Opening Address by Prof K Satku, Director of Medical Services 4th NUH Scientific Meeting for Operating Room Nurses on 28 April 2012 at the Conrad Centennial Hotel

1.           It gives me great pleasure to join you today at the 4^th NUH Scientific Meeting for Operating Room Nurses. I would like to begin by extending a warm welcome to all participants and a special welcome to our foreign delegates and speakers. Thank you for participating in this conference and sharing your expertise.

2.      I note that the 1^st Scientific Meeting was organized in 2003. Your ability to sustain interest in sharing skills and knowledge of operating room nursing, speaks volumes of your enthusiasm, initiative and dedication to advance the cause of operating room nursing.  I sense your deep commitment to improve peri-operative care for the patient and applaud you for that.

3       As an orthopaedic surgeon, I am familiar with the working environment of the operating room nurses. While some of you may have specific peri-operative nursing skills in specialty areas such as cardiovascular surgery, urology or neurosurgery, the principles and practice of patient safety prevail through all aspects of operating room nursing.  These include prevention of post-operative infections, prevention of wrong-site or wrong-patient surgery, and avoiding retention of foreign bodies.

4       I am glad to learn that the NUH operating room nurses have led several patient safety and quality improvement initiatives.  These include projects aimed at reducing post-operative wound infection, maintaining normothermia in post-operative patients, reducing wrong site surgery and analyzing the root cause for sentinel events and near misses.

5       However despite the many initiatives, sentinel events related to surgery in operating rooms still occur, with the numbers being fairly constant over the past decade.  Between 2002 and 2011, there were 8 to 13 sentinel events each year, related to surgery in operating rooms. . This accounted for about 20% of all sentinel events that were reported in our healthcare institutions.

6.      This trend of adverse events,  not significantly reducing, has been noted in other countries as well. Errors continue to happen despite root cause analysis and the introduction of the numerous protocols.  Observational studies show that despite briefing and training, the surgical teams have compliance rates with safety protocols and practices as low as 60 percent.

7       Protocols, are sometimes  viewed as trivial and therefore efforts to make the OR environment safer are undermined. Doctors in particular present a unique challenge. The doctors’ autonomy in the OR environment needs to be managed if progress is to be made.  Also, knowledge is emerging that protocols alone are not sufficient to effect a systemic change to eliminate errors and achieve high reliability in OR practice.

8       Increasingly, the call is made for a safety culture. James Reason describes this as an informed culture that has a heightened awareness of the possibility of failure, and works continuously to eliminate risks while building resilience.

9       How infused are we with this safety culture?  There are today numerous safety climate assessment tools such as the Safety Attitudes Questionnaire that measure the patient safety climate of an organization. Favorable scores are associated with better patient outcomes.

10     We need to take a journey in this direction. We need leadership that will make the OR environment safer for the patient. In this context, may I as a surgeon add that there is a vacuum in leadership. The operating room nurses are as well positioned as any other healthcare professional, to take on leadership roles in developing and sustaining a culture for safety.

11     The Robert Wood Johnson Foundation and the Institute of Medicine had in 2010 published a report called  “The Future of Nursing: Leading Change, Advancing Health”.  The report provides recommendations on how to transform the nursing profession, so that the profession could in turn be well positioned to influence and shape the health care system. The report states that “nurses at all levels need strong leadership skills to contribute to patient safety and quality of care.”

12     It is a call to translate nursing skills and knowledge to improve work processes, the work culture, and the work environment to improve the outcomes for patients. It is a call to nurses to go beyond their immediate area of responsibility to contribute to transforming the system as a whole. This call to action is particularly applicable to developing a culture of safety in the health care environment.

13     I note that a few speakers at this scientific meeting will provide you with insights on leadership and management. I hope that some among you would be fired up to take the lead and put in the effort to become agents of change.

14     We need nurse leaders who can engage their OR colleagues and inspire them to a common vision of creating a culture for safety - to inspire colleagues to give of themselves that additional discretionary effort that each one of us can give when we are inspired.  We need to engage, influence and bring out the best in the people working in our environment. In the operating room, nurses are well positioned to provide the necessary leadership to nurture a culture of safety.

15     The transformation of the system and work culture is a gradual process and requires the continuous commitment of individuals dedicated to the cause.  To this end, I hope the management of our healthcare institutions will empower and support our nursing leadership to lead and transform the OR environment to be safe for our patients.

16     In closing I commend the organizers for putting together an excellent programme. I am sure you will find the scientific programme interesting and you will have a most productive learning experience.  Thank you and have a pleasant day ahead.