice. This study explored surgeons' perspectives regarding the influence of intersurgeon procedural variation on the teaching and learning of surgical residents. DESIGN AND SETTING This qualitative study used a grounded theory-based analysis of observational and interview data. Observational data were collected in 3 tertiary care teaching hospitals in Ontario, Canada. Semistructured interviews explored potential procedural variations arising during the observations and prompts from an iteratively refined guide. Ongoing data analysis refined the theoretical framework and informed data collection strategies, as prescribed by the iterative nature of grounded theory research. PARTICIPANTS Our sample included 99 hours of observation across 45 cases with 14 surgeons. Semistructured, audio-recorded interviews (n = 14) occurred immediately following observational periods. RESULTS Surgeons endorsed the use of intersurgeon procedural variations to teach residents about adapting to the complexity of surgical practice and the norms of surgical culture. Surgeons suggested that residents' efforts to identify thresholds of principle and preference are crucial to professional development. Principles that emerged from the study included the following: (1) knowing what comes next, (2) choosing the right plane, (3) handling tissue appropriately, (4) recognizing the abnormal, and (5) making safe progress. Surgeons suggested that learning to follow these principles while maintaining key aspects of surgical culture, like autonomy and individuality, are important social processes in surgical education. CONCLUSIONS Acknowledging intersurgeon variation has important implications for curriculum development and workplace-based assessment in surgical education. Adapting to intersurgeon procedural variations may foster versatility in surgical residents. However, the existence of procedural variations and their active use in surgeons' teaching raises questions about the lack of attention to this form of complexity in current workplace-based assessment strategies. Failure to recognize the role of such variations may threaten the implementation of competency-based medical education in surgery.
Collapse
Affiliation(s)
- Tavis Apramian
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, London, Ontario, Canada.
| | - Sayra Cristancho
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Chris Watling
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Michael Ott
- Department of Surgery, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Lorelei Lingard
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| |
Collapse
|
9
|
Barth S, Schraagen JM, Schmettow M. Network measures for characterising team adaptation processes. ERGONOMICS 2015; 58:1287-1302. [PMID: 25677587 DOI: 10.1080/00140139.2015.1009951] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED The aim of this study was to advance the conceptualisation of team adaptation by applying social network analysis (SNA) measures in a field study of a paediatric cardiac surgical team adapting to changes in task complexity and ongoing dynamic complexity. Forty surgical procedures were observed by trained human factors researchers, and communication processes amongst team members were recorded. Focusing on who talked to whom, team communication structures, in response to changing task demands, were characterised by various network measures. Results showed that in complex procedures, the communication patterns were more decentralised and flatter. Also, in critical transition phases of the procedure, communication was characterised by higher information sharing and participation. We discuss implications for team adaptation theory and teamwork observation methods. PRACTITIONER SUMMARY The reasons for this study were to advance our conceptualisation of team adaptation processes and to further quantify team observation methods. We found that the surgical team studied adapted to complexity of surgical procedures by adopting flatter communication patterns. We quantified team observation methods by applying SNA techniques.
Collapse
Affiliation(s)
- Susanne Barth
- a Department of Communication Science - Corporate and Marketing Communication , University of Twente , P.O. Box 217, 7500 AE Enschede , The Netherlands
| | | | | |
Collapse
|
10
|
Welp A, Meier LL, Manser T. Emotional exhaustion and workload predict clinician-rated and objective patient safety. Front Psychol 2015; 5:1573. [PMID: 25657627 PMCID: PMC4302790 DOI: 10.3389/fpsyg.2014.01573] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/19/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS To investigate the role of clinician burnout, demographic, and organizational characteristics in predicting subjective and objective indicators of patient safety. BACKGROUND Maintaining clinician health and ensuring safe patient care are important goals for hospitals. While these goals are not independent from each other, the interplay between clinician psychological health, demographic and organizational variables, and objective patient safety indicators is poorly understood. The present study addresses this gap. METHOD Participants were 1425 physicians and nurses working in intensive care. Regression analysis (multilevel) was used to investigate the effect of burnout as an indicator of psychological health, demographic (e.g., professional role and experience) and organizational (e.g., workload, predictability) characteristics on standardized mortality ratios, length of stay and clinician-rated patient safety. RESULTS Clinician-rated patient safety was associated with burnout, trainee status, and professional role. Mortality was predicted by emotional exhaustion. Length of stay was predicted by workload. Contrary to our expectations, burnout did not predict length of stay, and workload and predictability did not predict standardized mortality ratios. CONCLUSION At least in the short-term, clinicians seem to be able to maintain safety despite high workload and low predictability. Nevertheless, burnout poses a safety risk. Subjectively, burnt-out clinicians rated safety lower, and objectively, units with high emotional exhaustion had higher standardized mortality ratios. In summary, our results indicate that clinician psychological health and patient safety could be managed simultaneously. Further research needs to establish causal relationships between these variables and support to the development of managerial guidelines to ensure clinicians' psychological health and patients' safety.
Collapse
Affiliation(s)
- Annalena Welp
- Industrial Psychology and Human Factors, Department of Psychology, University of Fribourg Fribourg, Switzerland
| | - Laurenz L Meier
- Department of Psychology, University of Fribourg Fribourg, Switzerland
| | - Tanja Manser
- Institute of Patient Safety, University Hospital Bonn Bonn, Germany
| |
Collapse
|
11
|
Weldon SM, Korkiakangas T, Bezemer J, Kneebone R. Communication in the operating theatre. Br J Surg 2014; 100:1677-88. [PMID: 24227352 DOI: 10.1002/bjs.9332] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Communication is extremely important to ensure safe and effective clinical practice. A systematic literature review of observational studies addressing communication in the operating theatre was conducted. The focus was on observational studies alone in order to gain an understanding of actual communication practices, rather than what was reported through recollections and interviews. METHODS A systematic review of the literature for accessible published and grey literature was performed in July 2012. The following information was extracted: year, country, objectives, methods, study design, sample size, healthcare professional focus and main findings. Quality appraisal was conducted using the Critical Appraisal Skills Programme. A meta-ethnographic approach was used to categorize further the main findings under key concepts. RESULTS Some 1174 citations were retrieved through an electronic database search, reference lists and known literature. Of these, 26 were included for review after application of full-text inclusion and exclusion criteria. The overall quality of the studies was rated as average to good, with 77 per cent of the methodological quality assessment criteria being met. Six key concepts were identified: signs of effective communication, signs of communication problems, effects on teamwork, conditions for communication, effects on patient safety and understanding collaborative work. CONCLUSION Communication was shown to affect operating theatre practices in all of the studies reviewed. Further detailed observational research is needed to gain a better understanding of how to improve the working environment and patient safety in theatre.
Collapse
Affiliation(s)
- S-M Weldon
- Department of Surgery and Cancer, Imperial College London
| | | | | | | |
Collapse
|
12
|
Schmutz J, Manser T. Do team processes really have an effect on clinical performance? A systematic literature review. Br J Anaesth 2013; 110:529-44. [DOI: 10.1093/bja/aes513] [Citation(s) in RCA: 227] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|