Scissors that cut

Improving quality of instruments to ensure safe surgery for children

Overview of the Project

Aim: to ensure the right instruments are available at the right time to ensure safe surgery. Project has potential to improve patient safety, staff satisfaction and quality of care provided to children having surgery in a major trauma centre. Clinical audit quantified problem and staff satisfaction questionnaire determined level of dissatisfaction with current provision of surgical instruments. Stakeholder analysis identified important stakeholders and allowed effective communication and engagement across traditional disciplinary and hierarchical boundaries. Complexity increased by context including trust merger, move to new hospital building and working with commercial partners. Supported by relationships at board level developed during fellowship

Results
Audit identified problems with instruments in 64% of operations potentially causing harm to 21% patients: including blunt scissors (34%), faulty or damaged instruments (31%) and correct instrument not available (23%). Scissor sharpening: 1300 pairs sharpened (of total 3000) - 60% sharpened, 15% replaced, 25% fit for purpose. Ongoing long term scissor sharpening programme defined. New high quality instruments ordered to ensure appropriate instruments always available. Dialogue between stakeholders opened clinicians, managers, board members, healthcare scientists and commercial partners. Staff education and engagement enabled effective challenge to normalisation of deviance, so that surgeons and scrub nurses no longer accept inadequate instruments.

Leadership Challenges

Culture eats strategy for breakfast

Contact Information Clare Rees

SpR in Paediatric Surgery, Barts Health NHS Trust clare.rees@bartshealth.nhs.uk 07813 638188

Learning about my own strengths/limitations and recognising styles and preferences of others enabled me to develop strategies for leadership and understand the importance of a communicating a clear vision. I observed that demonstrating commitment to quality and improvement inspired colleagues to try to change things that dont work. I will use improvement tools I have learned to change systems that inhibit safe, efficient patient care in the future. Key observations: Everybody is not the same Leadership is complex and requires authenticity and understanding Culture change is more important and more difficult than process change this was my biggest challenge, and changing it the biggest reward.