1. POOR SURGICAL TEAMWORK & SAFTEY ATTITUDES: THE UNSPOKEN NORM Kirengo T, Nyotu R, Ndanya S, Gitonga S

2. Contents Introduction Objectives Methodology Conclusion References

3. Introduction Team work is important in surgery due to; The high risk nature of the procedures undertaken The low room for error Surgical outcomes are dependent on both technical and non technical skills of the surgeon. Surgical adverse events occurring in theatre range from 33-66%(1,2) High performance practitioners possess non-technical skills as a part of their surgical expertise(3)

4. Introduction The three common factors contributing to errors (4): 1.Lack of experience with surgical task(53%) 2.Communication problems(43%) 3.Excessive workload(33%) Carter et al, in 2003, reported: Paradoxically most are errors are caused by well trained and highly motivated professionals(5)

5. Objectives Safety attitudes of theatre staff at Embu PGH Specifically: Job satisfaction, Management perceptions, Team work attitudes, Safety attitudes, Stress recognition Working conditions.

6. Methodology All operating theatre personnel were surveyed using the safety attitudes questionnaire A total of 97 of 120 questionnaires(81%) were received and analyzed The study lasted from January to May 2015. Microsoft Excel 2016 and SPSS version 22 were used to analyze the data.

7. Results OCCUPATIONRESPONDENTS Anesthetists/ Anesthesiologists 9 BSc Nurses8 Consultants6 Environmental Supports Staff 8 Medical Officers14 Medical Officer Interns11 Registered Nurses18 Students23 TOTAL97

8. Results EXPERIENCE IN YEARS PER OCCUPATION OCCUPATIONAVERAGE EXPERIENCEMINIMUM MAXIMUM Anesthetists/ Anesthesiologists 4.927 BSc Nurses3.126 Consultants5.646 Environmental Supports Staff 1.713 Medical Officers3.317 Medical Officer Interns111 Registered Nurses3.917 Students1.914

9. Results TEAM WORK ATTITUDES QUESTION AGREE STRONGLY AGREE SLIGHTLYNEUTRAL DISAGREE SLIGHTLY DISAGREE STRONGLY 1. Nurse input is well received in the operating theatre42.53%31.03%14.94%6.90%4.60% 3. Disagreements in the operating theatre are resolved appropriately (i.e. not who is right, but what is best for the patient)44.83%21.84%13.79%10.34%9.20% 4. I have the support I need from other personnel to care for patients49.43%20.69%14.94%8.05%6.90% 5. It is easy for theatre staff to ask questions when there is something that they do not understand48.31%32.58%8.99%4.49%5.62%

10. Results SAFETY CLIMATE QUESTION AGREE STRONGLY AGREE SLIGHTLYNEUTRAL DISAGREE SLIGHTLY DISAGREE STRONGLY 7. I would feel safe being treated here as a patient31.03%27.59%22.99%13.79%4.60% 8. Medical errors are handled appropriately in the operating theatre31.40%40.70%16.28%5.81% 9. I know the proper channels to direct questions regarding patient safety in the operating theatre44.05%33.33%8.33% 5.95% 10. I receive appropriate feedback about my performance15.91%21.59%22.73%20.45%19.32% 12. I am encouraged by my colleagues to report any patient safety concerns I may have32.95%28.41%23.86%5.68%9.09%

11. Results JOB SATISFACTION QUESTION AGREE STRONGLY AGREE SLIGHTLYNEUTRAL DISAGREE SLIGHTLY DISAGREE STRONGLY 15. I like my job75.00%10.23% 1.14%3.41% 16. Working here is like being part of a large family45.45%21.59%17.05%7.95% 17. This is a good place to work39.08%21.84%24.14%9.20%5.75% 18. I am proud to work in the operating theatre46.59%20.45% 5.68%6.82% 19. Morale in the operating theatre is high22.09%37.21%23.26%11.63%5.81%

12. Results STRESS RECOGNITION QUESTION AGREE STRONGLY AGREE SLIGHTLYNEUTRAL DISAGREE SLIGHTLY DISAGREE STRONGLY 20. When my workload becomes excessive, my performance is impaired59.55%14.61%13.48%4.49%7.87% 21. I am less effective at work when I am fatigued60.47%16.28%6.98%8.14% 22. I am more likely to make errors in tense or hostile situations56.32%18.39%8.05%6.90%10.34% 23. Fatigue impairs my performance during emergency situations48.28%19.54%9.20% 13.79% 20. When my workload becomes excessive, my performance is impaired59.55%14.61%13.48%4.49%7.87%

13. Results PERCEPTIONS OF MANAGEMENT QUESTION AGREE STRONGLY AGREE SLIGHTLYNEUTRAL DISAGREE SLIGHTLY DISAGREE STRONGLY 24. Hospital Management supports my daily efforts13.79%34.48%17.24%22.99%11.49% 25. Hospital Management doesn’t knowingly compromise on patient safety24.14%21.84%19.54%16.09%18.39% 26. Hospital Management is doing a good job22.73%28.41% 10.23% 27. Problem personnel are dealt with constructively by our hospital management16.67%23.81%33.33%11.90%14.29% 28. I get adequate, timely info about events that might affect my work6.98%32.56%25.58%12.79%22.09%

14. Results WORKING CONDITIONS QUESTION AGREE STRONGLY AGREE SLIGHTLYNEUTRAL DISAGREE SLIGHTLY DISAGREE STRONGLY 30. This hospital does a good job training new personnel21.59%23.86%25.00%12.50%17.05% 31. All necessary information for diagnostic and therapeutic decisions is routinely available to me12.79%22.09%24.42%16.28%24.42% 32. Trainees in my discipline are adequately supervised12.05%34.94%20.48%19.28%13.25%

15. Results SUMMARY OF ATTITUDES PER OCCUPATION PositionTeam Work %Safety % Job Satisfaction % Stress Recognition % Management Perceptions % Working Conditions % Anaesthetist31.8738.8466.8860.1644.7927.08 BSc Nurse46.4249.4972.1486.615055.95 Consultant5137.145193.7558.3351.67 Environmental support3542.8674.1759.3863.879.17 MO27.5032.1467.5068.7531.2520.83 MOI39.5039.2971.5080.6334.5846.67 Reg Nurse42.0536.1371.4773.5339.4636.76 Student nurse48.8441.4877.3162.9856.4146.15 KEY STRONGLY DISAGREE SLIGHTLY DISAGREENEUTRALSTLIGHTLY AGREESTRONGLY AGREE <25%25-49%50%51-75%>75%

16. Conclusion Attitudes survey provides useful information on the staff behavior Team work and safety attitudes in our facility were generally low Considerable discrepancies exist between attitudes and perceptions of different staff cadres Operating theatre should use objective methods to measure staff attitudes