AO Foundation Trustees Meeting 2018: Breakout session

Findings emerging from the July 14 AO Trauma breakout session at the AO Foundation Trustees Meeting 2018 in Basel, Switzerland provide a possible starting point for an AO Trauma safety-first culture focus in education.

14 August 2018

The breakout session on safety in health care featured two experts: Martin Egerth, a psychologist and the Senior Product Manager Human Factors and Leadership Trainings at Lufthansa Aviation Training GmbH near Munich, Germany, and Dr Matthias Münzberger, head of interdisciplinary emergency and rescue department at Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Germany. In their opening remarks on examples of disaster events in the aviation and shipping industries, Egerth and Münzberger explained that implementing a safety-first culture is more than following important and powerful checklists. Interhuman behavior and its resulting culture are crucial factors in avoiding or provoking hazardous situations.

These experts’ assertions are underpinned by a study about causes of errors, conducted by Münzberg, Ruessler, Egerth et al. in 2018 with 799 surgeons*. The study concludes that deficient communication is the second most frequent cause of errors in surgery. Compounding the dilemma is the possibility that, lacking a blame-free error culture, co-workers may not speak up due to an overlong hierarchal corporate culture or their own feelings of frustration, fear of being blamed or feeling they might not be heard. On the other hand, on the leadership level, lack of awareness, economic pressures and lack of self-reflection can lead to poor decisions. Consequently, even when checklists are implemented in most processes, 100 percent safety is not a given in daily operations.

Sharing experiences, defining measures

Asked by Egerth and Münzberger what their top priorities at work are, the 50 surgeons attending the breakout session stressed safety, quality and patient care. But what is needed to help teams work in ways that ensure the best safety outcome and therefore the best patient outcome? That question was explored by four working groups composed of AO Foundation Trustees and guests—all experts in their fields. Participants shared issues and experiences, brought their thought leadership to the table, and discussed measures to improve safety in their professional disciplines and within AO Trauma in general as a leader in education.

When the groups reconvened to continue the breakout session, they presented their findings on four topics:

  • Key elements for a safety-first culture
  • Key behavior markers expected from surgeons and key interpersonal competencies
  • What are the key leadership qualities needed, especially for younger generations of surgeons
  • How safe do participants want to be, how safe can they be, and defining their safety goal

The breakout session and its group discussions proved to be an ideal opportunity to examine how educating a safety-first culture might eventually be integrated into AO Trauma’s educational programs.


Safety Culture in Orthopaedic Surgery and Trauma Surgery–Where Are We Today?

799 active members of the Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) took part in the survey. 65% of the interviewed people stated that they noticed mistakes in their own clinical work environment at least once a week. The main reasons for these mistakes were time pressure, lack of communication, lack of staff, and stress. Technical mistakes or lack of knowledge were not of primary importance. 

The objective of this research was to achieve a subjective assessment of the frequency and causes of insecurities or errors in daily practice. 

Online-publiziert | Z Orthop Unfall © Georg Thieme
Verlag KG Stuttgart · New York | ISSN 1864 6697

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