NetworkZ Programme of Evaluation

Aims: Our primary aim is to demonstrate that NetworkZ improves outcomes for surgical patients. A second aim is to demonstrate improved processes in the operating room. Finally, we will explore the implementation process itself, to identify factors that facilitate or limit the uptake of patient safety initiatives such as NetworkZ.

Background: Delivery of safe and effective care to surgical patients depends on effective teamwork and communication between the whole operating room team. Unintended patient harm is a substantial burden on global health. On many occasions failures in teamwork and communication are an important contributing factor. The underpinning mechanisms for effective teamwork are having a shared mental model of the patient condition, the goals of treatment, and the plans for care. Effective communication strategies underpin the development of a shared mental model and mutual trust and respect. NetworkZ comprises realistic simulated surgical cases presenting communication challenges to surgical teams, followed by a debrief to enable participants to reflect on the events, expose assumptions and communication issues, and identify good practice.

Research Questions:
1) Does NetworkZ lead to improved patient outcomes?
2) Does NetworkZ lead to improved teamwork and communication in the operating room?
3) Does NetworkZ lead to improvements in the safety culture of the operating room?
4) What organisational and cultural factors determine a successful (or unsuccessful) implementation?

Methods: NetworkZ will be rolled out consecutively over 5 years across the 20 DHBs in four temporal cohorts with 12 month intervals between cohorts. The progressive roll out of NetworkZ supports a stepped wedge cluster research design that will enhance the robustness of comparisons between data collected before and after the initiative is introduced.

Our research approach is mixed methods. It includes a suite of outcomes measures, with hard outcomes from existing databases, and softer outcomes on processes relevant to the intervention. Baseline data and ongoing data will be collected at regular intervals over the course of the project for all DHBs in NZ.

 Summary of NetworkZ measures

Patient Outcome measures

Process measures

Implementation process

Days Alive and Out of Hospital at 90 Days (primary outcome measure)

ACC treatment injury claims

Post-operative complications

Staff surveys on teamwork and safety culture

In-theatre observation using WHOBARS

Staff turnover and sick leave records

Participant end of course evaluations

Uptake of NetworkZ within DHBs

Interviews with DHB managers and OR staff on implementation process


Data Analysis: Quantitative measures will be compared between pre- and post-rollout phases for this stepped wedge design using generalized linear models. Qualitative data from interviews will undergo generic thematic analysis.

Significance: NetworkZ represents a major quality initiative to improve outcomes for our patients. The stepped roll-out of the initiative across all 20 DHBs in NZ affords a limited time opportunity to produce evidence of the effectiveness of this innovative team training initiative, and develop knowledge that may inform the implementation of future safety interventions. This nationwide programme is an international first that could lead the world in changing culture and practices in operating rooms.

You can view the published research protocol at the Australian and New Zealand Clinical Trials Network website.


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