The Mas Yukawa Foundation is pleased to provide an update from last year’s winner of the Dr. Masaru Yukawa Award for Innovation in Workplace Wellness, Dr. Ariane Fielding. We’ve recently engaged in a short Q&A to see what she’s been doing on her path to actualizing her winning proposal – “Civility and Respect in the OR”.
Mas Yukawa Foundation: Please describe your current initiatives and what you hope to achieve, especially in terms of workplace wellness.
Dr. Fielding: An important part of wellness among surgical teams is how we deal with adverse events in the operating room. Errors in medicine are inevitable, but how we process them in the weeks and months afterwards can have a significant effects on the well-being of medical professionals. These effects include guilt, shame, anxiety, depression, impaired work performance and burnout. Physicians are sometimes referred to as the “second victims” in a medical error.
Critical Incident Debriefing is a structured, facilitated gathering of all involved participants in which the entire team learns about outcomes of the case after leaving the OR (such as the patient’s course in ICU) and allows them to discuss their feelings in a psychologically safe environment. It provides closure, and can help prevent gossip.. Having input, as well as hearing supportive or validating statements from other members of the team can make the physician feel less alone. Often important learning points are raised that benefit members of the team, in addition to increasing patient safety in the long run.
We feel that the process of Critical Incident Debriefing will bring our workplace colleagues closer together, help to mitigate feelings of guilt, shame, loneliness and burnout following an adverse event, and support physician and other healthcare workers’ wellness.
Within 3 months I plan to have met with the relevant medical leadership and OR educators to lay the groundwork for launching this initiative. I have also spoken with as many anesthesiologists as I can so far at the Grey Nuns to get an idea of what is being done so far for critical incident debriefing. From what I am hearing there is an email sent post-incident asking whether anyone is interested in a debrief, but as far as anyone can tell physicians have never participated.
I plan to send out a needs assessment to the surgeons, anesthesiologists, nurses, and allied health professionals to see what their local needs are and barriers to participation.
MYF: How are you going to identify critical incidents?
Dr. Fielding: At our institution, we include any event where a code blue (cardiac arrest) is called (even if it was called off soon after). We also include a massive hemorrhage, or any of the other standard anesthesia emergencies that are found in the Stanford Anesthesia Emergency Manual. There’s a different list for obstetrics, and they occur more frequently. In addition, if the managers, or anyone else become aware of a concerning or upsetting event of any kind they can ask for a debrief. We typically debrief 4-5 times per year. In the above study, they identified 89 events over a 12 month period, of which a little over 50% were debriefed.