ideas that change health and care | the king's fund ......a poster presentation by clare rees...

Where? • Paediatric surgery department of

large tertiary trauma centre • Expanded to whole trust

Scissors that cut: Improving quality of instruments to ensure safe surgery for children

Clare M Rees MD MRCS1,2 & Ashwini Joshi MS FRCS(Paed)1 1Dept of Paediatric Surgery, Barts Health NHS Trust, London, UK & 2NHS Leadership Academy, UK

@doccmr

What? Service improvement project : • Quality assessment of instruments • Process for identifying problems • Tray rationalisation to remove

unnecessary instruments • Communication & staff education • Scissor sharpening programme

Why? Significant problem with instruments in 64% of operations:

Who? New relationships

How? 1. Clinical audit over 1 month to quantify problem 2. Staff satisfaction survey 3. Standards identified: BSI, WHO checklist, CQC Outcomes 4. Stakeholder analysis defined who was involved 5. Quality improvement methodology including

• Root cause analysis (5 Whys) • Lean principles • Force field analysis • PDSA cycles

6. Audit repeated 1 year later to measure change

Well…? • Audit - problems with instruments in 58/91 (64%) of operations • Patients at risk of definite or possible harm in 19 cases (21%) • Staff did not feel that the situation was satisfactory:

So what? • Patient safety improved • Scissors sharpened – ongoing programme established

• Staff benefit – improved working environment and team relationships

What have I learned? • Leadership for improvement is complex, requires authenticity and understanding

• Seemingly simple problems can be ‘wicked’ problems requiring culture change

• Front-line clinical engagement is essential

This project was supported by the NHS Leadership Academy as part of the Clinical Leadership Fellowship 2011-2012

0 10 20 30 40 50

Other

Wrong size

No bipolar

Not available

Damaged

Faulty

Blunt scissors

Number of instruments

Sum it up in a Haiku?

“I have equipment to do my job”

After change programme: • Reaudit: problems in 33/116 (28%) operations p<0.0001 • Risk of harm to 12/112 patients (11%) p=0.009

3247 pairs of scissors entered sharpening programme so far

58% sharpened 29% passed

13% irreparable

AIM Right instruments Right operation Right time Right patient Safe surgery