Special Feature
May 04

Helping Your Team Soar
Communication and Evaluation are Keys to Successful OR Teams
by Amy Clarkson

FAST FACTS
• More than half of all CSTs work in hospital ORs.
• 36% of CSTs have an associate’s degree or higher.
• LCC-ST has certified more than 50,000 surgical staff.
Visit Liaison Council on Certification for Surgical Technologists, www.lcc-st.org for certification requirements

Surgery requires a finely skilled team of professionals, from the surgeon to the surgical technologist, from the first assistant to the circulating nurse. The team needs to work together, with no room for error – or for ego.

“ Everyone has a role in the operating room,” explains Linda Glawe, Certified Surgical Technologist. “The circulating nurse is there to document the patient; the surgical technologist gets the instruments ready and does the prep for the surgery. First assistants support the surgeon; they can do everything from placing clamps to closing the incision. There has to be a cooperative atmosphere.”
“In a field where you have people who work independently and make split-second decisions, there is a lot of stress,” says Cindy Crum, director of nurse education at the Veteran’s Administration in Arkansas. “We have strong personalities in the operating room. Sometimes, what goes on behind those doors is because of personalities. It makes it harder to communicate. Everyone has an opinion about what’s best for the patient.”

“Operating room personnel are a different breed,” continues Crum. “Sometimes we have battles about control, for instance, I knew one person who would always hide a certain instrument the doctor liked to use, so they could always be the one to give it to him, instead of the circulating nurse. Communication is the only way to get beyond those personalities and get the job done for the patient.”
“The problem of communication is widely recognized in the medical profession,” says Spencer Byrum, vice president of Crew Training International, in Memphis, TN. That’s where his company comes in. CTI teaches medical professionals ways to communicate more effectively, with the patient, with their staff and as a team. In an area where the staff is technically proficient, medical professionals often do not take the time to communicate well with each other.
“The single biggest component to doing a better job inside the operating room is communicating better,” Byrum says. “If everyone does a better job of explaining what they expect, what their responsibilities are, it’s better for patients. Things will go faster; there will be fewer surprises.”

“First of all, you have to actually listen,” Bryum conintues. “A key element in communication is listening. Too often, people are focused on the task at hand and don’t actually listen to what others are saying.”

In addition, effective communication is clear, timely and solution-driven. If there is a concern, medical professionals should speak clearly and propose a solution to the problem. “It sounds rudimentary,” he says. “But it’s important. If everyone has the right information, can communicate completely, then the outcome is better for the patient.”

But what happens when professionals fail to cooperate or argue over responsibilities and territory? Often, surgical staff vie for responsibility in the OR. Can personnel issues spill over into the OR, causing negative consequences for the patient? When you enter a new OR in a new hospital, do all the roles and rules change? Not necessarily. Byrum stresses that communication and standardized procedures are the answer to efficiency for the OR team as a whole.
Byrum trained as a pilot, but started a company in the 1990s with the goal of standardizing hospital procedures. He wants every procedure, in every hospital, in every state to operate using the exact same standards, much as pilots use checklists and procedures before every flight.

“There isn’t much difference in the jobs, really,” he says. “Both jobs require smart people who are able to make life or death decisions in a split second. In aviation, we reduced the number of accidents when we started using checklists and procedures, the same checklists, the same procedures, over and over. Hospitals should do the same thing.”

Byrum works with several health care systems and medical universities to turn his ideas into reality. Different communication techniques, standardized procedures and more efficient methods can significantly lower the accident rate in the OR

Many of the standard operating procedures from aviation can be applied to medicine. Currently, CTI is reshaping the flow of the emergency room in the Methodist Health System and at several hospitals around the country. Cincinnati Children’s Hospital, Vanderbilt Medical Group, American Academy of Orthopedic Surgeons and Methodist Health Care are only a few of the medical groups that are putting his ideas to practical use.

“Recognition of standardized procedures and processes can increase beneficial outcomes for patients,” explains Byrum. “In aviation, you cannot fly without doing certain things. We have procedures and checklists. Because they are there, they are written down; often they are checked and double-checked. It makes a huge difference in the number of accidents in aviation. It can make the same difference in the OR.”

Unfortunately, the medical field doesn’t have a system of standard practices and procedures. Often times, the methods used vary widely – even from hospital to hospital. By writing down the way a job is always done, it increases the success rate of the procedure.

“If you can take some of the ‘best practices’ from another industry and apply it in medicine, the benefits are incredible,” he says. “If there are standardized procedures in place for all the labs that are done, for all the forms that are completed, then you are not rushing. Doctors and their staffs can focus more on the case, than on the paperwork. That translates into a better quality of care for the patient.”

Cindy Crum, who is a Certified Surgical Technologist as well as a Certified Operating Room Nurse, says that the procedural issues in the OR occur as job descriptions evolved over the years. “Surgical technologists have a very important job, but they don’t have position or a license. There are some little issues between the techs and the circulating nurses that have evolved over the years. To keep those issues to a minimum, everyone needs a clarification of what’s acceptable and what’s not,” she said.

Linda Glawe, CTS believes being prepared for surgery can ensure success in the OR. “It’s imperative that people know their responsibilities,” she says. “You need to know that if something is needed, you can ask for it. Surgical techs should keep ahead of what they need for a surgery and have it ready before the surgery starts. Often, there’s very little time to ask for something different. But things do come up and you have to be one step ahead. It takes the entire team.”

Crum and Glawe also recommend surgical technologists take certifying examinations before they enter the operating room. The Liaison Council for Certification for the Surgical Technologists is responsible for testing and certifying surgical technologists and issues the CST credential to those who have completed an accredited education program and successfully undergone a rigorous four-hour exam.
“We push hard for certification,” Crum urges. “I’d like to see more hospitals and employers go toward mandatory certification. But as there are shortages in the field, many hospitals relax their standards just to get the positions filled.”

Glawe has always worked as a surgical technologist. She says certified technologists assure surgeons that they possess a certain amount of knowledge. “Certification is important because it shows people that you have the practical knowledge to go with the skill,” she says. “It’s up to you to apply it in the OR.”

Byrum also advocates for this approach. He believes every medical professional should be required to update their knowledge and be evaluated on a regular basis, much as pilots are tested annually.

“At any given year, pilots could undergo three possibly career-ending evaluations,” he concludes. “And it should be the same for medical professionals. The testing and evaluation should occur throughout their careers. Patients want to know their doctors and surgical teams are up to date on the latest procedures.”