Table 2

NetworkZ implementation strategies designed to tackle key implementation challenges

OQ challengeNetworkZ implementation strategies/actions
  • Instructor training, course development and mentoring was provided by a multidisciplinary project team in the UOA.

  • The overall programme was supported by a comprehensive national educational programme, an instructor programme, a communication strategy, an implementation strategy and an evaluation plan.

  • Local project groups identified instructors to attend the training programme and developed a local plan for implementing NetworkZ training in their DHB.

  • Meetings with DHB executive and middle management groups were used to ensure understanding of the programme, develop shared goals and seek agreement for the programme to run in their DHB.

  • DHB executive commitment to NetworkZ was formalised through a letter of agreement to support implementation, signed by the chief executive officer.

  • Each DHB was provided with a Laerdal 3G SimMan (Stavanger, Norway) simulator and access to surgical models.

  • A bespoke set of models was developed to encourage buy in and task fidelity for all members of the OT team.

  • Detailed instructions were provided on local implementation, including instructor training materials, detailed instructions on setting up the theatre, running the course and managing the risks of in situ simulation.

  • High-level support from national committees of chief executives, nursing, medical and financial officers, and influential bodies, including the professional colleges.

  • Collaboration with HQSC established and linked NetworkZ with an existing national programme for Safe Surgery.

  • Each DHB was encouraged to develop their own plan for how they would run the programme in their own institution.

  • We included quality assurance leads in meetings to link NetworkZ with existing quality improvement programmes.

  • Selected DHB staff were trained as instructors and simulation technicians.

  • NetworkZ used a blended instructor training model comprising a 2 day face-to-face workshop, an online programme of 20–30 hours of readings, videos, exercises and discussion boards and apprenticeship-style on-site training during courses. UOA faculty provided the initial NetworkZ training sessions for DHB staff in their own OTs so no travel was required to attend the training.

  • De-briefing was facilitated to encourage participants to identify their own learning and action points for the future.

  • Key staff offered a positive ‘can do’ attitude to delivery and support for the courses.

  • NetworkZ staff worked to maintain senior management support, and build the interest of OT staff through newsletters to senior managers, posters, staff presentations and regular update.

  • Feedback from course evaluations, reports, in-theatre observations and surveys were used to inform the staff and management team.

  • Accreditation was sought for continuing professional development from the relevant professional bodies.

  • DHB, District Health Boards; HQSC, Health Quality and Safety Commission; OQ, Organising for Quality; OT, operating theatre; UOA, University of Auckland.