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PRESIDENT’S MESSAGE

http://dx.doi.org/10.1016/j.aorn.2014.

� AORN, Inc, 2014

Excellence inPerioperative Management:Establishing a Culture ofSafetyVICTORIA M. STEELMANPhD, RN, CNOR, FAAN, AORN PRESIDENT

xcellence in perioperative management re-

quires an ongoing, vigilant effort to promote

patient safety by using evidence-based prac-

tices. Since the 2000 Institute of Medicine report,

To Err Is Human: Building a Safer Health System,1

there have been numerous initiatives to improve

the safety of patient care in the United States.2-4

Yet, in 2011, 30% of hospitalized patients sustained

adverse events.5 For the past three years, unin-

tended retention of a foreign body and wrong-

patient, wrong-site, wrong-procedure surgeries

have remained the sentinel events most frequently

reported to The Joint Commission.6

Analysis of research has shown that communi-

cation failures within interprofessional teams are

causes of medical errors1 and negative patient

outcomes.7-9 When analyzing adverse events, The

Joint Commission has found that human factors,

inadequate or ineffective leadership, and commu-

nication failures are the overall leading root causes

of sentinel events for each of the past three years.

Root causes of unintended retention of foreign

objects are leadership (79%), human factors (66%),

and communication failures (64%). Root causes of

wrong-patient, wrong-procedure, and wrong-site

events are inadequate or ineffective leadership

(82%), communication failures (68%), and human

factors (67%).10 This provides strong evidence for

04.010

the direction needed to improve the quality and

safety of perioperative patient care.

CULTURE OF SAFETY

Highly functioning teams make fewer errors.11 This

level of functioning is developed through effective

communication, a collective mindset, and a culture

that promotes patient safety above individual in-

terests. In a culture of safety, there is an expectation

that action is taken when necessary. Pressure comes

from all directions, peers and leaders.12 To improve

the culture of safety, leaders must be committed to

change, encourage staff members to openly share

safety information, and act on the safety concerns

reported. In contrast, when this culture does not

exist, staff members are often unwilling to report

adverse events and near misses for fear of retalia-

tion or a belief that nothing will be done in re-

sponse to the report.

Establishing a culture of safety in the perioper-

ative setting is a key responsibility of the periop-

erative leadership team. Managers and directors

must drive this cultural shift by visibly demon-

strating their commitment to safety and providing

the support and resources to achieve this change.

Their commitment must be visible, consistent, and

sustained over time because changing a culture

takes time. This may seem daunting to managers

July 2014 Vol 100 No 1 � AORN Journal j 1

July 2014 Vol 100 No 1 PRESIDENT’S MESSAGE

and directors who are busy rapidly responding to

everyday challenges with patients, personnel, phy-

sicians, and equipment and supplies. Assessing and

improving the culture of safety can easily be placed

lower on the list of priorities. Yet, resources are

available to assist these leaders to improve the

culture of safety.

TEAM STRATEGIES AND TOOLS TOENHANCE PERFORMANCE AND PATIENTSAFETY

This critically important cultural shift can be un-

dertaken by using the Team Strategies and Tools to

Enhance Performance and Patient Safety (Team-

STEPPS�), a systematic, stepwise, evidence-based

program originally developed by the US Depart-

ment of Defense Patient Safety Program in collab-

oration with the Agency for Healthcare Research

and Quality.13 The program’s scope has been ex-

panded nationally through the Agency for Health-

care Research and Quality and is now available to

all health care facilities.

TeamSTEPPS is a teamwork system designed

for health care professionals to improve safety and

optimize patient outcomes by improving team-

work and communication. The program includes a

training curriculum and materials to successfully

integrate teamwork principles into all areas of the

health care system, including the OR. The program

design is built on more than 20 years of research.13

The program has three phases:

n a baseline assessment of the culture of safety

within the health care organization;

n training of on-site trainers and health care per-

sonnel; and

n implementation, expansion, and sustainability.

Because the program is designed to be tailored to

the individual organization, the assessment is the

first step, undertaken to determine readiness to

change. Based on the assessment, an individual

training and implementation plan is established and

implemented. The goal of the last phase is to sus-

tain and spread the improvements in teamwork,

clinical process, and outcomes resulting from the

2 j AORN Journal

implementation. This phase ensures that opportu-

nities are in place to implement the tools taught,

allow individuals and teams to practice and receive

feedback on skills, and continually reinforce the

program principles.

Training sessions are available, without a regis-

tration fee, at regional training centers across the

country. These centers offer training and collabo-

ration with a diverse network of master trainers.

More information is available at http://teamstepps

.ahrq.gov/aboutnationalIP.htm.

SUMMARY

TeamSTEPPS is a powerful, evidence-based tool

available to perioperative leaders to promote pa-

tient safety. The program improves communication

and develops highly effective teams that optimize

the use of information, people, and resources;

resolve conflicts; improve information sharing;

eliminate barriers to quality and safety; and

achieve positive patient outcomes. TeamSTEPPS

is one available tool that perioperative leaders

should consider using in support of our pursuit

of excellence.

Editor’s note: TeamSTEPPs is a registered trade-

mark of the US Department of Defense, Falls

Church, VA, and the US Department of Health and

Human Services, Bethesda, MD.

References1. Kohn LT, Corrigan J, Donaldson MS. To Err Is Human:

Building a Safer Health System. Washington, DC:

National Academies Press; 2000:287.

2. Altman DE, Clancy C, Blendon RJ. Improving patient

safety d five years after the IOM report. N Engl J Med.

2004;351(20):2041-2043.

3. Barach P, Berwick DM. Patient safety and the reliability of

health care systems. Ann Intern Med. 2003;138(12):997-998.

4. Leape LL, Berwick DM. Five years after To Err Is

Human: What have we learned? JAMA. 2005;293(19):

2384-2390.

5. Classen DC, Resar R, Griffin F, et al. “Global trigger

tool” shows that adverse events in hospitals may be ten

times greater than previously measured. Health Aff

(Millwood). 2011;30(4):581-589.

6. Summary data of sentinel events reviewed by The Joint

Commission. The Joint Commission. http://www.joint

commission.org/assets/1/18/2004_to_2Q_2013_SE_Stats_

-_Summary.pdf. Updated 2013. Accessed April 18, 2014.

PRESIDENT’S MESSAGE www.aornjournal.org

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533-540.

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9. Rogers SO Jr, Gawande AA, Kwaan M, et al. Analysis of

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10. Sentinel event data: Root causes by event type 2004-

2013. The Joint Commission. http://www.jointcommission

.org/assets/1/18/Root_Causes_by_Event_Type_2004

-2Q2013.pdf. Updated March 2012. Accessed April 18,

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11. Salas E, DiazGranados D, Klein C, et al. Does team

training improve team performance? A meta-analysis.

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12. Develop a culture of safety. Institute for Healthcare Im-

provement. http://www.ihi.org/resources/Pages/Changes/

DevelopaCultureofSafety.aspx. Updated 2014. Accessed

April 14, 2014.

13. TeamSTEPPS�: National implementation. Agency for

Healthcare Research and Quality. http://teamstepps.ahrq

.gov/. Accessed April 14, 2014.

Victoria M. Steelman, PhD, RN, CNOR,

FAAN, is the AORN President and an assistant

professor at The University of Iowa College

of Nursing, Iowa City. Dr Steelman has no

declared affiliation that could be perceived

as posing a potential conflict of interest in the

publication of this article.

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