title: Can team training make surgery safer? Lessons for national implementation of a simulation-based programme.
abstract: OBJECTIVE
  Unintended patient harm is a major contributor to poor outcomes for surgical patients and often reflects failures in teamwork. To address this we developed a Multidisciplinary Operating Room Simulation (MORSim) intervention to improve teamwork in the operating room (OR) and piloted it with 20 OR teams in two of the 20 District Health Boards in New Zealand prior to national implementation. In this study, we describe the experience of those exposed to the intervention, challenges to implementing changes in clinical practice and suggestions for successful implementation of the programme at a regional or national level.
  
  
  METHODS
  We undertook semi-structured interviews of a stratified random sample of MORSim participants 3-6 months after they attended the course. We explored their experiences of changes in clinical practice following MORSim. Interviews were recorded, transcribed and analysed using a general inductive approach to develop themes into which interview data were coded. Interviews continued to the point of thematic saturation.
  
  
  RESULTS
  Interviewees described adopting into practice many of the elements of the MORSim intervention and reported positive experiences of change in communication, culture and collaboration. They described sharing MORSim concepts with colleagues and using them in teaching and orientation of new staff. Reported barriers to uptake included uninterested colleagues, limited team orientation, communication hierarchies, insufficient numbers of staff exposed to MORSim and failure to prioritise time for team information sharing such as pre-case briefings.
  
  
  CONCLUSIONS
  MORSim appears to have had lasting effects on reported attitudes and behaviours in clinical practice consistent with more effective teamwork and communication. This study adds to the accumulating body of evidence on the value of simulation-based team training and offers suggestions for implementing widespread, regular team training for OR teams.
authors.affiliation: Centre for Medical and Health Sciences Education and Department of Anaesthesia, University of Auckland, Auckland City Hospital, Auckland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Weller
authors.affiliation: Department of Trauma, Auckland City Hospital, Auckland.
authors.forename: Ian
authors.initials: I
authors.lastname: Civil
authors.affiliation: Department of Anaesthesiology, University of Auckland, Auckland City Hospital, Auckland.
authors.forename: Jane
authors.initials: J
authors.lastname: Torrie
authors.affiliation: Department of Anaesthesiology, University of Auckland, Auckland.
authors.forename: David
authors.initials: D
authors.lastname: Cumin
authors.affiliation: Department of Anaesthesia, Capital and Coast District Health Board, New Zealand.
authors.forename: Alexander
authors.initials: A
authors.lastname: Garden
authors.affiliation: Department of Psychological Medicine, University of Auckland, Auckland.
authors.forename: Arden
authors.initials: A
authors.lastname: Corter
authors.affiliation: Department of Anaesthesiology, University of Auckland, Auckland.
authors.forename: Alan
authors.initials: A
authors.lastname: Merry
mesh_terms: D000072077:Anesthetists / Q000193:education*; D002983:Clinical Competence / Q000592:standards; D003299:Cooperative Behavior; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D009520:New Zealand; D009741:Nursing Staff, Hospital / Q000193:education*; D009873:Operating Rooms / Q000458:organization & administration*; D061214:Patient Safety; D015397:Program Evaluation; D036301:Qualitative Research; D000066908:Simulation Training; D066231:Surgeons / Q000193:education*; D011795:Surveys and Questionnaires