Friday, May 15, 2009

FOCUS – Our Next Steps

By Dr. Bruce Spiess

FOCUS is very excited to announce that all the initial hospital sites have been visited and observed. The human factors research team employs a number of tools (called “LENS’) that have undergone validation and testing prior to being used as research tools in the present project. FOCUS is very proud to partner with the JHU Center on Quality Patient Care not only because of their and Dr. Pronovost’s international reputation, but also because it allowed both groups to further refine these human factors investigational tools. The tools employ survey instruments distributed prior to site visitation, extensive interviews with the entire operating room team (anesthesiology, surgery, perfusion and nursing) as well as the administration, on-site observation of cases, and post visitation surveys and interviews. The on-site team in a 2 day visit, examines communications, breaks in flow, ergonomics of equipment, and other systems constructs, all with a FOCUS upon how a team performs in a highly complex environment. The data from the various LENS’ are now being coded and collated. In discussions with the JHU team we are told: “The data is very rich, and full of possibilities for interventions that to improve patient safety – ones that can be done relatively easily and soon, and some that will take more earnest work”. What that means we cannot tell at this time, but suffice it to say that there will be directions and conclusions that can be drawn form this original first look inside the cardiac operating rooms.

What are the next steps?

Clearly we must finish what we have set out to accomplish, the first gathering of data and its analysis. As stated throughout the formation of FOCUS, this will be a scientific, data driven medical and sociological intervention. Until the data is analyzed, it is hard to say what interventions should proceed or in what order we should invoke changes. Although there is much data collected already, only five, albeit carefully selected and representative, sites have been studied. The FOCUS steering committee envisions that more sites should be studied (5-20 more), and that the beginning of a self-study program should be initiated. The form of the self-study tools will grow out of the data through a combined effort of the JHU human factors experts and the FOCUS Data Analysis Committee. It could well be that in the next 12 months we see the first recommendations from FOCUS come forward to be implemented and field tested at cardiac sites around the country. The on-going success of the FOCUS program itself is feeding back towards improving/reducing human error. By the existence and success of the initial site visits, national and even international curiosity is peaking. The FOCUS project is gaining exposure with reporting on the programs for educational meetings not only within the SCA but in other societies. The recent 14th Annual Update on Cardiopulmonary Bypass was held at Whistler, Canada March 14-20, 2009. At that meeting a session on patient safety was well received and the attendees asked for more and expanded sessions, workshops and team building training for future meetings all with the end goals of reducing human error in the cardiac operating rooms. So, in a small way the FOCUS program has already succeeded by creating buzz, discussion, and insight by the rank and file into how we go about delivering such complex care.

FOCUS has only begun – join us!