'Just Culture' encourages error reporting, improves patient safety
During a procedure in the OR, a medication is retrieved from the automated supply station and introduced onto the sterile field. The sterile field is then, unknowingly and unintentionally, contaminated by an unsterile medication. This example could happen in any operating room setting. In this case, the circulating nurse spoke…
Efficiency soars in wake of strategic OR cultural changes
Changes in staff responsibilities and greater collaboration have contributed to dramatically improved first-case on-time starts at the University of Louisville Hospital, Louisville, Kentucky—from about 35% to 86% in a little over a year. Turnover time has been reduced, too, with slow but steady progress suggesting that revamping existing structures can…
Lateral violence: Tools managers can use to help shift the culture
An orientee comes to you in tears saying a couple of tenured nurses have snapped at her or huffed impatiently when she asked a question. Several other staff have met with you individually about conflict and hurtful comments they say are happening on one of the specialty teams. You already…
What makes an OR "highly reliable"?
What makes an organization "highly reliable"—able to avoid the rare but serious breakdowns that can have devastating consequences for patients? A highly reliable organization is one that is "exceptionally consistent in accomplishing their goals and avoiding potentially catastrophic errors," notes the Agency for Healthcare Research and Quality (AHRQ). Some familiar…
Turning around the culture of an OR
In 2001, the ORs at Banner Baywood Medical Center were struggling—physicians were dissatisfied, case volume was down, and 13 staff positions were vacant. "There was a general lack of urgency. There just was no culture of efficiency," says Christine Halowell, RN, MS-HSA, CNOR, director of perioperative services for the Mesa,…
Support for staff when things go wrong
The patient had come to the OR for joint replacement surgery. Though she had a complicated medical history, there was no reason to believe she would have serious problems. But during the surgery, things went wrong, and despite everyone's efforts, the patient died. It hit the team hard, including the…
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