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Communication and Teamwork Improving Patient Outcomes at AHC

Professor Richard Henker is a researcher, educator and practitioner in nurse anesthesia from the University of Pittsburgh School of Nursing, USA. Professor Henker first volunteered with Angkor Hospital for Children (AHC) in 2006 when he was invited to train AHC’s nurse anesthetists. Dr. Henker has returned approximately thirty times since, often visiting multiple times a year.

In 2015 Professor Henker began delivering Crisis Team Management (CTM) training to AHC paediatricians, surgeons, nurses and Satellite Clinic staff. This course takes the scenario training developed in the Advanced Paediatric Life Support (APLS), Paediatric Life Support (PLS) and Paediatric Basic Assessment and Support in Intensive Care course (Paediatric BASIC) to the next level, with multidisciplinary team simulations and structured debriefing.

As well as paediatric knowledge, CTM training focuses on concepts of team performance such as leadership, team structure, situational awareness, mutual support and open communication. Improving team performance is a priority for AHC, as the development of non-technical skills has been shown to improve patient outcomes in emergency situations. CTM training best prepares participants for some of the emergencies they may encounter by allowing them to practice within their existing teams, in their own roles and in their own working areas.

Participants are directed in ‘closed loop’ communication, a technique whereby the receiver repeats the message back to the sender. Closed loop communication has been shown to reduce error rates by removing ambiguity from instructions and increasing awareness within the team: “This type of communication is better for teamwork because everyone in the room is aware and the team is working together,” says Professor Henker. “Communication is often more important than technology in improving patient outcomes.”

In 2016 Professor Henker also began the development of a CTM Training-of-the-Trainer (TOT) course. The TOT course was designed to prepare AHC physicians and nurses to become CTM instructors and assume the teaching of the CTM course in the future. AHC’s Education Department worked with the Professor Henker and his team to adapt the TOT course material for an AHC setting, with an increasing number of simulations and debriefings to be delivered in Khmer, making it more accessible to external Cambodian health workers. The course includes the concept of teamwork, strategy of teaching CTM, CTM scenario development, debriefing methods and course evaluation.

Since 2016 the TOT course has been delivered five times to total of twelve participants from throughout AHC. The long-term goal is for TOT participants to deliver a Khmer language-based CMT course with ongoing support from Professor Henker and his team. “I would like to see this course offered by AHC staff to other hospitals in Cambodia in future,” says Professor Henker. “That is the goal.”

We would like to thank Professor Henker and his team for bringing this invaluable training to AHC. Your enduring commitment will help us to develop strong and sustainable teamwork and become a replicable model of healthcare in Cambodia.

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