Non-technical Skills Research Articles

민간항공 부기장 팔로워십 유형에 따른 CRM의 리더십 및 팀워크 스킬 역량 비교

It has been observed that approximately 70% of aviation accidents are closely linked to human factors within the cockpit crew. To address this critical issue, the aviation industry has implemented CRM as an operational frameork. For the effective execution of CRM, it is vital for pilots to possess 5 non-technical skills. Among these, leadership and teamwork skills are crucial components, and it is not solely reliant on the captain's leadership but also influenced significantly by the quality of followership. Followership can be classified into various types, including pragmatic and exemplary followership, among others. This research hypothesized that these different followership types would have varying impacts on leadership and teamwork skill competency. The experimental results confirmed that the pragmatic followership was more conductive to enhancing leadership and teamwork skill competency compared to the exemplary followership. Furthermore, it was identified that pragmatic followership exhibited a slight tendency towards higher communication skill competencies in comparison to the exemplary followership.

Implementasi Total Quality Management melalui Penjaminan Mutu dan Pelibatan Stakeholder dalam Penyusunan Kurikulum SMK PK

The purpose of this study was to examine in depth the process of quality assurance and stakeholder involvement in the preparation of the SMK PK curriculum at SMKN 1 Purwosari. This research is qualitative research with descriptive method and case study design. The main data sources for the research came from school principals, deputy heads of curriculum, WMM (Deputy for Quality Management), heads of expertise programs, and industry representatives, while other parties became sources of supporting data. In-depth interviews, non-participant observation, and document review were the methods to collect the data. Collecting, condensing, presenting data, and concluding research findings were processes of data analysis. Triangulation of techniques and sources were the processes of checking the validity of the data. This study found that TPMPS (School Education Quality Assurance Team) carried out quality assurance in the preparation of the SMK PK curriculum. Stages of developing the SMK PK curriculum include analyzing the needs of school stakeholders, evaluating and planning, drafting, verifying draft, validating, and publishing. The quality aspects developed are vocational content which includes technical competencies (hard skills), non-technical skills (soft skills), and entrepreneurial skills. Stakeholders involved include internal customers, primary customers, and secondary customers.

Reliability and validity of Urdu PARENTS for assessing non-technical skills of paediatric residents in a teaching hospital in Pakistan

PurposeThe primary objective of our study is twofold. First, we assessed nontechnical skills (NTSs), such as the cognitive, social, and personal skills of postgraduate residents (PGRs), from paediatric caregivers’ perspectives in a paediatric emergency department (PED) of a tertiary care hospital. Second, we evaluated the reliability and validity of the ‘Parents’ Assessment of Residents Enacting Non-Technical Skills’ (PARENTS) instrument in its Urdu-translated version, ensuring its applicability and accuracy in the Pakistani context.Materials and methodsThis mixed-method study used an instrument translation and validation design. We translated an existing instrument, PARENTS, into Urdu, the national language of Pakistan, and administered it to paediatric caregivers in the PED of a tertiary care hospital. We collected data from 471 paediatric caregivers and coded them for analysis in AMOS and SPSS.ResultsThe Urdu-translated version of the PARENTS demonstrated reliability and internal validity in our study. The findings from the assessment revealed that paediatric caregivers expressed satisfaction with the knowledge and skill of residents. However, there was comparatively lower satisfaction regarding the residents’ display of patience or empathy towards the children under their care.ConclusionThe study findings support the validity and reliability of the PARENTS as an effective instrument for assessing the NTS of PGRs from the perspective of paediatric caregivers. With its demonstrated efficacy, medical educators can utilize PARENTS to pinpoint specific areas that require attention regarding the NTS of PGRs, thus facilitating targeted interventions for enhanced patient care outcomes.

The effects of crew resource management on flight safety culture: corporate crew resource management (CRM 7.0)

Abstract The main purpose of crew resource management (CRM) is to ensure safe flights by preventing possible errors with the effective use of non-technical skills. The aim of the current study is to examine the effects of CRM on flight safety culture (FSC) with the help of the structural equation model with 451 airline pilots. As a result of the analysis, it was determined that there was a significant correlation between CRM and FSC and that CRM has a significant positive effect on FSC. It has been demonstrated that if CRM awareness and skills are used effectively, the perception of FSC will also improve. Furthermore, these findings indicate that there is a need to progress to the corporate CRM phase, i.e., CRM 7.0, to ensure that organisation-wide FSC awareness is established through CRM awareness.

Human factors in pelvic exenteration: themes in high-performing teams.

The aim of this study was to investigate the role of human factors in pelvic exenteration and how team performance is optimized in the preoperative, intraoperative and postoperative phases. Qualitative analysis of focus groups was used to capture authentic human interactions that reflect real-world multiprofessional performance. Theatre teams were treated as clusters, with a particular focus group containing participants who worked together regularly. Three focus groups were conducted. Four themes emerged - driving force, technical skills, nontechnical skills and operational aspects - with a total of 16 subthemes. Saturation was reached by group 2, with no new subthemes emerging after this. There was some interaction between the themes and the subthemes. Broadly speaking, driving force led to the development of specialised technical skills and nontechnical skills, which were operationalized into successful service through operational aspects. This study of teams performing pelvic exenteration is the first in the field using this methodology. It has generated rich qualitative data with authentic insights into the pragmatic aspects of developing and delivering a service. In addition, it shows how the themes are connected or 'coupled' in a network, for example technical and non-technical skills. In a complex system, 'tight coupling' leads to both high performance and adverse events. In this paper, we report the qualitative aspects of high performance by pelvic exenteration teams in a complex sociotechnical system, which depends on tight coupling of several themes.

Non-technical skills and teamwork in trauma: from the emergency department to the operating room.

Management of a trauma patient is a challenging process. Swift and accurate clinical assessment is required and time-sensitive decisions and life-saving procedures must be performed in an unstable patient. This requires a coordinated response by both the emergency room (ER) and operating room (OR) teams. However, a team of experts does not necessarily make an expert team. Root cause analysis of adverse events in surgery has shown that failures in coordination, planning, task management and particularly communication are the main causes for medical errors. While most research is focused on the ER trauma team, the trauma OR team also deserves attention. In fact, OR team dynamics may resemble more the ER team than the elective OR team. ER and OR trauma teams assemble on short notice, and their members, who are from different specialties and backgrounds, may not train regularly together or even know each other beforehand. And yet, they have to perform high-risk procedures and make high stake decisions, in a time-sensitive manner. The airline industry has long recognized the role of team training and non-technical skills (NTS) in reducing hazards. The implementation of the so called crew resource management or crisis resource management (CRM) has significantly made airline travel safer and the transposition to the medical context, with specific training in non-technical skills, has also brought great benefits. In fact, it is clear that adoption of non-technical skills (NTS) in healthcare has led to an increase in patient safety. In this narrative review we recapitulate some of the key non-technical skills and their relevance in trauma, with a focus on both the emergency department (ER) and the operating room (OR) teams, as well as on the transition of care from one to the other. Also, we explore the use of debriefing the team, as well as the roles of NTS training in both undergraduate and postgraduate settings. We review some of the existing trauma training courses and their roles in developing NTS. Finally, we briefly address the challenges posed by the development of trauma hybrid operating rooms.

Nontechnical Skills for Intraoperative Team Members.

Nontechnical skills, defined as the set of cognitive and social skills used by individuals and teams to reduce error and improve performance in complex systems, have become increasingly recognized as a key contributor to patient safety. Efforts to characterize, quantify, and teach nontechnical skills in the context of perioperative care continue to evolve. This review article summarizes the essential behaviors for safety, described in taxonomies for nontechnical skills assessments developed for intraoperative clinical team members (eg, surgeons, anesthesiologists, scrub practitioners, perfusionists). Furthermore, the authors describe emerging methods to advance understanding of the impact of nontechnical skills on perioperative outcomes.

THE IMPACT OF WORKING IN A STATISTICAL COLLABORATION LABORATORY ON THE STATISTICS STUDENT COLLABORATORS

Graduate level statistics education curricula often emphasize technical instruction in theory and methodology but can fail to provide adequate practical training in applications and collaboration skills. We argue that a statistical collaboration center (“stat lab”) structured in the style of the University of Colorado Boulder’s Laboratory for Interdisciplinary Statistical Analysis (LISA) is an effective mechanism for providing graduate students with necessary training in technical, non-technical, and job-related skills. We summarize the operating structure of LISA, and then provide evidence of its positive impact on students via analyses of a survey completed by 123 collaborators who worked in LISA between 2008–15 while it was housed at Virginia Tech. Students described their work in LISA as having had a positive impact on acquiring technical (94%) and non-technical (95%) statistics skills. Five-sixths (83%) of the students reported that these skills will or have helped them advance in their careers. We call for the integration of stat labs into statistics and data science programs as part of a comprehensive and modern statistics education, and for further research on students’ experience in these labs and the impact on student outcomes.

Applied improvisation and transdisciplinary simulation: a necessity for any health curriculum?

From practising a procedure, such as a lumbar puncture, to explaining the aim and method and listening to concerns, the practice of health professionals requires a range of skills, often classified into technical and non-technical skills. Just as gestures and procedures can be taught, so can empathy and communication skills. This article introduces an innovative approach that unites both necessary types of skills. The specific framework of improvisational theatre ("improv") has widespread application, including the training of health professionals (health training improv). By sharing close contexts and skills, health training improv provides a valuable, safe, and effective learning environment that allows practitioners to practice exercises and situations that align with particular objectives. We created a transdisciplinary team to develop a programme of Health Professional Training Improv (HPTI), bringing together the fields of health, psychology, simulation, and arts. Since 2019, various health student groups (nurses, midwives, medical doctors, and speech therapists) have participated in a 16-h applied improv training workshop under the supervision of a professional improv facilitator. Additionally, drama students completed applied improv for health courses, which trained them to act as simulated patients, with a view to the implementation of transdisciplinary improv simulation sessions at SimUSanté (a multidisciplinary health simulation facility located in France). Students' feedback emphasized their interest in HPTI, the realism of the simulation sessions, and the skills they felt had improved. This feedback needs to be supplemented with quantitative data from standardised assessments. The development of this rich pedagogical and research framework, based on a transdisciplinary approach, has brought different fields together to prepare students for real patient encounters. It is essential to continue this training and conduct research to evaluate the curricula developed.

P091 A systematic review of simulation-based training tools for technical and non-technical skills in oral and maxillofacial surgery

P091 A systematic review of simulation-based training tools for technical and non-technical skills in oral and maxillofacial surgery

A Systematic Review of Immersive Virtual Reality for Nontechnical Skills Training in Surgery

Immersive virtual reality (IVR) can be utilized to provide low cost and easily accessible simulation on all aspects of surgical education. In addition to technical skills training in surgery, IVR simulation has been utilized for nontechnical skills training in domains such as clinical decision-making and pre-operative planning. This systematic review examines the current literature on the effectiveness of IVR for nontechnical skill acquisition in surgical education. A literature search was performed using MEDLINE, EMBASE, and Web of Science for primary studies published between January 1, 1995 and February 9, 2022. Four reviewers screened titles, abstracts, full texts, extracted data, and analyzed included studies to answer 5 key questions: How is IVR being utilized in nontechnical skills surgical education? What is the methodological quality of studies? What technologies are being utilized? What metrics are reported? What are the findings of these studies? The literature search yielded 2340 citations, with 12 articles included for qualitative synthesis. Of included articles, 33% focused on clinical decision-making and 67% on anatomy/pre-operative planning. Motion sickness was a recorded metric in 25% of studies, with an aggregate incidence of 13% (11/87). An application score was reported in 33% and time to completion in 16.7%. A commercially developed application was utilized in 25%, while 75% employed a noncommercial application. The Oculus Rift was used in 41.7% of studies, HTC Vive in 25%, Samsung Gear in 16.7% of studies, Google Daydream in 8%, and 1 study did not report. The mean Medical Education Research Quality Instrument (MERSQI) score was 10.3 ± 2.3 (out of 18). In all studies researching clinical decision-making, participants preferred IVR to conventional teaching methods and in a nonrandomized control study it was found to be more effective. Averaged across all studies, mean scores were 4.33 for enjoyment, 4.16 for utility, 4.11 for usability, and 3.73 for immersion on a 5-point Likert scale. The IVR nontechnical skills applications for surgical education are designed for clinical decision-making or anatomy/pre-operative planning. These applications are primarily noncommercially produced and rely upon a diverse array of HMDs for content delivery, suggesting that development is primarily coming from within academia and still without clarity on optimal utilization of the technology. Excitingly, users find these applications to be immersive, enjoyable, usable, and of utility in learning. Although a few studies suggest that IVR is additive or superior to conventional teaching or imaging methods, the data is mixed and derived from studies with weak design. Motion sickness with IVR remains a complication of IVR use needing further study to determine the cause and means of mitigation.

EMPLOYABILITY SKILLS FOR PROFESSIONAL ACCOUNTANTS IN THE MIDST OF INDUSTRY 4.0 – A LITERATURE REVIEW –

Most facets of modern life are being transformed in the light of recent technological developments. Similarly, the accounting industry is going through a significant redesign under the influence of Industry 4.0, often known as the Fourth Industrial Revolution, which tackles issues of automation and intelligence and incorporates them into accountants’ daily activities. The present research assesses the impact of these changes on the requirements of a work-ready accountant by enclosing the skills relevant for the accounting profession, with a focus on technology relevant skills. The originality of the study lies in its attempt to provide a robust and comprehensive guide to the accounting skill set that ensures the capabilities necessary to thrive in the digitalized accounting workplace of the future. In this way, the research treats both technical (traditional accounting skills) and non-technical skills, but nonetheless, it emphasizes a new set of skills derived from the digital transformation in the context of Industry 4.0. The new skill set addresses the requirements of cyber, digital, and technology competences, which arose from the intensive digitalization of accounting organizations. The paper is a thematic literature review that performs quantitative and qualitative analysis on the literature on accounting and professional bodies in the attempt to define an updated accountant profile in the era of digital technologies. The investigation validates the importance of cyber, digital, and technology skill sets and encourages accountants to upskill their competencies to meet the demands of accounting in the digital era.

Augmented reality for surgical skills training, update on the topic

Augmented reality (AR) combines digital information with physical reality, allowing users to interact with virtual data in their real environment. In medical education, this technology is attractive because it allows access to information without taking your eyes off the surgical field. The integration of surgical simulators in resident training offers flexible practice without direct supervision, with benefits such as objective performance evaluation, practice of unusual procedures, and the development of non-technical skills. In addition, simulators are useful for teaching new techniques to experts. In summary, AR and simulators offer valuable opportunities to improve surgical training. The objective of this review is to update the current state of augmented reality in surgical training. The use of augmented reality as an assessment tool in surgical training presents interesting perspectives that deserve consideration. AR can provide objective performance metrics by measuring the technical competency of surgical trainees, whether in a simulated operating environment or in real-world situations. This offers the opportunity to address subjective variability and potential bias in current assessment methods, which often rely on supervisor observation and rating. However, despite these advantages, there has not yet been a comprehensive review to evaluate the use of AR in surgical training. The cost-benefit and implications for data management have not yet been addressed.

SİMÜLASYON TEMELLİ TIP EĞİTİMİN BÜTÇEYE SAĞLADIĞI KLİNİK VE EKONOMİK FAYDALAR

Especially in the last two decades, there has been an increase in simulation-based training applications to increase the technical and non-technical skills of health care providers. In many scientific studies, thereare many studies on the effect of simulation education and research applications on theincrease of cost and clinical skills. In this study, we conducted a literature study on the clinical and economic benefits of simulation-based medical education on the budget. In this context, in order to determine the clinical and economic benefits of simulation-based medical education to the budget, a search was carried out on Google Schoolar, Pupmed and Science directs earch engines between 2010-2020 by entering the words "Simulation-basedmedical education, cost-effectiveness, budget effect". By using the word groups specified at theend of all these operations; Pubmed 75 Google Schoolar 162 and ScienceDirect 37 reached 274 results in total. All there sults obtained were reviewed and studies not directly related to the subject and the same articles that are duplicate of each other were excluded; A total of 21 results in the form of reviews, research articles, papers and reports were evaluated. The scientific studies evaluated within thescope of this study support the fact that simulation-based training practices provide clinical and economic benefits to the budget and that there is a positive relation ship between them.

Evaluation of video review tools for assessing non-technical skills in emergency department resuscitation teams: a systematic review

Background and importanceUse of video review in medicine is established in contexts such as surgery. Although not widely used in the emergency department (ED), some centres use it to evaluate non-technical skills (NTS) to support teaching and quality improvement.ObjectiveThere is no consensus on assessment of NTS using video review in the ED and the purpose of this review was to identify tools used in this context.Design, setting and participantsStudies were identified using Embase, Medline, CINAHL and Google Scholar. Inclusion criterion for the review was NTS of resuscitation teams working within the ED were assessed using video review. A systematic search method was used, and results were synthesised after search criteria was checked by two independent reviewers. Authors settled on the same 9 studies eligible for inclusion.Outcome measures and analysisReliability and validity of tools identified for use in this context. Due to the heterogeneity of studies, no meta-analysis occurred.Main resultsThere are 9 studies included in the review. The review was registered with PROSPERO (Ref No: CRD42022306129). Four unique tools were identified – 6 studies used T-NOTECHS, 1 used TTCA-24, 1 used CALM and 1 used the Communication tool. T-NOTECHS is validated in the literature for use in this context.ConclusionT-NOTECHS is the tool of choice for assessing ED teams in this context.

Protective resources against stress among student nurses: Influences of self-efficacy, emotional intelligence and conflict management styles

AimsThis study aimed to investigate the levels of stress among French student nurses and the influence of different personal resources on their well-being and stress levels. BackgroundStudent nurses have to cope with strong emotional demands, leading them to experience academic stress. Recent studies have highlighted the influence of personal resources such as self-efficacy, conflict management styles and emotional intelligence on the ability to cope with stressful situations. However, the contributions of these different factors have so far been explored separately. DesignA multicenter cross-sectional survey was performed from February to April 2022. The sample consisted of 1021 first-year student nurses from different nursing schools in France (including 890 women and 113 men), aged 18–55 years. MethodsStudents completed an online questionnaire containing measures of well-being, Perceived Stress Scale, Occupational Stress, Generalized Self-Efficacy Scale, Emotional Intelligence and Conflict Management Styles. ResultsNearly half (40.4%) of participants reported experiencing symptoms of stress. However, they also reported a satisfactory well-being and high self-efficacy for coping with stressful situations. Multiple regression analyses revealed major contributions of self-efficacy to stress and well-being and additional mediation models showed that these contributions were partially mediated by awareness of one’s own and others’ emotions. ConclusionsThese findings highlight the importance of continuing to work on the construction of appropriate educational activities that are consistent with the technical and, above all, nontechnical skills of student nurses.

Principles of Effective Simulation-Based Teaching Sessions in Medical Education: A Narrative Review.

A challenge for medical educators is to provide learning opportunities that allow students to develop technical and non-technical skills as set by the clearly defined learning objectives within their relevant institutions. This is particularly relevant in clinical education, which encompasses a vast majority of medical education. Specifically, clinical education is highly variable, with numerous distractions, interruptions and variability in learning experience and quality of clinical educators which often result in underprepared medical students by the time they transition into clinical practice. Simulation-based teaching (SBT) has been a key pedagogical approach that has been implemented into curriculum design to assist with addressing some of these educational challenges. However, their implementation is highly variable, and research into evidence-based best practice considerations in SBT design and implementation is fundamental to their success in medical student development. A narrative review was performed following a computer-assisted search on electronic databases Medline, Embase and Google Scholar. Relevant papers that explored the role of SBT in medical education were considered for this review. SBT is an important pedagogical approach to support the education of medical students. Their use has the benefit of providing a standardised and safe environment that mimics 'real life' as a means of allowing students to hone key skills with respect to clearly defined learning outcomes. The role of debriefing and feedback is crucial to the development of efficacious SBT programs, and therefore the upskilling and training of educators is a key aspect of evidence-based SBT design. Despite this, medical educators must be cognisant of the limitations of SBT. These include the cost and resources required to develop and implement SBT sessions, the effort and conceptualisation required to standardise and ensure these programs reflect real-life situations as well as the degree of training for facilitators to ensure they can best deliver and achieve learning outcomes and provide effective debriefing and feedback for students. Understanding the educational frameworks and the evidence-based best practice principles for SBT design and implementation is highly necessary for medical educators given the resource demands of SBT programs.

Human Behaviour in Veterinary Care

Abstract The human in veterinary practice is an oft-neglected component of both human and animal welfare. Those in vet practice, including veterinarians, vet nurses, technical staff, and front-of-house staff all have a role to play in ensuring that animals receive the best possible care. How should clinicians approach the cognitive load of decision making in stressful situations, recognise the biases in their decision making, and balance non-technical skills alongside highly specialised clinical skills to support animal health? Veterinary work requires effective communication across diverse teams in stressful situations, and good animal care necessitates an understanding of human factors in the veterinary practice. Even after care has concluded, veterinarians need to recognise the impact that human behaviour has on supporting animal welfare. We describe how human behaviour impacts veterinary care, and how veterinarians can utilise up-to-date research on human behaviour such as the Knowledge Deficit Model of communication, the Theory of Planned Behaviour, and the 5As Behavioural Change model to improve animal welfare. Information © The Authors 2023

Collecting evidence of validity for an assessment tool for Norwegian medical students’ non-technical skills (NorMS-NTS): usability and reliability when used by novice raters

BackgroundThe NorMS-NTS tool is an assessment tool for assessing Norwegian medical students’ non-technical skills (NTS). The NorMS-NTS was designed to provide student feedback, training evaluations, and skill-level comparisons among students at different study sites. Rather than requiring extensive rater training, the tool should capably suit the needs of busy doctors as near-peer educators. The aim of this study was to examine the usability and preliminary assess validity of the NorMS-NTS tool when used by novice raters.MethodsThis study focused on the usability of the assessment tool and its internal structure. Three raters used the NorMS-NTS tool to individually rate the team leader, a medical student, in 20 video-recorded multi-professional simulation-based team trainings. Based on these ratings, we examined the tools’ internal structure by calculating the intraclass correlation coefficient (ICC) (version 3.1) interrater reliability, internal consistency, and observability. After the rating process was completed, the raters answered a questionnaire about the tool’s usability.ResultsThe ICC agreement and the sum of the overall global scores for all raters were fair: ICC (3,1) = 0.53. The correlation coefficients for the pooled raters were in the range of 0.77–0.91. Cronbach’s alpha for elements, categories and global score were mostly above 0.90. The observability was high (95%-100%). All the raters found the tool easy to use, none of the elements were redundant, and the written instructions were helpful. The raters also found the tool easier to use once they had acclimated to it. All the raters stated that they could use the tool for both training and teaching.ConclusionsThe observed ICC agreement was 0.08 below the suggested ICC level for formative assessment (above 0.60). However, we know that the suggestion is based on the average ICC, which is always higher than a single-measure ICC. There are currently no suggested levels for single-measure ICC, but other validated NTS tools have single-measure ICC in the same range. We consider NorMS-NTS as a usable tool for formative assessment of Norwegian medical students’ non-technical skills during multi-professional team training by raters who are new to the tool. It is necessary to further examine validity and the consequences of the tool to fully validate it for formative assessments.

Transforming Team Performance Through Reimplementation of the Surgical Safety Checklist

Patient safety interventions, like the World Health Organization Surgical Safety Checklist, require effective implementation strategies to achieve meaningful results. Institutions with underperforming checklists require evidence-based guidance for reimplementing these practices to maximize their impact on patient safety. To assess the ability of a comprehensive system of safety checklist reimplementation to change behavior, enhance safety culture, and improve outcomes for surgical patients. This prospective type 2 hybrid implementation-effectiveness study took place at 2 large academic referral centers in Singapore. All operations performed at either hospital were eligible for observation. Surveys were distributed to all operating room staff. The study team developed a comprehensive surgical safety checklist reimplementation package based on the Exploration, Preparation, Implementation, Sustainment framework. Best practices from implementation science and human factors engineering were combined to redesign the checklist. The revised instrument was reimplemented in November 2021. Implementation outcomes included penetration and fidelity. The primary effectiveness outcome was team performance, assessed by trained observers using the Oxford Non-Technical Skills (NOTECH) system before and after reimplementation. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used to assess safety culture and observers tracked device-related interruptions (DRIs). Patient safety events, near-miss events, 30-day mortality, and serious complications were tracked for exploratory analyses. Observers captured 252 cases (161 baseline and 91 end point). Penetration of the checklist was excellent at both time points, but there were significant improvements in all measures of fidelity after reimplementation. Mean NOTECHS scores increased from 37.1 to 42.4 points (4.3 point adjusted increase; 95% CI, 2.9-5.7; P < .001). DRIs decreased by 86.5% (95% CI, -22.1% to -97.8%; P = .03). Significant improvements were noted in 9 of 12 composite areas on culture of safety surveys. Exploratory analyses suggested reductions in patient safety events, mortality, and serious complications. Comprehensive reimplementation of an established checklist intervention can meaningfully improve team behavior, safety culture, patient safety, and patient outcomes. Future efforts will expand the reach of this system by testing a structured guidebook coupled with light-touch implementation guidance in a variety of settings.