title: Improving the Quality of Ward-based Surgical Care With a Human Factors Intervention Bundle.
abstract: OBJECTIVE
  This study aimed to explore the impact of a human factors intervention bundle on the quality of ward-based surgical care in a UK hospital.
  
  
  BACKGROUND
  Improving the culture of a surgical team is a difficult task. Engagement with stakeholders before intervention is key. Studies have shown that appropriate supervision can enhance surgical ward safety.
  
  
  METHODS
  A pre-post intervention study was conducted. The intervention bundle consisted of twice-daily attending ward rounds, a "chief resident of the week" available at all times on the ward, an escalation of care protocol and team contact cards. Twenty-seven junior and senior surgeons completed validated questionnaires assessing supervision, escalation of care, and safety culture pre and post-intervention along with interviews to further explore the impact of the intervention. Patient outcomes pre and postintervention were also analyzed.
  
  
  RESULTS
  Questionnaires revealed significant improvements in supervision postintervention (senior median pre 5 vs post 7, P = 0.002 and junior 4 vs 6, P = 0.039) and senior surgeon approachability (junior 5 vs 6, P = 0.047). Both groups agreed that they would feel safer as a patient in their hospital postintervention (senior 3 vs 4.5, P = 0.021 and junior 3 vs 4, P = 0.034). The interviews confirmed that the safety culture of the department had improved. There were no differences in inpatient mortality, cardiac arrest, reoperation, or readmission rates pre and postintervention.
  
  
  CONCLUSIONS
  Improving supervision and introducing clear protocols can improve safety culture on the surgical ward. Future work should evaluate the effect these measures have on patient outcomes in multiple institutions.
authors.affiliation: Imperial Patient Safety Translational Research Centre, Department of Surgery & Cancer, Imperial College London, London, UK.
authors.forename: Maximilian J
authors.initials: MJ
authors.lastname: Johnston
authors.forename: Sonal
authors.initials: S
authors.lastname: Arora
authors.forename: Dominic
authors.initials: D
authors.lastname: King
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000046:Academic Medical Centers / Q000592:standards*; D002983:Clinical Competence; D013502:General Surgery / Q000592:standards; D006801:Humans; D008505:Medical Staff, Hospital / Q000592:standards*; D011182:Postoperative Care / Q000592:standards*; D058996:Quality Improvement; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000592:standards*; D011795:Surveys and Questionnaires; D000078329:Workforce