20 YEARS IN OP E RAT ING THEAT R E S
on continuing professional development, feedback and reflection. She commented that simulation training has also developed greater opportunities for proficiency among team members and is a powerful learning tool. There have been improvements on the management of clinical risk compared to twenty years ago, but there is still more work to do. Melanie identified that we need to look at roles carefully thinking forward, and there are many opportunities for new roles, but we need clarity on the scope, boundaries and responsibilities of new roles. Staff need to be open minded that new roles may bring professional challenges, but it can bring new opportunities and new professionals still have positive motivations in their roles in caring for patients. There is certainly a great need to work on staffing, currently, and how we can support not only new staff, but also those who are stressed and suffering. International recruitment is a stop gap which we are currently relying on, but we need to do some creative thinking for the future. Turnover is a huge issue in an ever-changing and pressurised work environment – so we need to ensure that we have the correct support facilities in place; resilience is essential. Trusts really need to focus on preparation of leaders, so that they can effectively support new staff and enable retention of longer serving staff. Employers also need to focus on finding good quality facilities, support and development for staff, for the way healthcare professionals need to work – now and in the future. Valuing the workforce needs time and attention, and there needs to be more focus on facilitating this. A brief after thought, but one that is
worthy of mention, is that Melanie thinks we should ensure that emerging diseases are on the radar – there needs to be an understanding on how that can affect future practice and the challenges that will bring. Professor Jane Reid was president of AfPP 2005-2009 and was invited to be part of the professional response to the soon to be launched World Health Organizations’ Surgical Safety Checklist. Jane subsequently
did a great deal of work with the implementation, oversight and development work at Patient Safety First and at AfPP. Jane reports that she is delighted that the tool for surgical safety has been implemented in many hospitals around the world, and she has witnessed it in India, Russia and parts of Africa. It is a powerful tool, aided by a briefing at the beginning of the surgical list and a debriefing at the end – leading to better communication and understanding between team members. It is generally nurse-led, although some of the more mature surgeons are still ambivalent about its use. However, younger surgeons ‘get it’ and want it to be in place. There is still, however, much work to do to ensure it is universally applied and that it is undertaken with engagement and not by rote. It is in use not only in surgery but also in endoscopy, and some specialties – such as ophthalmic surgery – have amended it to suit their patients and surgery better. It is also in use in general practice. Professor Reid said that she was clear that the introductions of the team to each other, in the briefing, were fundamental to teamwork and that those with a voice, enabled by the briefing, are more likely to speak up if they see something going wrong. She said that the study of human factors, which contributed so much to the development of the checklist and to patient safety science, was very late coming to healthcare. Ten years before healthcare started to learn its core features, it had been in use in the nuclear industry and aviation. The work we still have to do, to ensure the Safe Surgery Checklist continues to be applied to reduce patient safety incidents, is further education, training and promotion by everyone in a professional related role. It also needs a political campaign, including AfPP and the Royal College of Surgeons. In order to be clear what newly qualified professionals need to know about the checklist and how to diligently apply it, more research
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is needed, as well as leadership support. Stories of where the checklist has made a difference need to be made available for professionals and patients and their families. It will only be a good story if it is applied with understanding and continuing emphasis. Mona Guckian Fisher was president of AfPP 2015-2017. She has worked in many different roles in healthcare at a management level and other positions and has, for the past 14 years, been running her own business focused on risk management, perioperative audit and medico-legal work. Her first comments were that the patient experience has improved immensely in the last 20 years, with anaesthesia and surgical techniques leading the way. The development of enhanced recovery beliefs and fast track has followed the reduction of hours of fasting to a more common-sense approach. Interventional cardiology has saved patients from intrusive major surgery and made great steps forward for the patient.
It used to be that patients stayed days
longer, sometimes weeks, before they were allowed home; the length of stay nowadays is almost too fast, landing patients unsupported at home without sufficient briefing as to what they should expect and how to react. This has left many patients feeling – and being – very vulnerable. There is also a fear among professionals to prescribe heavy duty analgesia. Dr. Shipman has a lot to answer for, also leaving patients at home without appropriate pain relief. Perioperative care has always been an incredibly challenging environment but there has been a great improvement over the 20 years by use of the Standards document produced by AfPP. There is also guidance for risk management audits and calculations for staffing numbers for safe care. Mona commented that despite the use of the standards document, Never Events do not appear to be reducing in the way she expected. There is also a continuing lack of
NOVEMBER 2022
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