LETTERS TO THE EDITOR Missing perspective in the discussion of safety culture I am writing with regard to the “Table Talk” article, “Sustaining a culture of safety: are we one step forward or three steps back?” (December 2013, Vol 98, No 6). I have two comments about this article: 1. A graphic comparing the rate of OR sentinel events before the Universal ProtocolTM was mandated with the rate of OR sentinel events after the mandate would have answered the question posed in the title. In my experience, there is shock value in seeing this truth. The truth is that, even when applied as recommended, the Universal Protocol has only marginally reduced the rate of OR sentinel events. The persistent root causes are failures in what make teams effective: leadership and communication. 2. Analysis of the evidence suggests, and this article acknowledges, that team communication is the determinant precursor to establishing an effective safety culture. The article shares the perspective of a nurse manager, a staff nurse, a surgeon, an anesthesiologist, a risk manager, and the chief executive officer of AORN. Yet, whose perspective is missing from this discussion and who is part of every time out? It is the surgical technologist. Input from a surgical technologist would not have been difficult to obtain, and it would have supported the writers’ contention that “teamwork” is the key to success. The absence of this perspective leads me to believe that we continue to provide lip service to teamwork and to the transfer of proven techniques from successful, high-reliability organizations to the OR. The omission is telling. If there was no value in including the opinion of 25% of OR staff members for this article, then it is not difficult to understand

Ó AORN, Inc, 2014

why the average OR lacks effective teamwork, is not highly reliable, and is not much safer than before The Joint Commission’s mandate. Editor’s note: The Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery is a trademark of The Joint Commission, Oakbrook Terrace, IL. KENNETH YOUNG MBA, CST, CPHQ, CPPS SURGICAL TECHNOLOGIST NASHVILLE, TN http://dx.doi.org/10.1016/j.aorn.2014.01.021

Author response. Lack of inclusion was not an omission of the value of other team members but rather related to length of submission. As we all know, this “Table Talk” article did not include the perspective from the surgical technologist; however, it also did not include the perspectives of a physician assistant, advanced practice nurse, certified RN anesthetist, or perianesthesia nurse. This does not detract from the importance of any of these team members in maintaining a culture of safety. AORN as an association, through our active participation in the Council on Surgical and Perioperative Safety, and each of us individual nurses partner with all of these team membersdas well as those whose perspectives were included in this particular “Table Talk” articledin our combined efforts to improve safety for our patients. CHARLOTTE L. GUGLIELMI MA, BSN, RN, CNOR PERIOPERATIVE NURSE SPECIALIST BETH ISRAEL DEACONESS MEDICAL CENTER BOSTON, MA http://dx.doi.org/10.1016/j.aorn.2014.01.022

April 2014

Vol 99 No 4


AORN Journal j 455