Purpose for the Program
Improving patient safety has become a major focus for healthcare organizations, especially in high-risk areas such as obstetrics. Teamwork and collaboration among the healthcare team are essential for improved outcomes for mothers and neonates, error prevention, and quality care. Clinical care in obstetrics is complex, and the healthcare team often deals with rapidly changing or ambiguous patient situations, time pressures, and decisions that have the potential for serious consequences. The healthcare team is made up of individual expert clinicians, but these clinicians are not necessarily experts in working together and communicating effectively. Thus, the purpose of this program is to take teams of expert clinicians in a healthcare system and turn them into expert (functioning) teams.
Four obstetric units within a healthcare system proposed to take patient safety to a higher level with the goals of improving clinical quality and outcomes; keeping mothers, infants, and family members safe; and becoming more effective and efficient as a team. The strategy was to combine the best practices of team/crew training and the tools needed to develop a high-reliability culture into one patient safety program for obstetric care providers. Interdisciplinary classroom education was developed and included crew training concepts related to communication, teamwork, and collaboration; high-reliability culture error prevention tools; and simulation and experiential learning. Other tools, such as chain of communication, board rounds, preprocedure and postprocedure briefings, and contingency teams were discussed during the educational program but implemented one at a time to hardwire the changes.
Implementation, Outcomes, and Evaluation
An interdisciplinary team was involved in the program planning and development and served as trainers. Teams of obstetricians, anesthesiologists, certified nurse anesthetists, midwives, neonatologists, neonatal nurse practitioners, registered nurses (RNs), obstetric technicians, and unit secretaries participated in the collaborative training experience. Qualitative and quantitative data were collected related to clinical outcomes as well as teamwork and collaboration.
Implications for Nursing Practice
Improvements have been identified in multiple areas, including quality, communication, and teamwork, and the use of tools to support communication (e.g., board rounds and briefings) has been sustained. A comprehensive program that addresses both the development of expert teams and the tools needed to shape a high-reliability culture provides the needed framework for delivering care in a safe, reliable, and accountable environment with engaged healthcare providers.