Making Surgeries Safer:
Non-technical Skills in Operating Theatres
About the SWANS Initiative
Every year, 2.4 million surgical procedures are carried out in Australia with an adverse event rate of 22%. Findings suggest that as many as 48% of these adverse events are highly preventable.
Next to technical skills, non-technical skills such as decision-making, communication and team work impact surgical outcomes.
The SWANS project investigates the utility of non-technical skills and their various elements. It strives to uncover some of the mechanisms that support the positive impact of non-technical skills.
SWANS is an abbreviation of Surgical Work Team Advanced Non-Technical Skills. It is a reference to Perth's many Black swans and the many uncertain and hard to foresee aspects of safety critical work environments.
Multi-Professional Team Briefings
Multi-professional briefings are short 3 – 5 minute meetings before the start of an operating list. These meetings include all professional groups working in the operating theatre that day.
Multi-professional briefings are designed to facilitate effective communication and coordination between team members, and support theatre efficiency and safety. They involve proactive planning to ensure efficiency, and they help surgical teams to set a collaborative tone for the day. They only take up a couple of minutes at the start of surgical lists.
The research behind is based on research carried out by a multi-disciplinary team of researchers and medical practitioners at the University of Western Australia. For the research, data were collected in collaboration with four major hospitals in Western Australia. The research team carried out in-theater observations and engaged staff via surveys.
Funded by the Western Australian Department of Health, the research was conducted to understand the effects of briefings and coordination between professional groups, specifically in the areas of problem solving and speaking up, helping and offering support, information exchange, and proposing changes.
Conducting Multi-Professional Team Briefings
Briefings are best conducted following 5 easy steps. The different steps help surgical staff to get to know each other, provide an overview of the work that lies ahead, and opportunities discuss details of each case.
We advice to include all of these steps in your briefing practice. However, we also encourage you to customise the briefings to your and your team's needs.
Case review provides more detailed information on each case. It clarifies roles, expected complexities, potential complications, equipment requirements, and team member level of experience with procedures. Based on the individual case review, changes to the list order that will enhance workflow can be identified before the first patient is called.
Some Practical Tips
Who initiates the briefing?
The briefings can be initiated by any of the staff members.
These briefings are everyone’s briefings.
Tone and (body) language
Use “we” instead of “I” during briefings.
Standing in a circle also helps to ensure that everyone can see each other, and make the briefing feel more inclusive for everyone.
Who leads the Briefing?
The briefings can be led by any member of staff.
We would advise staff to take turns in leading the briefing, however it is no issue if the same individuals lead the briefings.
Using open ended questions effectively
Open ended questions can stimulate free flowing conversation. Direct some of your open questions (but not all) at specific individuals to engage those with relevant knowledge to actively participate.
Common Barriers and How to Overcome Them
Based on surveys completed by theatre staff, the UWA team identified that briefings are currently not a common practice at WA Hospitals. We also found that those who experience briefings less often in their work were more dissatisfied with their theatre experience.
The most commonly cited barrier to using team briefings was that not everyone was present before the start of the list.
Some ways to overcome this could be to notify colleagues over the PA system, include the the missing person by dialling in through a phone call (on speaker mode), or to simply insist on starting the list only after a briefing is conducted.
Prof. Sharon Parker
Dr. Laura Fruhen
Other team members
Dr Joseph Carpini
(University of Western Australia)
Prof. Yee Leung
(WA Gynaecologic Cancer Service, King Edward Memorial Hospital for Women, University of Western Australia)
A/Prof. Stewart Flemming
(Fiona Stanley Hospital & Fremantle Hospital)