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Liverpool Heart and Chest Hospital, Thomas Drive, L14 3PE
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RIF Funding for Surgical Patients

Date: 01 November 2014 10:42

A team at Liverpool Heart and Chest Hospital has been successful in securing funding from NHS England’s Regional Innovation Fund (RIF) to improve care for patients undergoing major surgery.

The £50,000 award will be used by the Trust to enhance team performance by developing ‘shared mental models’ to optimise communications and reduce errors in cardiac surgical procedures.   

“We are delighted that our bid to the RIF was accepted,” said Mr Mark Pullan, Consultant Cardiac Surgeon and Clinical Lead for Cardiac Surgery.

The RIF is designed to support and promote the adoption of innovation and the spread of best practice across the NHS.

He continued: “Studies show that where there are communication and teamwork failures in cardiac surgery, these lead to technical errors and adverse patient outcomes.

“Effective communication is strongly influenced by the extent to which the team members have a shared mental model (SMM) of the procedure. A shared mental model is the model possessed by an individual or the team regarding the activities of the participants, and how these are to be coordinated to achieve a successful outcome.” 

“Our plan is to investigate techniques to create a SMM among teams in our hospital who are involved in cardiac surgery. We will then use this approach through our non-technical skills training to produce enhanced communication, better teamwork and reduced errors.”

Dr Jonathan Kendall, Consultant Anaesthetist and the Trust’s Patient Safety Lead, added: “Whilst our focus in this project will be coronary artery bypass grafting (CABG), our highest volume surgical procedure, the funding will also allow us to spread the innovation using the same methodology with other types of surgery and interventional cardiology. 
“Recent national reports have highlighted the importance of patient safety, teamwork and communication in delivering the highest quality of patient care. Therefore first and foremost, this project is concerned with improving the care that we provide to our patients, by bringing the culture of patient safety into sharp focus and reducing adverse events.”

About the project

The project brings together three established approaches:

  • Non-Technical Skills training 
  • SHERPA methodology 
  • Shared Mental Models (SMM) to improve team performance and reduce errors

The SHERPA proactive risk identification process has been used in a number of healthcare applications to identify potential risks. However, the consensus group knowledge sharing process that is integral to SHERPA has never been formally applied in a patient safety context.

In this project we will focus on the capability of the methodology to capture the insights from different teams and use this information to develop optimised processes and shared mental models in those areas of CABG theatre activity where this is feasible and desirable.

The documented output from the consensus group sessions will capture good practice, identify risks, and develop strategies to mitigate these risks.  No other approach has considered the practical application of the SMM concept as a means of understanding and documenting the ways in which the activities in a team are coordinated, and using this information to enhance teamwork by combining it with simulator based NTS training.

This work is innovative as it uses knowledge elicitation and proactive error reduction techniques, which have been applied extensively in the safety critical industries such as rail, oil and gas, but have not been applied in within healthcare.

The use of SHERPA consensus groups in the safety critical industries is documented in the Safety Cases required in industries such as oil, gas and chemical manufacture that fall within the Control of Major Accident Hazards (COMAH) regulations.  This usage is not in the public domain. However, since the SHERPA process is identical to the methodology set out in the HSE guidance notes it will be used in the majority of the large number of Safety Reports that are submitted each year.

In healthcare, there is evidence that the possession of a shared mental model is an important contributor to effective communications and improved Situation Awareness.  Haig et al cite the development of a shared mental model as being critical for improving shift handovers and facilitating inter-clinician communication.  Westli et al endorse the value of a shared mental model for developing effective teamwork, but observe that it has rarely been applied in the context of NTS training.  Their study showed that behavioural markers of shared mental models predicted effective medical management in trauma teams better than teamwork skills.

They conclude that shared mental models are needed to effectively utilise team member’s skills and that they support effective information exchange in ‘excellent’ teams.  Undre et al report that medical teams with low levels of shared mental models are more prone to error arising from poor communications.

In summary, the proposed project will bring together systematic knowledge elicitation and error prediction techniques from safety critical systems analysis to support the development of shared mental models as part of NTS training programmes.