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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 MRCS 1,2 & Ashwini Joshi MS FRCS(Paed) 1 1 Dept of Paediatric Surgery, Barts Health NHS Trust, London, UK & 2 NHS 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
