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Surgical Safety and the Highly Reliable Surgical Team

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The main goals are: improve safety of surgical patients undergoing procedures at Kaiser Permanente, Fresno and improvement of surgical safety attitudes of both physicians and OR staff resulting in an environment that will decrease risk to patients undergoing surgical intervention and further maintain a no never events record.
The purpose of this thesis is to develop alternative methods to ensure 100% compliance with the use of a surgical briefing. exceeding the requirements of Joint Commission’s Universal Protocol (The Joint Commission , 2009) by OR staff members and physicians utilizing the surgery department at Kaiser Permanente Fresno, California.
Although surgical safety is more than a local challenge, only addressing individual behaviors and habits at a local level can raise the threshold to decrease significant surgical mishaps. Kaiser Permanente OR staff and surgeons are comprised of very well seasoned and experienced caregivers. As new concepts come to light, it can be challenging for those individuals to perceive the benefit of incorporating what is viewed as unnecessary, time consuming and laborious steps to prevent errors when they may not have had any personal history of such errors. Kaiser Permanente is a very complex, highly structured healthcare system and as such, has a high degree of formalization within the organization. This is can be seen demonstrated throughout the local, regional, national offices and medical centers. In addition Kaiser Permanente is comprised of three distinct businesses: Kaiser Foundation Hospitals and their subsidiaries (KFH), and the Kaiser Foundation Health Plan (KFHP) which are both not for profit corporations. The Permanente Medical Group (TPMG) which consists of eight separate physician groups, is a for profit enterprise.
Kaiser Permanente has 37 Medical Centers and 400 medical offices nationally. Northern California is their largest region, which accounts for 20 Medical Centers. Kaiser Permanente Fresno has 5 distinct medical office buildings (MOB) located between Selma and Oakhurst California. The Fresno Medical Center has a complement of 169 licensed beds, 8 surgical suites with an additional 2 labor and delivery suites. The facility provides both inpatient and ambulatory surgical care, which is facilitated by 200 physicians, 500 plus nurses, along with 80 medical support staff, servicing 108,000 members.
There is currently a goal to integrate and adopt all regional job descriptions at the local levels. There are national, regional, as well as local policy and procedures covering many