Surgery


l Identify which steps are important. l Understand whether NHS Trusts are teaching non-techincal skills.


l Identify key themes and patterns from the emergent data.


In total, twenty-two NHS England Trusts participated. The study was undertaken via Qualtrics to ensure anonymity. This equates to 15% of NHS England Trusts that have operating theatres as part of their routine or emergency patient services. This study took a representative sample. The authors had no influence on the selection of participants; it was a completely random selection. As the sample of staff was determined by the participants volunteering from across NHS England, it can therefore be argued, that it is possible to generalise the results for the entire research population, which is NHS England. Denscombe (2021)21


writes that “the basic


principle of sampling is that it is possible to produce accurate findings without the need to collect data from each and every member of a research population”. There was a range of hierarchical agenda-for-change bands, age and professional qualification held, i.e., RGN or ODP.


Results Several questions from round two were re- explored: Q1. Should the NHS be pro-active rather than re-active? 68% of respondents stated that time and investment in training on non-technical skills and Human Factors must occur and that senior NHS leaders in the organisation should engage with theatres to understand the challenges faced. A review of the literature found that Degani and Wiener (1993), cited in Vats et al, (2010),22


found that the surgical


safety checklist is unlikely to be implemented or maintained without the backing of senior leadership within each organisation. Leadership for the successful implementation of the SSC is key, as Conley, Singer and Edmondson (2011), cited in Barimani et al (2020),23


concluded,


following a study of five hospitals. Engagement of leadership was seen as a key factor in the success of the SSC adoption. Having leaders actively promote the SSC was deemed to be successful; therefore, hospital leaders need to work on all staff’s perception and resistance to change, by educating staff that the hospital’s priority, is one of patient safety (Gillespie et al, 2010 and Conley, Singer and Edmondson, 2011, cited in Barimani et al, 2020).23 Smith et al (2015)24


commented that,


importantly, communication between hospital leadership and front-line practitioners must


Strongly agree 57.14% Agree 28.57% Somewhat agree 9.52% Neither agree nor disagree 4.76%


Figure 1 – Should non-technical skills be a part of mandatory training?


be open, honest, and constructive to obtain the buy-in necessary for the successful initiative of the checklist.


Q2. With regard to multidisciplinary team working, 62% of respondents asked for collective training on the Surgical Safety Checklist, Human Factors and simulation sessions.


Q3. The second edition of the National Safety Standards for Invasive Procedures (NatSSIPs) was launched on the 23 January 2023 and 55% of respondents stated that the NHS should provide support for introducing and educating the staff on NatSSIPs.


Q4. Surgical fires: 76% of respondents either strongly agreed or agreed that non-airway surgical fires should be classed as a Never Event, thus taking the reportable intraoperative Never Events from three to four. (Surgical airway fires caused by a combination of oxygen and the use of a laser do not meet the definition of a ‘Never Event’, but other types of fires are wholly preventable). There is no national guidance or safety


recommendations to prevent fires in the operating theatres. These types of incidents, therefore, cannot be defined as a ‘Never Event’. But is this right? Stormont, Anand and Deibert (2022)25


£188,969 (based on 6 November 2022 exchange rates). At a time of austerity and the current living crisis (2022/2023) this is monies that global health providers can ill afford to pay out. In contrast, the National Reporting and Learning System (NRLS) database in England and Wales identified thirty-seven reported surgical fires between January 2012 and December 2018 (Keeley, 2020).26 NHS Revolution (2019), cited in Keeley (2020),26


reported that £13.9 million has been paid out in damages and legal costs for 459 cases relating to clinical negligence caused by surgical burn. The term ‘Never Event’ was first introduced be Ken Kizer, in 2001, in reference to shocking medical errors that should never have occurred (Lembitz and Clarke, 2009).12 Devlin (2021)26


suggested that the Medical


Defence Union (MDU) should regard the term ‘Never Event’ as a misnomer because we are no closer to eradicating these errors. Devlin (2021)27 also suggest that the use of the word ‘Never’ reinforces the unhelpful concepts of blame and liability and is a distraction. Tingle (2022)28


not change or be diluted. Tingle (2022)28


argued that the term should also


stated that ‘very few fires are


unpreventable, and all surgical fires should be considered a Never Event’. Fisher’s American study (2015), cited in Stormont, Anand and Deibert (2022)25


stated


that the number of surgical fires ranges from 550-600 annually, which is about as common as incorrect surgical site procedures. Choudhry et al ’ s American study (2017), cited in Stormont, Anand and Deibert (2022),25


claimed that, of 114


cases identified involving surgical fires, 60% resulted in a median award of $215,000, or


argued that, when a Never Event occurs, it cannot be excused, and it is still a Never Event by any use of terminology. This was supported from the findings from the Delphi study, as 68% of the respondents stated the phrase should remain. Theatres are fast paced and have great potential to cause patient harm inadvertently. A multidisciplinary team approach to patient care is required. Non-technical skills such as culture, communication, attitudes, team working, leadership and situational awareness are skills that each member of the team uses daily. Human error cannot be completely eradicated. The Gordon et al, (2017)29


study stated


that consideration of non-technical skills in education is required. Later, Prineas et al


April 2023 I www.clinicalservicesjournal.com 21


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