The Role of Collective Mindfulness in Delivering Reliable and Safe Perioperative Care to Neonates

Vanderbilt University Medical Center, Nashville TN

Investigators

Abstract

7. PROJECT SUMMARY/ABSTRACT High-reliability organizations (HROs) such as aircraft carrier flight decks and nuclear power plants are organizations that operate hazardous technologies in a nearly error-free manner under trying conditions rife with complexity, interdependence, and time pressure. Case studies of HROs as well as in a few healthcare organizations that follow the principles of HROs suggest that a robust safety culture enables more reliable work processes, and thus safer performance. More tangibly, safety culture can be seen ?coming to life? in HROs through specific behavioral processes observed in front-line employees collectively termed collective mindfulness (CM). These five interrelated behavioral processes (also called safety organizing behaviors) are: (1) preoccupation with failure; (2) reluctance to simplify interpretations; (3) sensitivity to operations; (4) commitment to resilience, and (5) deference to expertise. Healthcare is increasingly examining and adopting the principles of CM as a means to improve quality and safety of care delivery. The critical need for achieving HRO status in healthcare is no more apparent than in neonatal perioperative care, which is among the highest risk services hospitals may provide. Neonates are highly vulnerable to iatrogenic events due to their small size, fragility, and exceptional sensitivity to environmental stressors. The objective of this pilot study is to measure the prevalence of CM in neonatal intensive care unit (NICU) and operating room (OR) teams and its impact on non-routine events (NREs) ? defined as any event that is perceived by care providers or skilled observers as a deviation from optimal care based on the clinical situation - during neonatal perioperative care. The project will leverage an active large prospective observational study (IRB-approved NICHD R01) that is defining the epidemiology of risk for neonates in the perioperative environment through an innovative analysis of NREs and contributory factors. We propose a two-year pilot study to characterize CM behaviors in NICU and OR teams and to measure their impact on patient safety as measured by the incidence and severity of NREs during NICU-to-OR handovers and subsequent care. Our Specific Aims are to: 1) Conduct a prospective observational pilot study of NICU and OR teams to: a) estimate the prevalence of perceived CM (i.e., self-reported using the SOS) during the perioperative period and b) delineate the relationship(s) between team attributes, case attributes, and perceived CM scores; 2) Determine the impact of perceived CM on the incidence and severity of NREs occurring during and across phases of neonatal perioperative care; and 3) Conduct a preliminary validation of a provisional behavioral marker system, by assessing the concordance of observed (expert ratings of A-V recordings) and perceived CM (self-reported SOS scores) in the same perioperative teams. We anticipate that knowledge gained from this study will lay the groundwork for a multi-center study on the impact of team-based HRO interventions on neonatal safety in the perioperative environment.