In our hospital, which is a medium-sized community hospital, we have a strong focus on quality and safety. We were one of the first hospitals in Belgium to become accredited by JCI (the international branch of Joint Commission) and we introduced the Time-out procedure years before it became common practice in the country. This was only possible because some people of the quality department, as well as some leading physicians, are really committed to safety.
In the week of the second module of MHCD though, our deputy CMO saw one of the residents, who would later on not join the surgery, performing the time-out procedure and putting an arrow on the patient to mark the site of surgery. Of course this is not according to our policy, which clearly states that the time-out procedure should be performed by the surgeon doing the surgery and as we say ‘The one who holds the knife, is the one who puts the arrow’. The situation observed was obviously a safety risk.
My colleague immediately sent an email to all surgeons, anesthesiologists and OR-nurses, reminding them of the correct Time-out and site-marking procedure and of the risks of non-compliance.
Later on, the incident was discussed in the quality committee. We realized that, although many physicians and nurses really believe the procedures make sense, although we train new physicians and residents and although people of the quality department regularly do observations and on paper everything looks fine, compliance to the time-out procedure in practice is not perfect in all cases.
One of the solutions proposed, was anonymous observations of the time-out procedure. Since it’s obvious that observations are being performed when people of the quality department enter the OR room and since this might influence the practice of the time-out procedure, it was suggested to ask three surgeons and three anesthesiologists to anonymously observe their colleagues performing the time-out procedure and systematically report to the leadership about the performance of the individual surgeons, anesthesiologists and nurses.
I do believe in coaching by peers to use group pressure to improve compliance to the safety procedures. But I’m very reluctant to introduce or even propose our surgeons and anesthesiologists the above mentioned anonymous observations by peers. Even though compliance to the time-out procedure might improve this way, it would probably still not become perfect. But more importantly, even if it would be possible to become the best time-out hospital in the world, we would institutionalize distrust in our surgical teams. And a lack of trust between the members of our teams, undoubtedly constitutes another safety risk for our patients.
I’d like to ask whether the members of our group have the same opinion or whether, on the other hand, some might have good experiences whit this type of anonymous observations by team members.