Symposium Emphasizes Trust, Teamwork, Culture

Article Outline

• Session Highlights
• Conclusion
• References
• Copyright

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For the last seven years, AORN has hosted the Executive Symposium on surgical patient care. This annual event gives members of the perioperative team the opportunity to come together to discuss solutions to common problems affecting the patient and surgical team in the OR. Participants in this year's Executive Symposium included surgical teams from many hospitals across the country, including directors of surgery, chiefs of surgery, and chiefs of anesthesia. These professionals realize that if a culture of patient safety is to be achieved, it is through a collaborative effort of the surgical team members, not just the nurses who are leading the way. In addition to the hospital teams, there were representatives from surgical specialty associations including the American Association of Nurse Anesthetists, the American College of Surgeons, the American Society of Anesthesiologists, and the Association of Surgical Technologists. This year's Executive Symposium focused on trust, teamwork, and culture, all of which are critical to improving surgical quality and efficiency. The topics and speakers were dynamic and diverse.

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Session Highlights 

Bruce Muma, MD; Christine Zambricki, RN, CRNA, FAAN; and Judy Pins, RN, BSN, MBA, talked about the importance of developing a nurturing culture focused on the patient and family experience. Dr Muma and Ms Zambricki are hospital administrators for the new Henry Ford West Bloomfield Hospital in West Bloomfield, Michigan. According to Zambricki,

The hospital's goal is to take health and healing beyond the boundaries of imagination by focusing on quality, safety, memorable care, compassionate care, and efficiencies.¹

The Board of Henry Ford Health System made a nontraditional choice by hiring a former executive from the Ritz Carlton Corp to be the hospital's chief executive officer in 2006. The hospital then implemented the Ritz Carlton model of customer service, which empowers the employees to do what it takes to exceed the patients' expectations. For example, the hospital serves only healthy, fresh, nonfried foods to its employees and patients, but on one occasion, when all the patient wanted was a hamburger, a hospital staff member drove to a local burger joint and picked one up. As a result of its customer service initiatives as well as exemplary care, the hospital currently ranks in the 99th percentile for overall patient satisfaction, according to Zambricki.¹

Stephen M.R. Covey, author of The Speed of Trust,² discussed the economics of trust within our health care system.

Trust always affects two outcomes: speed and cost. When trust goes down, speed goes down and cost goes up. When trust goes up, speed goes up and cost goes down.³

We see this phenomenon occurring daily in our work environments between department personnel and surgical team members. For example, if, as circulating nurses, we do not trust our colleagues in the preoperative holding area to appropriately prepare the patient for surgery, we will question their work and may reperform work that they have already done, resulting in decreased speed and increased cost to the organization and patient.

Although it is crucial to promoting an effective work environment, trust is not something that happens overnight; it takes time to build a culture of trust. Steps for building trust include

Perhaps the most important component for developing trust is listening to others.

David Marx, BS, JD, gave a presentation based on his book Whack-a-Mole: The Price We Pay for Expecting Perfection.⁴ We work in health care systems with processes that are imperfect. As caregivers, we are fallible, and by our own human nature, we will unintentionally make mistakes. We attempt to design our health care system for safety, but it is often the decisions we make as individuals that ultimately predict whether an error will occur because we have control over the choices we make.

I could not help but relate this to the teamwork that is needed during the “time out” process. We continue to hear from our members that they are working in environments in which time outs are not performed on a routine basis or are not supported by surgeons, administrators, or even other nurses. The time out process has been established to ensure that the right procedure is performed on the right site for the right patient. Not a week goes by that we do not hear about a sentinel event occurring that could have been prevented if the staff would have used the tools and checklists for ensuring correct site surgery. Used properly, these checklists, protocols, and tools can help eliminate errors, but it is our decision—as a surgical team or an individual—to appropriately apply these tools. Not following proven protocols could be classified as reckless behavior, a conscious and deliberate choice to put our patients at risk. Yet it frequently takes an adverse event for surgical teams or individuals to become serious about performing time outs. As nurses, it is our responsibility to advocate for the safest practices for our patients.

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Conclusion 

Another Executive Symposium has come to a successful conclusion. By continuing to offer this symposium, AORN continues to stay true to the mission of promoting safety and optimal outcomes for patients undergoing operative and other invasive procedures by working collaboratively with other professionals and organizations to meet our patients' needs. Trust, teamwork, and culture are critical elements for providing safe and effective care. If these elements are not present in our health care facilities, our patients may suffer unintended consequences. As perioperative nurses, we must continue to be at the forefront, advocating for our patients at their most vulnerable time. We have the tools and the knowledge. The only thing missing in some of our hospitals is the culture of safety.

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References 

1. Zambricki C. Creating and embedding culture. Presented at: The Executive Symposium; August 31, 2009; Napa Valley, CA.
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2. Covey SMR , Merrill RR . The Speed of Trust: The One Thing that Changes Everything . New York, NY: Free Press; 2006;
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3. Covey SMR. The speed of trust. Presented at: The Executive Symposium; August 31, 2009; Napa Valley, CA.
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4. Marx D , Bray A . Whack-a-Mole: The Price We Pay for Expecting Perfection . Plano, TX: By Your Side Studios; 2009;
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