• Review raises multiple concerns over theatre safety and culture at Aintree University Hospital FT
  • Trust told to develop “clear thresholds and intolerance of poor behaviour and bullying”
  • Reports followed series of eight “never events” in 12-month period

An independent review has cited concerns about safety and culture within a trust’s surgical theatres and has warned multiple pressures were creating a sense of “chaos and uncertainty”.

The attitude and behaviour of some staff at Aintree University Hospital Foundation Trust created the potential for “error prone situations”, the reviewers suggested, and the trust was told to develop “clear thresholds and intolerance of poor behaviour and bullying”.

The review also referenced criticisms of the trust’s senior management, noting many staff across all professions had remarked how the senior team and board members “rarely walk the floor to feel the pulse of the theatres”.

Jane Reid, of Wessex Patient Safety Collaborative, was invited to undertake the review last summer following a series of eight “never events” in the year to March 2018. The Royal College of Surgeons also conducted a review in November.

HSJ has obtained both reports via freedom of information laws, although both have been partly redacted. An initial FOI was rejected, but the redacted reports were released on appeal.

The trust said it responded quickly to the incidents and is now rolling out a “comprehensive safety-first strategy”.

Professor Reid stressed there was some “excellent and exemplary work” in the trust’s theatres, and said the care delivered was generally kind and compassionate.

She also noted “many younger clinicians/consultants” had demonstrated a positive leadership stance and were striving to ensure surgical checklists were properly embedded.

But her review included the following criticisms:

  • A number of staff failing to appreciate the relationship between their attitude and behaviour and the potential to create error prone situations;
  • A poor culture of “speaking up” about patient safety;
  • Shortfalls in leadership behaviour of certain individuals;
  • Failure to recognise in several theatres that music is a distraction and safety risk;
  • Efforts from operating teams to engage with surgical safety checklists were compromised by some clinicians who won’t support it;
  • Routine workarounds were used in response to intense demand pressures, despite them being known safety violations;
  • Sense of “chaos and uncertainty” due to heavy workloads, poor listing and scheduling for theatre work, late list changes, and pressures from the emergency department;
  • Unnecessary bureaucracy had turned surgical checklist processes into tick-box exercises, rather than being central to the operating procedures; and
  • An “overwhelming view” among staff that the trust board valued productivity and finances ahead of “people and patients”.

The Royal College of Surgeons review, which partly relied on Professor Reid’s findings, said some staff attributed the “difficult behaviours” in the theatres to a “perceived hierarchy”.

It added there was tension between surgeons wanting to “get the lists done” and stoppages caused by the safety processes, as well as “dismissive views” of safety processes in some smaller specialties.

It said the trust should acknowledge responsibility for the “systemic weaknesses” which contributed to the never events.

A trust spokesman said: “While these independent reports found significant amounts of good practice, they also highlighted areas for improvement. We responded swiftly to the incidents and have developed a comprehensive safety-first strategy, which is being rolled out across the trust.

“To support the longer-term work to embed a safety culture, we increased the visibility of leaders within theatres and have nominated safety champions in each area.”

AUHFT is due to merge with Royal Liverpool and Broadgreen University Hospitals Trust later this year. The reports said it would be crucial to address the safety and cultural issues ahead of this.