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Coffey EK, Walker RM, Nicholson P, Gillespie BM. Prioritising patients for semi-urgent surgery: A scoping review. J Clin Nurs 2024; 33:2509-2524. [PMID: 38334175 DOI: 10.1111/jocn.17056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Semi-urgent surgery where surgical intervention is required within 48 h of admission and the patient is medically stable is vulnerable to scheduling delays. Given the challenges in accessing health care, there is a need for a detailed understanding of the factors that impact decisions on scheduling semi-urgent surgeries. AIM To identify and describe the organisational, departmental and contextual factors that determine healthcare professionals' prioritising patients for semi-urgent surgeries. METHODS We used the Joanna Briggs Institute guidance for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) checklist. Four online databases were used: EBSCO Academic Search Complete, EBSCO Cumulative Index to Nursing and Allied Health Literature, OVID Embase and EBSCO Medline. Articles were eligible for inclusion if they published in English and focussed on the scheduling of patients for surgery were included. Data were extracted by one author and checked by another and analysed descriptively. Findings were synthesises using the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework. RESULTS Twelve articles published between 1999 and 2022 were included. The Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework highlighted themes of emergency surgery scheduling and its impact on operating room utilisation. Gaps in the management of operating room utilisation and the incorporation of semi-urgent surgeries into operating schedules were also identified. Finally, the lack of consensus on the definition of semi-urgent surgery and the parameters used to assign surgical acuity to patients was evident. CONCLUSIONS This scoping review identified patterns in the scheduling methods, and involvement of key decision makers. Yet there is limited evidence about how key decision makers reach consensus on prioritising patients for semi-urgent surgery and its impact on patient experience. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Elyse K Coffey
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Rachel M Walker
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Patricia Nicholson
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Gold Coast University Hospital, Gold Coast Health Nursing and Midwifery Education and Research Unit, Gold Coast, Queensland, Australia
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Sarofim M. Psychological safety in medicine: what is it, and who cares? Med J Aust 2024; 220:398-399. [PMID: 38479403 DOI: 10.5694/mja2.52263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/20/2023] [Indexed: 05/06/2024]
Affiliation(s)
- Mina Sarofim
- St George Hospital, Sydney, NSW
- University of Sydney, Sydney, NSW
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de Laurentis C, Pirillo D, Di Cristofori A, Versace A, Calloni T, Trezza A, Villa V, Alberti L, Baldo A, Nicolosi F, Carrabba G, Giussani C. Boosting teamwork between scrub nurses and neurosurgeons: exploring the value of a role-played hands-on, cadaver-free simulation and systematic review of the literature. Front Surg 2024; 11:1386887. [PMID: 38558881 PMCID: PMC10978771 DOI: 10.3389/fsurg.2024.1386887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Recently, non-technical skills (NTS) and teamwork in particular have been demonstrated to be essential in many jobs, in business as well as in medical specialties, including plastic, orthopedic, and general surgery. However, NTS and teamwork in neurosurgery have not yet been fully studied. We reviewed the relevant literature and designed a mock surgery to be used as a team-building activity specifically designed for scrub nurses and neurosurgeons. Methods We conducted a systematic review by searching PubMed (Medline) and CINAHL, including relevant articles in English published until 15 July 2023. Then, we proposed a pilot study consisting of a single-session, hands-on, and cadaver-free activity, based on role play. Scrub nurses were administered the SPLINTS (Scrub Practitioners' List of Intraoperative Non-Technical Skills) rating form as a self-evaluation at baseline and 20-30 days after the simulation. During the experiment, surgeons and scrub nurses role-played as each other, doing exercises including a simulated glioma resection surgery performed on an advanced model of a cerebral tumor (Tumor Box, UpSurgeOn®) under an exoscope. At the end, every participant completed an evaluation questionnaire. Results A limited number of articles are available on the topic. This study reports one of the first neurosurgical team-building activities in the literature. All the participating scrub nurses and neurosurgeons positively evaluated the simulation developed on a roleplay. The use of a physical simulator seems an added value, as the tactile feedback given by the model further helps to understand the actual surgical job, more than only observing and assisting. The SPLINTS showed a statistically significant improvement not only in "Communication and Teamwork" (p = 0.048) but also in "Situation Awareness" (p = 0.031). Conclusion Our study suggests that team-building activities may play a role in improving interprofessional teamwork and other NTS in neurosurgery.
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Affiliation(s)
- Camilla de Laurentis
- School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - David Pirillo
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Andrea Di Cristofori
- School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Tommaso Calloni
- School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Milan, Italy
- Neurosurgery, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Trezza
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Valentina Villa
- Operating Room, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Lucia Alberti
- Operating Room, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Angelo Baldo
- School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Federico Nicolosi
- School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Milan, Italy
| | - Giorgio Carrabba
- School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Carlo Giussani
- School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Levesque MJ, Etherington C, Lalonde M, Moradi N, Sikora L, Stacey D. Interventions to facilitate interprofessional collaboration in the operating theatre: A scoping review. J Perioper Pract 2024; 34:6-19. [PMID: 36468241 PMCID: PMC10771025 DOI: 10.1177/17504589221137978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Ineffective collaboration can increase adverse events in the operating theatre. When professionals work collaboratively, they are more likely to improve patient safety and outcomes. AIM To identify interprofessional collaboration interventions involving operating theatre teams and describe their effect on facilitating communication, teamwork, and safety. METHODS A scoping review of four databases. Results were analysed by identifying interventions and mapping their related outcomes. RESULTS Twenty studies evaluated single or multi-faceted interventions. Despite low-quality study designs (no randomised controlled trials), four interventions (eg: briefings, checklists, team training, debriefing) improved communication and teamwork, and enhanced safety outcomes. Only one study, using team training, reported that organisational level interventions (eg: Standard Operating Procedures, Lean quality improvement management system) improved teamwork and safety outcomes. CONCLUSION Several studies reported interventions enhanced interprofessional collaboration within operating theatre teams. Although findings were in favour of improved communication and teamwork, more rigorous research is required.
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Affiliation(s)
| | | | - Michelle Lalonde
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Narges Moradi
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Mathis MR, Janda AM, Yule SJ, Dias RD, Likosky DS, Pagani FD, Stakich-Alpirez K, Kerray FM, Schultz ML, Fitzgerald D, Sturmer D, Manojlovich M, Krein SL, Caldwell MD. Nontechnical Skills for Intraoperative Team Members. Anesthesiol Clin 2023; 41:803-818. [PMID: 37838385 PMCID: PMC10703542 DOI: 10.1016/j.anclin.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
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.
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Affiliation(s)
- Michael R Mathis
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Allison M Janda
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Steven J Yule
- Department of Clinical Surgery, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, Scotland
| | - Roger D Dias
- Department of Emergency Medicine, Brigham & Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Korana Stakich-Alpirez
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Fiona M Kerray
- Department of Clinical Surgery, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, Scotland
| | - Megan L Schultz
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - David Fitzgerald
- Department of Clinical Sciences, Medical University of South Carolina College of Health Professions, A 151 Rutledge Avenue, Charleston, SC 29403, USA
| | - David Sturmer
- Department of Perfusion, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Milisa Manojlovich
- School of Nursing, University of Michigan, 426 N Ingalls Street, Ann Arbor, MI 48104, USA
| | - Sarah L Krein
- Department of Internal Medicine, University of Michigan and Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Matthew D Caldwell
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Lee H, Woodward-Kron R, Merry A, Weller J. Emotions and team communication in the operating room: a scoping review. MEDICAL EDUCATION ONLINE 2023; 28:2194508. [PMID: 36995978 PMCID: PMC10064827 DOI: 10.1080/10872981.2023.2194508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/20/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
Training in healthcare team communication has largely focused on strategies to improve information transfer with less focus on interpersonal dynamics and emotional aspects of communication. The Operating Room (OR) may be one of the most emotionally charged hospital environments, and is one requiring excellent team communications. We aimed to identify literature reporting on the emotional aspects of OR team communication. Our research questions were: what are the triggers in the environment that provoke an emotional response affecting communication, and what are the emotional responses to communication between OR team members; and how do these emotional aspects of communication affect the function of the OR team? We undertook a Scoping Review of literature across relevant databases following published guidelines, and narrative synthesis of the identified studies. From the 10 included studies we identified three themes: (1) Emotional experiences in the OR and their contributors; (2) Effects of emotional experiences on team communication; and (3) Solutions to manage the emotional experiences in the OR. Theme 1 sub-themes were: (1) Range of emotions experienced in the OR; (2) Hierarchical culture and (3) Leadership expectations as contributors to negative emotions. The OR is an emotionally charged environment. The hierarchical culture can inhibit staff from speaking up, and failure of leaders to meet team expectations, e.g., through appropriate and timely communication, may cause frustration and stress. The consequences of emotions include poor team dynamics, ineffective communication and potential negative impact on patient care. Few studies described strategies to manage emotions in the OR. The studies reviewed describe an environment where emotions can run high, affecting interpersonal communications, team function and patient care. The few identified studies relevant to our research questions demonstrate a need to better understand the emotional aspects of OR team communication and the effectiveness of interventions to improve these.
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Affiliation(s)
- Henrietta Lee
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Grafton,Auckland1023, New Zealand
| | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Parkville, VIC3010, Australia
| | - Alan Merry
- Department of Anaesthesiology, School of Medicine, The University of Auckland, Grafton, Auckland1023, New Zealand
- Honorary Consultant, Department of Anaesthesia and Perioperative Care, Auckland City Hospital, Park Rd, Grafton, Auckland1023, New Zealand
| | - Jennifer Weller
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Grafton,Auckland1023, New Zealand
- Honorary Consultant, Department of Anaesthesia and Perioperative Care, Auckland City Hospital, Park Rd, Grafton, Auckland1023, New Zealand
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Ramjaun A, Hammond Mobilio M, Wright N, Masella M, Snyman A, Serrick C, Moulton CA. Beyond the Surgical Safety Checklist: Using Intraoperative Handoff to Facilitate Team Situation Awareness in the OR. Ann Surg 2023; 278:e1142-e1147. [PMID: 36912035 DOI: 10.1097/sla.0000000000005838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND The surgical safety checklist (SSC) has been credited with improving team situation awareness (SA) in the operating room. Although the SSC may support team SA at the outset of the operative case, intraoperative handoff provides an opportunity for either SA breakdown or, more preferably, SA reinforcement. High-functioning surgical teams demonstrate a high level of continued SA, whereas teams deficient in SA are more likely to be affected by surgical errors and adverse events. To date, no interprofessional intraoperative tools exist to support team SA beyond the SSC. METHODS This study was divided into 2 phases. The first used qualitative methods to (1) characterize intraoperative handoff processes across surgery, nursing, anesthesia, and perfusion, and (2) identify cultural factors that shaped handoff practices. Data for phase one were collected over 38 observation days and 41 brief interviews. Phase 2, informed by phase 1, used a modified Delphi process to create a tool for use during intraoperative handoff. Data were analyzed iteratively. RESULTS Handoff practices were not standardized and rarely involved the entire team. In addition we uncovered cultural factors-specifically assumptions held by participants-that hindered team communication during handoff. Assumptions included: (1) team members are interchangeable, (2) trained individuals are able to determine when it is appropriate to handoff without consulting the OR team. Despite claims of improved teamwork resulting from the SSC, many participants held a fragmented view of the OR team, resulting in communication challenges during handoff. Findings from both phases of our study informed the development of multidisciplinary intraoperative handoff tools to facilitate shared team situation awareness and a shared mental model. CONCLUSIONS Intraoperative handoff occurs frequently, and offers the opportunity for either renewed or fractured team SA beyond the SSC.
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Affiliation(s)
| | | | - Nicole Wright
- The Wilson Centre, Toronto, ON, Canada
- Toronto General Hospital, Toronto, ON, Canada
| | | | - Adam Snyman
- Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | | | - Carol-Anne Moulton
- The Wilson Centre, Toronto, ON, Canada
- Toronto General Hospital, Toronto, ON, Canada
- Department of Surgery, University Health Network, Toronto, ON, Canada
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Wong BJ, Nassar AK, Earley M, Chen L, Roman-Micek T, Wald SH, Shanafelt TD, Goldhaber-Fiebert SN. Perceptions of Use of Names, Recognition of Roles, and Teamwork After Labeling Surgical Caps. JAMA Netw Open 2023; 6:e2341182. [PMID: 37976068 PMCID: PMC10656635 DOI: 10.1001/jamanetworkopen.2023.41182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Communication failures in perioperative areas are common and have negative outcomes for both patients and clinicians. Names and roles of teammates are difficult to remember or discern contributing to suboptimal communication, yet the utility of labeled surgical caps with names and roles for enhancing perceived teamwork and connection is not well studied. Objective To evaluate the use of labeled surgical caps in name use and role recognition, as well as teamwork and connection, among interprofessional perioperative teammates. Design, Setting, and Participants In this quality improvement study, caps labeled with names and roles were distributed to 967 interprofessional perioperative clinicians, along with preimplementation and 6-month postimplementation surveys. Conducted between July 8, 2021, and June 25, 2022, at a single large, academic, quaternary health care center in the US, the study comprised surgeons, anesthesiologists, trainees, and all interprofessional hospital staff who work in adult general surgery perioperative areas. Intervention Labeled surgical caps were offered cost-free, although not mandatory, to each interested clinician. Main Outcome and Measure Quantitative survey of self-reported frequency for name use and role recognition as well as postimplementation sense of teamwork and connection. The surveys also elicited free response comments. Results Of the 1483 eligible perioperative clinicians, 967 (65%; 387 physicians and 580 nonphysician staff; 58% female) completed preimplementation surveys and received labeled caps, and 243 of these individuals (51% of physicians and 8% of staff) completed postimplementation surveys. Pre-post results were limited to physicians, due to the low postsurvey staff response rate. The odds of participants reporting that they were often called by their name increased after receiving a labeled cap (adjusted odds ratio [AOR], 13.37; 95% CI, 8.18-21.86). On postsurveys, participants reported that caps with names and roles substantially improved teamwork (80%) and connection (79%) with teammates. Participants who reported an increased frequency of being called by their name had higher odds for reporting improved teamwork (AOR, 3.46; 95% CI, 1.91-6.26) and connection with teammates (AOR, 3.21; 95% CI, 1.76-5.84). Free response comments supported the quantitative data that labeled caps facilitated knowing teammates' names and roles and fostered a climate of wellness, teamwork, inclusion, and patient safety. Conclusions and Relevance The findings of this quality improvement study performed with interprofessional teammates suggest that organizationally sponsored labeled surgical caps was associated with improved teamwork, indicated by increased name use and role recognition in perioperative areas.
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Affiliation(s)
- Becky J. Wong
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Aussama K. Nassar
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Michelle Earley
- Department of Surgery, Division of General Surgery, Stanford School of Medicine, Stanford, California
| | - Ling Chen
- Interventional Platform Education, Stanford, California
| | | | - Samuel H. Wald
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Tait D. Shanafelt
- Division of Hematology, Department of Medicine, Stanford School of Medicine, Stanford, California
| | - Sara N. Goldhaber-Fiebert
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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9
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Sirevåg I, Tjoflåt I, Hansen BS. Expanding the non-technical skills vocabulary of operating room nurses: a qualitative study. BMC Nurs 2023; 22:323. [PMID: 37723549 PMCID: PMC10507908 DOI: 10.1186/s12912-023-01500-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Operating room nurses have specialised technical and non-technical skills and are essential members of the surgical team. The profession's dependency of tacit knowledge has made their non-technical skills difficult to access for researchers, thus, creating limitations in the identification of the non-technical skills of operating room nurses. Non-technical skills are categorised in the crew resource management framework, and previously, non-technical skills of operating room nurses have been identified within the scope of the framework. The purpose of this study is to explore operating room nurses' descriptions of their practices in search for non-technical skills not included in the crew resource management framework. METHODS This study has a qualitative design. An expert panel of experienced operating room nurses (N = 96) in Norway provided qualitative descriptions of their practice in a Delphi survey. The data were analysed in an inductive thematic analysis. This study was conducted and reported in line with Standards for Reporting Qualitative Research (SRQR). RESULTS The inductive thematic analysis developed two themes, 'Ethical competence' and 'Professional accountability', that encompass operating room nurses' novel descriptions of their non-technical skills. The participants take pride in having the patients' best interest as their main objective even if this may threaten their position in the team. CONCLUSIONS This study has identified novel non-technical skills that are not described in the crew resource management framework. These findings will contribute to the development of a new behavioural marker system for the non-technical skills of operating room nurses. This system will facilitate verbalisation of tacit knowledge and contribute to an increased knowledge about the operating room nursing profession.
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Affiliation(s)
- Irene Sirevåg
- Faculty of Health Sciences, Department of Caring and Ethics, University of Stavanger, Postboks 8600, Stavanger, 4036, Norway.
| | - Ingrid Tjoflåt
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Britt Sætre Hansen
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
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Frödin M, Rogmark C, Nellgård B, Gillespie BM, Wikström E, Andersson AE. Interactive Interventions Can Improve Hand Hygiene and Aseptic Techniques During Perioperative Care-Experience From the "Safe Hands" Project. J Perianesth Nurs 2023; 38:284-290. [PMID: 36319520 DOI: 10.1016/j.jopan.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/27/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This paper evaluates a theory-driven, interactive hand hygiene (HH) intervention, the Safe Hands project, based on theories of organizational learning and culture including leadership support, dialogue and co-creation. DESIGN This prospective quasi-experimental study used unobtrusive overt observations to evaluate adherence to HH recommendations after implementing an infection-prevention intervention. METHODS The primary outcome was differences in HH practices "Before aseptic/clean procedure" (WHO moment 2), "After body fluid exposure risk" (WHO moment 3) and performance of aseptic techniques. One operating room (OR) department served as the study hospital and the other as the control hospital, both at Swedish university hospitals. Adherence to HH guidelines was measured 4 times during 2015 to 2017. FINDINGS The intervention site displayed a significant improvement in adherence to HH guidelines and aseptic techniques. WHO 2; from 23.8% to 36.2%, (P = .014), WHO 3; from 22.2% to 42.3%, (P = .002), and aseptic techniques; from 17.5% to 31.6%, (P = .003). No changes in adherence were identified at the control site. The use of contaminated gloves decreased post intervention at the study operating department. CONCLUSIONS This study shows that implementing tailored interventions that are underpinned by theories from organizational learning and culture can improve adherence to hand hygiene in a complex setting as the OR up to 6 months post-intervention. The interprofessional co-creation of standards operating procedures addressing specific care procedures and emphasizing the importance of aseptic techniques can be an acceptable and feasible way to reduce the risks of contaminating medical devices and patients during perioperative care.
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Affiliation(s)
- Maria Frödin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden; Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Västra Götalandregionen, Sweden.
| | - Cecilia Rogmark
- Department of Orthopedics Malmö, Lund University, Skane University Hospital, Lund, Skane, Sweden; The Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Västra Götalandregionen, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Västra Götalandregionen, Sweden
| | - Brigid M Gillespie
- NMHRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Griffith, Queensland, Australia; Health Service, Gold Coast University Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden
| | - Annette E Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden
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11
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Duffy CC, Bass GA, Yura C, Dymek M, Lorenzi C, Kaplan LJ, Clapp JT, Atkins JH. Thematic mapping of perioperative incident reporting data to relational coordination domains. J Interprof Care 2023; 37:245-253. [PMID: 36739556 DOI: 10.1080/13561820.2022.2057454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Communication failure is a common root cause of adverse clinical events. Problematic communication domains are difficult to decipher, and communication improvement strategies are scarce. This study compared perioperative incident reports (IR) identifying potential communication failures with the results of a contemporaneous peri-operative Relational Coordination (RC) survey. We hypothesised that IR-prevalent themes would map to areas-of-weakness identified in the RC survey. Perioperative IRs filed between 2018 and 2020 (n = 6,236) were manually reviewed to identify communication failures (n = 1049). The IRs were disaggregated into seven RC theory domains and compared with the RC survey. Report disaggregation ratings demonstrated a three-way inter-rater agreement of 91.2%. Of the 1,049 communication failure-related IRs, shared knowledge deficits (n = 479, 46%) or accurate communication (n = 465, 44%) were most frequently identified. Communication frequency failures (n = 3, 0.3%) were rarely coded. Comparatively, shared knowledge was the weakest domain in the RC survey, while communication frequency was the strongest, correlating well with our IR data. Linking IR with RC domains offers a novel approach to assessing the specific elements of communication failures with an acute care facility. This approach provides a deployable mechanism to trend intra- and inter-domain progress in communication success, and develop targeted interventions to mitigate against communication failure-related adverse events.
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Affiliation(s)
- Caoimhe C Duffy
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Perioperative & Procedural Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gary A Bass
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Yura
- Division of Perioperative & Procedural Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Malwina Dymek
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Cara Lorenzi
- Division of Perioperative & Procedural Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Section of Surgical Critical Care, Corporal Michael Crescencz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Justin T Clapp
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua H Atkins
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Levesque MJ, Etherington C, Lalonde M, Stacey D. Interprofessional Collaboration in the OR: A Qualitative Study of Nurses' Perspectives. AORN J 2022; 116:300-311. [PMID: 36165657 DOI: 10.1002/aorn.13784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/22/2021] [Accepted: 01/12/2022] [Indexed: 11/06/2022]
Abstract
Interprofessional collaboration (IPC) in the OR enhances safe and effective patient care. The aim of this qualitative study was to explore perioperative nurses' perspectives on their contributions to IPC. We conducted a secondary analysis of 19 semistructured interviews with perioperative RNs and completed inductive thematic analysis with subsequent categorization of the themes into the Interprofessional Education for Collaborative Patient-Centred Practice Framework. Nurses expressed the importance of being heard through effective communication, feeling confident in their role, being aware of interdependent roles, and sharing a common understanding. From nurses' perspectives, use of structured processes enabled organization of interdisciplinary patient care. Nurses showed leadership skills when they anticipated the needs of the team and recognized they needed support to develop these skills. They contributed to IPC through their shared understanding of common goals, leadership skills in the OR, and active involvement in delivering structured processes.
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Hosseinpour A, Keshmiri F, Jambarsang S, Jabinian F, Shiryazdi SM. The effect of interprofessional education on interprofessional professionalism behaviors of the surgical team members. BMC Nurs 2022; 21:239. [PMID: 36008834 PMCID: PMC9414088 DOI: 10.1186/s12912-022-01015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Interprofessional professionalism (IPP) has been introduced as one of the critical sub-competencies of interprofessional collaboration. This study aimed to assess the effect of interprofessional education on the behavior of interprofessional professionalism among the surgical team in the intervention compared to the control group. METHODS This is a quasi-experimental study. The participants were nurses in anesthetist and surgical technology and surgical residents of Shahid Sadoughi Hospital (n = 150) who were included in the study by the census. The intervention employed an interprofessional case-based learning strategy to explore themes of interprofessional professionalism. Two assessors used the Interprofessional Professionalism Assessment (IPA) tool to measure learners' performance while observing them in practice prior to the intervention, one and three months after the intervention. Data were analyzed using descriptive tests (mean and SD) and RM-ANOVA. RESULTS In this study, the participants in the intervention (n = 78) and the control (n = 72) groups entered the study. The Baseline IPA scores of participants were reported as 1.25 (0.12) and 1.21 (0.1) in the intervention and control groups, respectively. The IPA score of the participants in the intervention group (2.59 (0.26) and 2.54 (0.24)) was higher than the control group (1.17 (0.08) and 1.12 (0.07)) after one and three months of the intervention (P = 0.0001). The effect of educational interventions was reported at the large level (Eta Square = 0.89). CONCLUSION Interprofessional professionalism in surgical teams has been recognized as a critical element of team-based care. The present study used an interprofessional education strategy to develop IPP behavior. All professions benefited from interprofessional education. It is suggested that all surgical team professionals participate in interprofessional education.
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Affiliation(s)
- Azam Hosseinpour
- Department of Operating Room, School of Allied Medical Sciences, Qom University of Medical Sciences, Qom, Iran
| | - Fatemeh Keshmiri
- Medical Education Department, Education Development Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Sara Jambarsang
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Jabinian
- Department of Operating Room and Anesthesiology, School of Allied Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Mostafa Shiryazdi
- General Surgery Department, Medical School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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14
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Baloul MS, Lund S, D’Angelo J, Yeh VJH, Shaikh N, Rivera M. LEGO ®-based communication assessment in virtual general surgery residency interviews. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2022; 1:22. [PMID: 38013704 PMCID: PMC9171471 DOI: 10.1007/s44186-022-00021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/03/2022] [Accepted: 05/11/2022] [Indexed: 10/27/2022]
Abstract
Purpose Effective communication skills are a critical quality and skill that is highly sought after for surgeons which largely impacts patient outcomes. Residency programs design their interview processes to select the best candidates. LEGO®-based activities have been frequently used to enhance communication skills and team building. This study investigates the effectiveness and reliability of a novel LEGO®-based communication assessment in interviews for surgical residencies and the feasibility of implementing it in a virtual setting. Methods This study conducted a retrospective analysis of a LEGO®-based communication assessment at the program's 2020/2021 residency interviews. Each applicant was assessed on a different model. The total scores were analyzed for consistency among raters and correlated to faculty interviews. Furthermore, the impact of the assessment structure, scoring criteria, and range of models' difficulties on the total scores were explored. Results A total of 54 categorical and 55 preliminary applicants interviewed on 2 days. The assessment on different models and had no impact on applicants' total scores for either categorical and preliminary groups (p = 0.791 and 0.709, respectively). The communication components of the assessment showed high consistency between the raters. The two applicant groups displayed a statistically significant difference (p = 0.004) in the communication evaluation and model accuracy components. Total scores did not correlate with the faculty interviews of standardized questions in either group. Conclusion This novel LEGO®-based communication assessment showed high reliability and promising results as a tool to assess communication and problem solving for residency interviews that can be readily implemented in a virtual setting. Supplementary Information The online version contains supplementary material available at 10.1007/s44186-022-00021-4.
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Affiliation(s)
| | - Sarah Lund
- Department of Surgery, Mayo Clinic, Rochester, MN USA
- Mayo Clinic Multidisciplinary Simulation Center, Rochester, MN USA
| | - Jonathan D’Angelo
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN USA
| | | | | | - Mariela Rivera
- Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, 200 1st ST SW, Rochester, MN 55905 USA
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15
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Nes E, White BAA, Malek AJ, Mata J, Wieters JS, Little D. Building Communication and Conflict Management Awareness in Surgical Education. JOURNAL OF SURGICAL EDUCATION 2022; 79:745-752. [PMID: 34952815 DOI: 10.1016/j.jsurg.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/16/2021] [Accepted: 11/27/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE A group of surgeons and a medical educator constructed a curriculum to strengthen communication and emotional intelligence skills in the surgical setting. DESIGN The curriculum consisted of a small group discussion series occurring during medical students' eight-week surgery clerkship. The curriculum targeted the following objectives: building team rapport, exploring self-management strategies in team communication, recognizing communication styles, diagnosing conflict, identifying opportunities in professional and personal development, and discussing professionalism in medicine. Students completed pre-post Likert style tests about their knowledge and understanding of the above-mentioned topics. SETTING Texas A&M University College of Medicine, Surgical Clerkship at Baylor Scott and White Medical Center, a level 1 trauma center, in Temple, TX. PARTICIPANTS Twenty-four students in their third year of medical school completed the communication curriculum. RESULTS Wilcoxon sign test was used to analyze the non-parametric data and multiple repeat tests required the significance level (p-Value) be adjusted to 0.003. Students showed significant increase in understanding of conflict management, their ability to communicate effectively, and their awareness of communication preferences (p < 0.001). In addition, they recognized better ways to engage with other students, residents, and staff on their rotation (p = 0.002) and felt more confident in their ability to handle feedback (p = 0.001). Open-ended responses on the post-test had overwhelmingly positive feedback with themes of awareness, psychological safety, and team rapport. Finally, students requested that the curriculum be taught longitudinally throughout their third-year clerkships. CONCLUSIONS Our curriculum enabled students to improve their awareness of communication, conflict management, team dynamics, and professionalism. These important competencies will support students throughout their training and in their practice as future surgeons.
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Affiliation(s)
- Emily Nes
- Boston Children's Hospital, Department of Surgery, Boston, Massachusetts; Baylor Scott and White Health System, Department of Surgery, Temple, Texas
| | - Bobbie Ann Adair White
- Baylor Scott and White Health System, Department of Surgery, Temple, Texas; MGH Institute of Health Professions, Health Professions Education Program, Boston, Massachusetts; Texas A&M, College of Medicine, Temple, Texas.
| | - Adil Justin Malek
- Baylor Scott and White Health System, Department of Surgery, Temple, Texas
| | - Jonaphine Mata
- Johns Hopkins, Department of Medicine, Baltimore, Maryland; Texas A&M, College of Medicine, Temple, Texas
| | - J Scott Wieters
- Baylor Scott and White Health System, Department of Emergency Medicine, Temple, Texas; Texas A&M, College of Medicine, Temple, Texas
| | - Dan Little
- Baylor Scott and White Health System, Department of Surgery, Temple, Texas; Texas A&M, College of Medicine, Temple, Texas
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16
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Bello C, Filipovic MG, Andereggen L, Heidegger T, Urman RD, Luedi MM. Building a well-balanced culture in the perioperative setting. Best Pract Res Clin Anaesthesiol 2022; 36:247-256. [DOI: 10.1016/j.bpa.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
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17
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Behzad I, Elahe M. Patient Safety Culture and Spiritual Health in the Operating Room: An Iranian Exploratory Qualitative Study. JOURNAL OF RELIGION AND HEALTH 2022:10.1007/s10943-022-01531-7. [PMID: 35478307 DOI: 10.1007/s10943-022-01531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
The concept of patient safety and spiritual health are considered essential components of health care systems and form the main pillars of quality care in many health care organizations. This study aims to explain the culture of patient safety and spiritual health in the operating room from the perspectives of operating room physicians and nurses. This qualitative study was of qualitative conventional content analysis type using purposive sampling. Data were collected using semi-structured interviews. Graneheim and Landman (2004) methods were used to analyze the data. To analyze the data of this research, 5 main themes including continuous and dynamic training and upgrading of safety skills, attention to spirituality, conscientiousness and work commitment, effective communication and teamwork, equipping human and logistical resources based on the principle of care, accurate recognition of instructions and error control were obtained. According to the findings, a proper understanding of patient safety culture can improve patient safety culture and increase the quality of services provided to patients.
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Affiliation(s)
- Imani Behzad
- Department of Operating Room, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Mousavi Elahe
- Department of Operating Room, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran
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18
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Pavithra A, Sunderland N, Callen J, Westbrook J. Unprofessional behaviours experienced by hospital staff: qualitative analysis of narrative comments in a longitudinal survey across seven hospitals in Australia. BMC Health Serv Res 2022; 22:410. [PMID: 35351097 PMCID: PMC8962235 DOI: 10.1186/s12913-022-07763-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/07/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Unprofessional behaviours of healthcare staff have negative impacts on organisational outcomes, patient safety and staff well-being. The objective of this study was to undertake a qualitative analysis of narrative responses from the Longitudinal Investigation of Negative Behaviours survey (LION), to develop a comprehensive understanding of hospital staff experiences of unprofessional behaviours and their impact on staff and patients. The LION survey identified staff experiences and perceptions related to unprofessional behaviours within hospitals. METHODS Two open-ended questions within the LION survey invited descriptions of unprofessional staff behaviours across seven hospitals in three Australian states between December 2017 and November 2018. Respondents were from medical, nursing, allied health, management, and support services roles in the hospitals. Data were qualitatively analysed using Directed Content Analysis (DCA). RESULTS From 5178 LION survey responses, 32% (n = 1636) of participants responded to the two open-ended questions exploring staff experiences of unprofessional behaviours across the hospital sites surveyed. Three primary themes and 11 secondary themes were identified spanning, i) individual unprofessional behaviours, ii) negative impacts of unprofessional behaviours on staff well-being, psychological safety, and employee experience, as well as on patient care, well-being, and safety, and iii) organisational factors associated with staff unprofessional behaviours. CONCLUSION Unprofessional behaviours are experienced by hospital staff across all professional groups and functions. Staff conceptualise, perceive and experience unprofessional behaviours in diverse ways. These behaviours can be understood as enactments that either negatively impact other staff, patients or the organisational outcomes of team cohesion, work efficiency and efficacy. A perceived lack of organisational action based on existing reporting and employee feedback appears to erode employee confidence in hospital leaders and their ability to effectively address and mitigate unprofessional behaviours.
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Affiliation(s)
- Antoinette Pavithra
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Neroli Sunderland
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Joanne Callen
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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A scoping review of barriers, facilitators and tools to escalation of care processes in the emergency department. CAN J EMERG MED 2022; 24:300-312. [DOI: 10.1007/s43678-022-00268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/14/2022] [Indexed: 11/02/2022]
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20
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Which Factors Promote Shared Understanding Between Physicians and Nurses in Inpatient Oncology Care Settings?: A Qualitative Exploration. Cancer Nurs 2022; 45:E338-E344. [PMID: 34010215 PMCID: PMC8602402 DOI: 10.1097/ncc.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Effective communication between physicians and nurses is crucial to the safety of patients, especially for those with cancer, which is a complex disease requiring multidisciplinary treatment. However, little is known about the factors that contribute to effective communication, which is defined as the development of shared understanding between two or more people. OBJECTIVE This qualitative secondary analysis was conducted to identify factors that contribute to shared understanding between physicians and nurses from video-recorded conversations that occurred between them during inpatient rounds on oncology units. METHODS We used inductive grounded theory to identify videos depicting moments of shared understanding. We then searched for preceding events to develop a preliminary conceptual model that described the factors contributing to shared understanding. RESULTS Four factors emerged as contributors to shared understanding: engagement, clarification, confirmation, and resolution. These factors occurred in sequence with engagement occurring first and resolution occurring last, as the closure of a communication exchange. CONCLUSIONS Existing interventions to improve communication include some of the factors identified as contributing to shared understanding (eg, closed-loop communications require clarification and confirmation). However, nurses may need to pay attention to all four factors to develop shared understanding that will promote effective communication with physicians and thereby enhance cancer care. IMPLICATIONS FOR PRACTICE Nurses achieve effective communication when they are assertive and avoid indirect communication. A greater awareness of body language and positioning in relation to a physician at the start of a communication exchange may increase the effectiveness of nurse-physician communication.
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Black GB, van Os S, Machen S, Fulop NJ. Ethnographic research as an evolving method for supporting healthcare improvement skills: a scoping review. BMC Med Res Methodol 2021; 21:274. [PMID: 34865630 PMCID: PMC8647364 DOI: 10.1186/s12874-021-01466-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between ethnography and healthcare improvement has been the subject of methodological concern. We conducted a scoping review of ethnographic literature on healthcare improvement topics, with two aims: (1) to describe current ethnographic methods and practices in healthcare improvement research and (2) to consider how these may affect habit and skill formation in the service of healthcare improvement. METHODS We used a scoping review methodology drawing on Arksey and O'Malley's methods and more recent guidance. We systematically searched electronic databases including Medline, PsychINFO, EMBASE and CINAHL for papers published between April 2013 - April 2018, with an update in September 2019. Information about study aims, methodology and recommendations for improvement were extracted. We used a theoretical framework outlining the habits and skills required for healthcare improvement to consider how ethnographic research may foster improvement skills. RESULTS We included 283 studies covering a wide range of healthcare topics and methods. Ethnography was commonly used for healthcare improvement research about vulnerable populations, e.g. elderly, psychiatry. Focussed ethnography was a prominent method, using a rapid feedback loop into improvement through focus and insider status. Ethnographic approaches such as the use of theory and focus on every day practices can foster improvement skills and habits such as creativity, learning and systems thinking. CONCLUSIONS We have identified that a variety of ethnographic approaches can be relevant to improvement. The skills and habits we identified may help ethnographers reflect on their approaches in planning healthcare improvement studies and guide peer-review in this field. An important area of future research will be to understand how ethnographic findings are received by decision-makers.
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Affiliation(s)
| | - Sandra van Os
- Department of Applied Health Research, UCL, London, UK
| | | | - Naomi J Fulop
- Department of Applied Health Research, UCL, London, UK
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22
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Nyberg A, Olofsson B, Otten V, Haney M, Fagerdahl AM. Patient safety during joint replacement surgery: experiences of operating room nurses. BMJ Open Qual 2021; 10:bmjoq-2021-001604. [PMID: 34750189 PMCID: PMC8576473 DOI: 10.1136/bmjoq-2021-001604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/25/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Avoidable complications for surgical patients still occur despite efforts to improve patient safety processes in operating rooms. Analysis of experiences of operating room nurses can contribute to better understanding of perioperative processes and flow, and why avoidable complications still occur. AIM To explore aspects of patient safety practice during joint replacement surgery through assessment of operating room nurse experiences. METHOD A qualitative design using semistructured interviews with 21 operating room nurses currently involved in joint replacement surgery in Sweden. Inductive qualitative content analysis was used. RESULTS The operating room nurses described experiences with patient safety hazards on an organisational, team and individual level. Uncertainties concerning a reliable plan for the procedure and functional reporting, as well as documentation practices, were identified as important. Teamwork and collaboration were described as crucial at the team level, including being respected as valuable, having shared goals and common expectations. On the individual level, professional knowledge, skills and experience were needed to make corrective steps. CONCLUSION The conditions to support patient safety, or limit complication risk, during joint replacement surgery continue to be at times inconsistent, and require steady performance attention. Operating room nurses make adjustments to help solve problems as they arise, where there are obvious risks for patient complications. The organisational patient safety management process still seems to allow deviation from established practice standards at times, and relies on individual-based corrective measures at the 'bedside' at times for good results.
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Affiliation(s)
- Anette Nyberg
- Department of Nursing, Faculty of Medicine, Umeå University, Umeå, Sweden .,Department of Surgical and Perioperative Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Birgitta Olofsson
- Department of Nursing, Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Sciences, Orthopedics, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Volker Otten
- Department of Surgical and Perioperative Sciences, Orthopedics, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Michael Haney
- Department of Surgical and Perioperative Sciences, Anesthesiology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Ann-Mari Fagerdahl
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Mansour D, Sayeed Z, Padela MT, McCarty S, Tonnos F, Silas D, Mostafa G, Yassir WK. Accountable Operating Room Teams. Orthopedics 2021; 44:e463-e470. [PMID: 34292838 DOI: 10.3928/01477447-20210618-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
With Medicare reimbursement diminishing and the aging population consuming more health care, hospitals continue to push for reforms to improve the efficiency of health care delivery, decrease consumption, and elevate the quality of care. Operating rooms command a large share of hospital resources but are also major revenue generators. Surgical care has evolved to become more efficient and accountable. Defining the characteristics of an accountable operating room team has been more elusive and inconsistent. This review defines the characteristics of accountable operating room teams and recommends measures by which to evaluate them. [Orthopedics. 2021;44(4):e463-e470.].
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Urpo M, Eskola S, Suominen T, Roos M. Teamwork: a perspective of perioperative nurses. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2021.12.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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25
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Fagerdahl AM, Torbjörnsson E, Sondén A. An Interprofessional E-Learning Resource to Prepare Students for Clinical Practice in the Operating Room-A Mixed Method Study from the Students' Perspective. Healthcare (Basel) 2021; 9:healthcare9081028. [PMID: 34442165 PMCID: PMC8393395 DOI: 10.3390/healthcare9081028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022] Open
Abstract
The operating room is a challenging learning environment for many students. Preparedness for practice is important as perceived stress and the fear of making mistakes are known to hamper learning. The aim was to evaluate students' perspectives of an e-learning resource for achieving preparedness. A mixed methods design was used. Students (n = 52) from three educational nursing and medical programs were included. A questionnaire was used to explore demographics, student use of the e-learning resource, and how the learning activities had helped them prepare for their clinical placement. Five focus group interviews were conducted as a complement. Most students (79%) stated that the resource prepared them for their clinical placement and helped them to feel more relaxed when attending to the operating room. In total, 93% of the students recommended other students to use the e-learning resource prior to a clinical placement in the operating room. Activities containing films focusing on practical procedures were rated as the most useful. We conclude that an e-learning resource seems to increase students' perceived preparedness for their clinical practice in the operating room. The development of e-learning resources has its challenges, and we recommend student involvement to evaluate the content.
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Affiliation(s)
- Ann-Mari Fagerdahl
- Department of Clinical Science and Education, Karolinska Institutet, 118 83 Stockholm, Sweden; (E.T.); (A.S.)
- Wound Centre, Södersjukhuset, 118 83 Stockholm, Sweden
- Correspondence:
| | - Eva Torbjörnsson
- Department of Clinical Science and Education, Karolinska Institutet, 118 83 Stockholm, Sweden; (E.T.); (A.S.)
- Department of Surgery, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Anders Sondén
- Department of Clinical Science and Education, Karolinska Institutet, 118 83 Stockholm, Sweden; (E.T.); (A.S.)
- Department of Surgery, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden
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Stevens EL, Hulme A, Salmon PM. The impact of power on health care team performance and patient safety: a review of the literature. ERGONOMICS 2021; 64:1072-1090. [PMID: 33775234 DOI: 10.1080/00140139.2021.1906454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Communication failure within health care teams is a major cause of patient harm across health care settings. Factors which contribute to communication failure include actual or perceived 'power'. Whilst a great deal of ergonomics research has focussed on teamwork in health care, the role of power in relation to measurable patient safety and performance outcomes remains relatively unknown. This article presents the findings from a review of the literature on power within multidisciplinary health care team settings. Following a systematic literature search, nineteen studies were evaluated in terms of research design, methods and analyses across the included studies. The main impacts resulting from power imbalances include negative effects on team collaboration, decision-making, communication and overall performance. Wider patient safety research, and more specifically the ergonomics discipline, is encouraged to address the complex interplay between power and teamwork in the health care sector.Practitioner Statement: We conducted a review of studies focussed on the influence of power on teamwork in health care. The findings show that power can have negative impacts on collaboration, decision-making, communication, and team performance. We conclude that power represents an important area for ergonomics, both in health care and other settings.Abbreviations: CRM: crew resource management; TEM: threat and error management; SNA: social network analysis; EAST: event analysis of systemic teamwork.
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Affiliation(s)
- Erin L Stevens
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Adam Hulme
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sunshine Coast, Australia
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Douglas N, Demeduik S, Conlan K, Salmon P, Chee B, Sullivan T, Heelan D, Ozcan J, Symons G, Marane C. Surgical caps displaying team members' names and roles improve effective communication in the operating room: a pilot study. Patient Saf Surg 2021; 15:27. [PMID: 34321063 PMCID: PMC8317270 DOI: 10.1186/s13037-021-00301-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/08/2021] [Indexed: 12/01/2022] Open
Abstract
Background Teamwork in the operating theatre is a complex emergent phenomenon and is driven by cooperative relationships between staff. A foundational requirement for teamwork is the ability to communicate effectively, and in particular, knowing each other’s name. Many operating theatre staff do not know each other’s name, even after formal team introductions. The use of theatre caps to display a staff member’s name and role has been suggested to improve communication and teamwork. Methods We hypothesized that the implementation of scrub hats with individual team members' names and roles would improve the perceived quality and effectiveness of communication in the operating theatre. A pilot project was designed as a pre-/post-implementation questionnaire sent to 236 operating room staff members at a general hospital in suburban Melbourne, Victoria, Australia, between November 6 to December 18, 2018. Participants included medical practitioners (anaesthetists, surgeons, obstetricians and gynaecologists), nurses (anaesthetic, scrub/scout and paediatric nurses), midwives and theatre technicians. The primary outcome was a change in perceived teamwork score, measured using a five position Likert scale. Results Of 236 enrolled participants, 107 (45%) completed both the pre and post intervention surveys. The median perceived teamwork response of four did not change after the intervention, though the number of low scores was reduced (p = 0.015). In a pre-planned subgroup analysis, the median perceived teamwork score rose for midwives from three to four (p < 0.001), while for other craft groups remained similar. The median number of staff members in theatre that a participant did not know the name of reduced from three to two (p < 0.001). Participants reported knowing the names of all staff members present in the theatre more frequently after the intervention (31% vs 15%, p < 0.001). The reported rate of formal team introductions was not significantly different after the intervention (34.7% vs 47.7% p = 0.058). Conclusions In this study, we found that wearing caps displaying name and role appeared to improve perceived teamwork and improve communication between staff members working in the operating theatre.
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Affiliation(s)
- Ned Douglas
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, VIC, Australia. .,Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC, Australia.
| | - Sophie Demeduik
- Department of Midwifery Education, Western Health, St. Albans, VIC, Australia
| | - Kate Conlan
- Operating Theatre, Western Health, St. Albans, VIC, Australia
| | | | - Brian Chee
- Department of Anaesthesia, Pain and Perioperative Medicine, Western Health, Locked Bag 2, Footscray, VIC, 3011, Australia
| | - Taylor Sullivan
- Operating Theatre, Western Health, St. Albans, VIC, Australia
| | - David Heelan
- Department of Anaesthesia, Pain and Perioperative Medicine, Western Health, Locked Bag 2, Footscray, VIC, 3011, Australia
| | - John Ozcan
- Department of Anaesthesia, Pain and Perioperative Medicine, Western Health, Locked Bag 2, Footscray, VIC, 3011, Australia
| | - Gareth Symons
- Department of Anaesthesia, Pain and Perioperative Medicine, Western Health, Locked Bag 2, Footscray, VIC, 3011, Australia
| | - Candida Marane
- Department of Anaesthesia, Pain and Perioperative Medicine, Western Health, Locked Bag 2, Footscray, VIC, 3011, Australia
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Churruca K, Ellis LA, Pomare C, Hogden A, Bierbaum M, Long JC, Olekalns A, Braithwaite J. Dimensions of safety culture: a systematic review of quantitative, qualitative and mixed methods for assessing safety culture in hospitals. BMJ Open 2021; 11:e043982. [PMID: 34315788 PMCID: PMC8317080 DOI: 10.1136/bmjopen-2020-043982] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The study of safety culture and its relationship to patient care have been challenged by variation in definition, dimensionality and methods of assessment. This systematic review aimed to map methods to assess safety culture in hospitals, analyse the prevalence of these methods in the published research literature and examine the dimensions of safety culture captured through these processes. METHODS We included studies reporting on quantitative, qualitative and mixed methods to assess safety culture in hospitals. The review was conducted using four academic databases (PubMed, CINAHL, Scopus and Web of Science) with studies from January 2008 to May 2020. A formal quality appraisal was not conducted. Study purpose, type of method and safety culture dimensions were extracted from all studies, coded thematically, and summarised narratively and using descriptive statistics where appropriate. RESULTS A total of 694 studies were included. A third (n=244, 35.2%) had a descriptive or exploratory purpose, 225 (32.4%) tested relationships among variables, 129 (18.6%) evaluated an intervention, while 13.8% (n=96) had a methodological focus. Most studies exclusively used surveys (n=663; 95.5%), with 88 different surveys identified. Only 31 studies (4.5%) used qualitative or mixed methods. Thematic analysis identified 11 themes related to safety culture dimensions across the methods, with 'Leadership' being the most common. Qualitative and mixed methods approaches were more likely to identify additional dimensions of safety culture not covered by the 11 themes, including improvisation and contextual pressures. DISCUSSION We assessed the extent to which safety culture dimensions mapped to specific quantitative and qualitative tools and methods of assessing safety culture. No single method or tool appeared to measure all 11 themes of safety culture. Risk of publication bias was high in this review. Future attempts to assess safety culture in hospitals should consider incorporating qualitative methods into survey studies to evaluate this multi-faceted construct.
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Affiliation(s)
- Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Anne Hogden
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Institute of Health Service Management, University of Tasmania, Hobart, Tasmania, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Aleksandra Olekalns
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Paige JT, Garbee DD, Bonanno LS, Kerdolff KE. Qualitative Analysis of Effective Teamwork in the Operating Room (OR). JOURNAL OF SURGICAL EDUCATION 2021; 78:967-979. [PMID: 33160940 DOI: 10.1016/j.jsurg.2020.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/28/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To conduct focus group interviews with operating room (OR) personnel to determine components of effective teamwork to inform a revision of a teamwork assessment instrument. DESIGN Qualitative research study targeting OR personnel using semi-structured focus group interviews of interprofessional OR personnel. Responses were digitally recorded and transcribed. Qualitative analysis was undertaken by 2 reviewers who identified major themes related to effective teamwork. Inter-coder agreement was employed to confirm findings and themes. SETTING Major academic medical center and Level 1 Trauma Center in Southeastern United States. PARTICIPANTS Fifteen OR staff members including surgeons, an anesthesiologist, nurse anesthetists, circulating nurses, and scrub technicians. RESULTS Three focus groups involving 15 individuals (2 surgeons, 1 anesthesiologist, 8 nurse anesthetists, 2 circulating nurses, and 2 surgical technologists) were conducted over a 1-month period in 2017. Four major themes related to effective teamwork emerged from analysis: (1) Smooth flow, (2) United effort, (3) Communication, and (4) Positive attitude. CONCLUSIONS Among the OR team members, agreement regarding effective teamwork centers around the concepts of smooth procedural flow, unified effort, clear communication, and positive attitude of the team. These findings have helped refine a teamwork instrument to increase its utility for formative use in the clinical environment.
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Affiliation(s)
- J T Paige
- LSU Health New Orleans School of Medicine, New Orleans, Louisiana.
| | - D D Garbee
- LSU Health New Orleans School of Nursing, New Orleans, Louisiana
| | - L S Bonanno
- LSU Health New Orleans School of Nursing, New Orleans, Louisiana
| | - K E Kerdolff
- LSU Health New Orleans School of Medicine, New Orleans, Louisiana
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Cohen TN, Griggs AC, Kanji FF, Cohen KA, Lazzara EH, Keebler JR, Gewertz BL. Advancing team cohesion: Using an escape room as a novel approach. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/25160435211005934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams. Methods This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post-escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M. Results Sixty-two teams participated (n = 280 participants) of which 31 teams (50%) successfully “escaped” in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F(4, 254) = 24.10, p < .001; Wilks’ Λ = .725; partial η2 = .275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline. Conclusions This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums.
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Affiliation(s)
- Tara N Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew C Griggs
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Falisha F Kanji
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kate A Cohen
- Department of Enterprise Information Services, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Elizabeth H Lazzara
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Joseph R Keebler
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Bruce L Gewertz
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Dellefield ME, Verkaaik CA. Using the Observational Teamwork Assessment in Surgery Instrument to Measure RN Teamwork During Cardiac Surgery: Lessons Learned. J Nurs Care Qual 2021; 36:162-168. [PMID: 32568965 DOI: 10.1097/ncq.0000000000000497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical teams aspire to be safe and avoid preventable deaths. A lack of teamwork has been associated with safety failures, including adverse events and errors. PURPOSE The purpose of the pilot study was to: (1) modify the Observational Teamwork Assessment in Surgery (OTAS) and the original data collection method to measure registered nurse (RN) teamwork during the intraoperative phase of 5 open heart surgical procedures and (2) recommend strategies to further test the reliability and validity of the modified OTAS. METHODS This was a pilot study of the OTAS using direct observation. RESULTS Although characterized as psychometrically rigorous in prior systematic reviews, using the OTAS to measure RN teamwork in the intraoperative phase of cardiac surgery revealed deficits in its content validity and reliability. The OTAS and its original data collection method were modified. CONCLUSION Recommendations for further use of the modified OTAS to increase its reliability and validity are given.
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Grozdanovic D, Janackovic GL, Grozdanovic M, Mitkovic MB, Mitkovic MM. The Selection of Main Surgical Work Factors in Operating Rooms. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211067497. [PMID: 34908506 PMCID: PMC8689611 DOI: 10.1177/00469580211067497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The main component of error minimization in operating rooms (ORs) is to maintain high reliability of surgical teams. The analysis of adverse events in the OR reveals deficiencies in cognitive and interpersonal skills as the main factors influencing surgeons’ errors. Therefore, research of these additional factors is necessary, besides factors related to surgeons’ clinical knowledge and technical skills. In this paper, the key factors for evaluating activities in surgical operating rooms are identified. Fuzzy analytic hierarchy process is used for identification of key factors. Fifteen key factors are identified for evaluating activities in surgical operating rooms to improve the efficiency of surgical operations. For each group of activities (surgical “capabilities,” operating room characteristics, and non-technical skills), five factors are identified. As the most important, the following factors are obtained: communication, indoor environment standardization, and tool handle design. The aim of the analysis of these key factors is surgeons’ work capability enhancement, rational design of operating rooms, and advancement of operators’ cognitive and interpersonal skills.
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Affiliation(s)
| | | | - Miroljub Grozdanovic
- Faculty of Occupational Safety, Full member of Engineering Academy of Serbia, University of Nis, Nis, Serbia
| | - Milorad B. Mitkovic
- Faculty of Medicine, Full member of Serbian Academy of Science and Arts, University of Nis, Nis, Serbia
| | - Milan M. Mitkovic
- Clinical Centre Nis, Nis, Serbia; Faculty of Medicine, University of Nis, Nis, Serbia
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Meeuwissen SNE, Gijselaers WH, Wolfhagen IHAP, Oude Egbrink MGA. Working beyond disciplines in teacher teams: teachers' revelations on enablers and inhibitors. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:33-40. [PMID: 33351174 PMCID: PMC7809069 DOI: 10.1007/s40037-020-00644-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Health professions education faces transitions from monodisciplinary to integrated education and from soloist teachers to interdisciplinary teacher teams. Interdisciplinary teamwork has been found complex and prone to conflict. Teachers' perceptions of why some teams work and learn as a real interdisciplinary team and others do not are lacking in this setting. We studied the factors that teachers perceive as enabling and/or inhibiting interdisciplinary team learning. METHODS In this exploratory, qualitative study, we conducted 17 semi-structured, vignette-guided interviews with teachers recruited from diverse disciplines in undergraduate health professions programmes at Maastricht University, the Netherlands, through maximum variation sampling. Team learning research informed data collection and template analysis. RESULTS We identified three themes representing the factors that teachers perceived to influence interdisciplinary team learning: 'alignment/misalignment with the educational philosophy' (regarding personal attributes, tendencies and motivation), 'leadership practices' (encompassing team vision, responsibility and reflection), and 'involvement in organisational processes' (covering organisational decision-making, support and learning opportunities). For interdisciplinary team learning in development of integrated education, teachers emphasised their personal ability to move beyond disciplinary boundaries. Shared team leadership enabled the creation of a shared vision, shared responsibility, and team reflection. Lastly, teacher involvement in educational management, peer support and learning was considered important. DISCUSSION To work beyond disciplines in health professions education, teachers should take an interest in integrated education, share responsibility and work in an environment where people continuously learn from others. Organisations can facilitate this by involving teachers in decision-making processes and providing faculty development aimed to foster shared leadership and team reflection.
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Affiliation(s)
- Stephanie N E Meeuwissen
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Wim H Gijselaers
- Department of Educational Research and Development, School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - Ineke H A P Wolfhagen
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Institute for Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mirjam G A Oude Egbrink
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Institute for Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Physiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Manojlovich M, Harrod M, Hofer T, Lafferty M, McBratnie M, Krein SL. Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study. BMJ Qual Saf 2020; 30:747-754. [PMID: 33168635 PMCID: PMC8140397 DOI: 10.1136/bmjqs-2020-011441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND How quickly physicians respond to communications from bedside nurses is important for the delivery of safe inpatient care. Delays in physician responsiveness can impede care or contribute to patient harm. Understanding contributory factors to physician responsiveness can provide insights to promote timely physician response, possibly improving communication to ensure safe patient care. The purpose of this study was to describe the factors contributing to physician responsiveness to text or numeric pages, telephone calls and face-to-face messages delivered by nurses on adult general care units. METHODS Using a qualitative design, we collected data through observation, shadowing, interviews and focus groups of bedside registered nurses and physicians who worked in four hospitals in the Midwest USA. We analysed the data using inductive content analysis. RESULTS A total of 155 physicians and nurses participated. Eighty-six nurses and 32 physicians participated in focus groups or individual interviews; we shadowed 37 physicians and nurses across all sites. Two major inter-related themes emerged, message and non-message related factors. Message-related factors included the medium nurses used to convey messages, physician preference for notification via one communication medium over another and the clarity of the message, all of which could cause confusion and thus a delayed response. Non-message related factors included trust and interpersonal relationships, and different perspectives between nurses and physicians on the same clinical issue that affected perceptions of urgency, and contributed to delays in responsiveness. CONCLUSIONS Physician responsiveness to communications from bedside nurses depends on a complex combination of factors related to the message itself and non-message related factors. How quickly physicians respond is a multifactorial phenomenon, and strategies to promote a timely response within the context of a given situation must be directed to both groups.
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Affiliation(s)
| | - Molly Harrod
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Timothy Hofer
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Megan Lafferty
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sarah L Krein
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Schulte A, Suarez-Ibarrola R, Wegen D, Pohlmann PF, Petersen E, Miernik A. Automatic speech recognition in the operating room - An essential contemporary tool or a redundant gadget? A survey evaluation among physicians in form of a qualitative study. Ann Med Surg (Lond) 2020; 59:81-85. [PMID: 32994988 PMCID: PMC7501482 DOI: 10.1016/j.amsu.2020.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 01/30/2023] Open
Abstract
Introduction For decades, automatic speech recognition (ASR) has been the subject of research and its range of applications broadened. Presently, ASR among physicians is mainly used to convert speech into text but not to implement instructions in the operating room (OR). This study aimed to evaluate physicians of different surgical professions on their personal experience and posture towards ASR. Methods A 16-item survey was distributed electronically to hospitals and outpatient clinics in southern Germany addressing physicians on the potential applications of ASR in the OR. Results The survey was responded by 185 of 2693 physicians (response rate: 6.9%) with a mean age of 41.8 ± 9.8 years. ASR is desirable in the OR regardless of the field of speciality (93.7%). While only 2.7% have used ASR, 87.9% evaluate its future potential as high. 91.0% of those working in a university hospital would consider testing ASR, while 67.5% of those in non-university hospitals and practices (p = 0.001). 90.1% of responders of strictly surgical specialities see potential in ASR while 73.7% in non-surgical specialities evaluate its future potential as high (p = 0.01). 58.3% of those over the age of 60 consider the use of ASR without a headset to be imaginable, while 96.3% among those under the age of 60. There were no statistically significant differences regarding sex and professional position. Conclusion Foreseeably, ASR is anticipated to be integrated into ORs and valued at a high market potential. Our study provides information about physicians’ individual preferences from various surgical disciplines regarding ASR. ASR is a desirable tool in the OR regardless of the field of speciality. While 90.1% interviewees from surgical specialities see potential in ASR and 73.7% from non-surgical specialities assess its future potential as high. There were no statistically significant differences regarding sex and professional position. For an ASR system to be implemented in the OR, it needs to be sophisticated and updatable since there are still several technical requirements to be fulfilled. Foreseeably, ASR is anticipated to be integrated into the OR and valued at a high market potential.
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Affiliation(s)
- Antonia Schulte
- Department of Urology, Faculty of Medicine, Medical Centre – University of Freiburg, Freiburg, Germany
- Corresponding author. University of Freiburg – Medical Centre Faculty of Medicine Department of Urology, Hugstetter Str. 55, D-79106, Freiburg, Germany.
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, Medical Centre – University of Freiburg, Freiburg, Germany
| | | | - Philippe-Fabian Pohlmann
- Department of Urology, Faculty of Medicine, Medical Centre – University of Freiburg, Freiburg, Germany
| | - Elina Petersen
- Epidemiological Study Center, University Hospital Hamburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Centre – University of Freiburg, Freiburg, Germany
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Real-Time Person Identification in a Hospital Setting: A Systematic Review. SENSORS 2020; 20:s20143937. [PMID: 32679781 PMCID: PMC7411609 DOI: 10.3390/s20143937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/04/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022]
Abstract
In the critical setting of a trauma team activation, team composition is crucial information that should be accessible at a glance. This calls for a technological solution, which are widely available, that allows access to the whereabouts of personnel. This diversity presents decision makers and users with many choices and considerations. The aim of this review is to give a comprehensive overview of available real-time person identification techniques and their respective characteristics. A systematic literature review was performed to create an overview of identification techniques that have been tested in medical settings or already have been implemented in clinical practice. These techniques have been investigated on a total of seven characteristics: costs, usability, accuracy, response time, hygiene, privacy, and user safety. The search was performed on 11 May 2020 in PubMed and the Web of Science Core Collection. PubMed and Web of Science yielded a total n = 265 and n = 228 records, respectively. The review process resulted in n = 23 included records. A total of seven techniques were identified: (a) active and (b) passive Radio-Frequency Identification (RFID) based systems, (c) fingerprint, (d) iris, and (e) facial identification systems and infrared (IR) (f) and ultrasound (US) (g) based systems. Active RFID was largely documented in the included literature. Only a few could be found about the passive systems. Biometric (c, d, and e) technologies were described in a variety of applications. IR and US techniques appeared to be a niche, as they were only spoken of in few (n = 3) studies.
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Stucky CH, De Jong MJ, Kabo FW, Kasper CE. A Network Analysis of Perioperative Communication Patterns. AORN J 2020; 111:627-641. [DOI: 10.1002/aorn.13044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Ivarsson J, Åberg M. Role of requests and communication breakdowns in the coordination of teamwork: a video-based observational study of hybrid operating rooms. BMJ Open 2020; 10:e035194. [PMID: 32461294 PMCID: PMC7259866 DOI: 10.1136/bmjopen-2019-035194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study investigated the functional role of 'requests' in the coordination of surgical activities in the operating room (OR). A secondary aim was to describe, closely, instances of potential miscommunication to scrutinise how so-called conversational repairs were used to address and prevent mistakes. DESIGN Non-participant video-based observations. SETTING Team coordination around image acquisitions (digital subtraction angiography) done during endovascular aortic repair (EVAR) procedures in a hybrid OR. METHODS The study followed and documented a total of 72 EVAR procedures, out of which 12 were video-recorded (58 hours). The results were based on 12 teams operating during these recorded surgeries and specifically targeted all sequences involving controlled apnoea. In total, 115 sequences were analysed within the theoretical framework of conversation analysis. RESULTS The results indicated a simple structure of communication that can enable the successful coordination of work between different team members. Central to this analysis was the distinction between immediate requests and pre-requests. The results also showed how conversational repairs became key in establishing joint understanding and, therefore, how they can function as crucial resources in safety management operations. CONCLUSION The results suggest the possibility of devising an interactional framework to minimise problems with communication, thereby enabling the advancement of patient safety. By making the distinction between different types of requests explicit, certain ambiguities can be mitigated and some misunderstandings avoided. One way to accomplish this practically would be to tie various actions to clearer and more distinct forms of expression.
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Affiliation(s)
- Jonas Ivarsson
- Department of Applied Information Technology, University of Gothenburg, Goteborg, Sweden
| | - Mikaela Åberg
- Department of Education, Communication and Learning, University of Gothenburg, Goteborg, Sweden
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Abstract
Extreme teams (ETs) work in challenging, high pressured contexts, where poor performance can have severe consequences. These teams must coordinate their skill sets, align their goals, and develop shared awareness, all under stressful conditions. How best to research these teams poses unique challenges as researchers seek to provide applied recommendations while conducting rigorous research to test how teamwork models work in practice. In this article, we identify immersive simulations as one solution to this, outlining their advantages over existing methodologies and suggesting how researchers can best make use of recent advances in technology and analytical techniques when designing simulation studies. We conclude that immersive simulations are key to ensuring ecological validity and empirically reliable research with ETs.
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Råberus A, Holmström IK, Galvin K, Sundler AJ. The nature of patient complaints: a resource for healthcare improvements. Int J Qual Health Care 2020; 31:556-562. [PMID: 30346537 DOI: 10.1093/intqhc/mzy215] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/31/2018] [Accepted: 10/10/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore the nature, potential usefulness and meaning of complaints lodged by patients and their relatives. DESIGN A retrospective, descriptive design was used. SETTING The study was based on a sample of formal patient complaints made through a patient complaint reporting system for publicly funded healthcare services in Sweden. PARTICIPANTS A systematic random sample of 170 patient complaints was yielded from a total of 5689 patient complaints made in a Swedish county in 2015. MAIN OUTCOME MEASURE Themes emerging from patient complaints analysed using a qualitative thematic method. RESULTS The patient complaints reported patients' or their relatives' experiences of disadvantages and problems faced when seeking healthcare services. The meanings of the complaints reflected six themes regarding access to healthcare services, continuity and follow-up, incidents and patient harm, communication, attitudes and approaches, and healthcare options pursued against the patient's wishes. CONCLUSIONS The patient complaints analysed in this study clearly indicate a number of specific areas that commonly give rise to dissatisfaction; however, the key findings point to the significance of patients' exposure and vulnerability. The findings suggest that communication needs to be improved overall and that patient vulnerability could be successfully reduced with a strong interpersonal focus. Prerequisites for meeting patients' needs include accounting for patients' preferences and views both at the individual and organizational levels.
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Affiliation(s)
- Anna Råberus
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalens University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | | | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Trainer HM, Jones JM, Pendergraft JG, Maupin CK, Carter DR. Team Membership Change “Events”: A Review and Reconceptualization. GROUP & ORGANIZATION MANAGEMENT 2020. [DOI: 10.1177/1059601120910848] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Driven by views of teams as dynamic systems with permeable boundaries, scholars are increasingly seeking to better understand how team membership changes (i.e., team members joining and/or leaving) shape the functioning and performance of organizational teams. However, empirical studies of team membership change appear to be progressing in three largely independent directions as researchers consider: (a) how newcomers impact and are impacted by the teams they join; (b) how teams adapt to member departures; or (c) how teams function under conditions of high membership fluidity, with little theoretical integration or consensus across these three areas. To accelerate an integrative stream of research on team membership change, we advance a conceptual framework which depicts each team membership change as a discrete team-level “event” which shapes team functioning to the extent to which it is “novel,” “disruptive,” and “critical” for the team. We use this framework to guide our review and synthesis of empirical studies of team membership change published over the past 20 years. Our review reveals numerous factors, across conceptual levels of the organization, that determine the strength (i.e., novelty, disruptiveness, criticality) of a team membership change event and, consequently, its impact on team functioning and performance. In closing, we provide propositions for future research that integrate a multilevel, event-based perspective of team membership change and demonstrate how team membership change events may impact organizational systems over time and across levels of observation.
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Bressers G, Brydges M, Paradis E. Ethnography in health professions education: Slowing down and thinking deeply. MEDICAL EDUCATION 2020; 54:225-233. [PMID: 31923340 DOI: 10.1111/medu.14033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/19/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Ethnography has been gaining appreciation in the field of health professions education (HPE) research, yet it remains misunderstood. Our article contributes to this growing literature by describing some of the key tensions with which both aspiring and seasoned ethnographers should productively struggle. METHODS We respond to the injunction made by Varpio et al (2017) that HPE researchers should ground their methodological ventures in their historical and philosophical tenets. To do so, we first review core ethnographic texts that provide a background for ethnographic research in HPE, then provide an orienting definition to bind the specificities of ethnographic research. Finally, we review core theoretical and practical considerations for ethnographic research. RESULTS Ethnography is a slow and deep approach to knowledge production, and as such it requires careful engagement with theory and deliberate choice of methods. Core theoretical tensions include the ontological, epistemological and axiological dimensions of ethnography, and concerns with quality and rigour. Practical tensions include the scope and remit of ethnography, the importance of observing naturally occurring behaviour and the crafting of rich field notes. CONCLUSIONS We encourage ethnographers to pursue scholarship that challenges the status quo. Ethnographers should favour deep encounters with research participants, dig deep into the cultural and structural aspects of HPE and be reflexive about knowledge outputs. At a time in HPE when the pressures to publish are high, using ethnography as a research methodology offers an opportunity to slow down and think deeply.
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Affiliation(s)
- Guusje Bressers
- Department of Educational Research and Development, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Madison Brydges
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Elise Paradis
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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Holmes T, Vifladt A, Ballangrud R. A qualitative study of how inter-professional teamwork influences perioperative nursing. Nurs Open 2020; 7:571-580. [PMID: 32089854 PMCID: PMC7024613 DOI: 10.1002/nop2.422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/18/2019] [Accepted: 11/05/2019] [Indexed: 11/30/2022] Open
Abstract
Aim To explore Norwegian operating room nurses' perceptions of how team skills in the inter-professional operating room team influence perioperative nursing in relation to patient safety. Design A qualitative, descriptive study based on interviews. Methods Ten operating room nurses (N = 10) employed in four Norwegian hospitals were interviewed individually. A qualitative inductive content analysis was conducted. The study was reported adhering to the Consolidated Criteria for Reporting Qualitative Research Checklist. Results Three generic categories, containing three subcategories each, were identified illuminate the operating room nurses' perceptions. The operating room team's team skills influence on (a) the quality of perioperative nursing, about task performance, result for the patient and learning; (b) the progress of perioperative nursing, by keeping focus on the task, being prepared and task distribution and (c) the operating room nurses' work environment in the operating room, including confidence, stress and energy use and irritation or job satisfaction.
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Affiliation(s)
- Thekla Holmes
- Department of Health Sciences GjøvikFaculty of Medicine and Health SciencesNorwegian University of Science and TechnologyGjøvikNorway
- Department of SurgeryInnlandet Hospital TrustGjøvikNorway
| | - Anne Vifladt
- Department of Health Sciences GjøvikFaculty of Medicine and Health SciencesNorwegian University of Science and TechnologyGjøvikNorway
| | - Randi Ballangrud
- Department of Health Sciences GjøvikFaculty of Medicine and Health SciencesNorwegian University of Science and TechnologyGjøvikNorway
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Stucky CH, De Jong MJ, Kabo FW. Military Surgical Team Communication: Implications for Safety. Mil Med 2019; 185:e448-e456. [DOI: 10.1093/milmed/usz330] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
AbstractIntroductionMedical error is the third leading cause of death in the United States, contributing to suboptimal care, serious patient injury, and mortality among beneficiaries in the Military Health System. Recent media reports have scrutinized the safety and quality of military healthcare, including surgical complications, infection rates, clinician competence, and a reluctance of leaders to investigate operational processes. Military leaders have aggressively committed to a continuous cycle of process improvement and a culture of safety with the goal to transform the Military Health System into a high-reliability organization. The cornerstone of patient safety is effective clinician communication. Military surgical teams are particularly susceptible to communication error because of potential barriers created by military rank, clinical specialty, and military culture. With an operations tempo requiring the military to continually deploy small, agile surgical teams, effective interpersonal communication among these team members is vital to providing life-saving care on the battlefield.MethodsThe purpose of our exploratory, prospective, cross-sectional study was to examine the association between social distance and interpersonal communication in a military surgical setting. Using social network analysis to map the relationships and structure of interpersonal relations, we developed six networks (interaction frequency, close working relationship, socialization, advice-seeking, advice-giving, and speaking-up/voice) and two models that represented communication effectiveness ratings for each participant. We used the geodesic or network distance as a predictor of team member network position and assessed the relationship of distance to pairwise communication effectiveness with permutation-based quadratic assignment procedures. We hypothesized that the shorter the network geodesic distance between two individuals, the smaller the difference between their communication effectiveness.ResultsWe administered a network survey to 50 surgical teams comprised of 45 multidisciplinary clinicians with 522 dyadic relationships. There were significant and positive correlations between differences in communication effectiveness and geodesic distances across all five networks for both general (r = 0.819–0.894, P < 0.001 for all correlations) and task-specific (r = 0.729–0.834, P < 0.001 for all correlations) communication. This suggests that a closer network ties between individuals is associated with smaller differences in communication effectiveness. In the quadratic assignment procedures regression model, geodesic distance predicted task-specific communication (β = 0.056–0.163, P < 0.001 for all networks). Interaction frequency, socialization, and advice-giving had the largest effect on task-specific communication difference. We did not uncover authority gradients that affect speaking-up patterns among surgical clinicians.ConclusionsThe findings have important implications for safety and quality. Stronger connections in the interaction frequency, close working relationship, socialization, and advice networks were associated with smaller differences in communication effectiveness. The ability of team members to communicate clinical information effectively is essential to building a culture of safety and is vital to progress towards high-reliability. The military faces distinct communication challenges because of policies to rotate personnel, the presence of a clear rank structure, and antifraternization regulations. Despite these challenges, overall communication effectiveness in military teams will likely improve by maintaining team consistency, fostering team cohesion, and allowing for frequent interaction both inside and outside of the work environment.
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Affiliation(s)
- Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310-7301
| | - Marla J De Jong
- University of Utah College of Nursing, Annette Poulson Cumming Building, 10 South 2000 East, Salt Lake City, UT 84112-5880
| | - Felichism W Kabo
- Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Room 3348 ISR, Ann Arbor, MI 48106-1248
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Sundler AJ, Hjertberg F, Keri H, Holmström IK. Attributes of person-centred communication: A qualitative exploration of communication with older persons in home health care. Int J Older People Nurs 2019; 15:e12284. [PMID: 31642182 DOI: 10.1111/opn.12284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 08/18/2019] [Accepted: 09/27/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Previous research points to challenges related to the home healthcare of older persons and to the complexity of communication. Although person-centred care has been advocated widely, there remains a need for in-depth knowledge on how to enable person-centred and supportive communication in the care of older persons. AIM The aim of this study was to explore attributes of person-centred communication between nurses and older persons being cared for in their home. METHODS A descriptive study with a qualitative approach was conducted. A data set from the COMHOME-study consisting of 77 audio-recorded home healthcare visits between registered nurses and older persons was analysed with a method for qualitative thematic analysis. RESULTS The findings indicate that the attributes of person-centred communication comprise recognising, inviting and involving older persons. To facilitate this form of communication, attentiveness and responsiveness on the part of RNs seemed significant. Person-centred communication was facilitated when the RNs used verbal expressions to emphasise and acknowledge the older persons' views and were attentive to their emotions and expressions. CONCLUSION The nurses' attentiveness and responsiveness seems important for person-centred communication with older persons. Communication skills are needed to recognise, invite and involve older persons in their care and to support their health and well-being. Implication for practice The importance of communication which facilitate a person-centred approach by nurses should be acknowledged when caring for older persons and included in education and training.
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Affiliation(s)
- Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | | | - Helena Keri
- Home healthcare, Jönköping municipality, Jönköping, Sweden
| | - Inger K Holmström
- School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Sifaki-Pistolla D, Melidoniotis E, Dey N, Chatzea VE. How trust affects performance of interprofessional health-care teams. J Interprof Care 2019; 34:218-224. [PMID: 31390238 DOI: 10.1080/13561820.2019.1631763] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Interprofessional teamwork in health-care settings is considered a valuable means of enhancing patient management. Literature has highlighted the importance of trust in building effective health-care teams. The present study aimed to investigate and further understand the perceptions of health-care professionals regarding trust and performance within their working team, as well as to assess the association between them and team performance. "TRUST" questionnaire, a valid instrument for measuring the relationship of trust and team performance was distributed to the members of the perioperative teams located in two different hospitals (a University and a General Hospital) in Greece. Two multivariate linear regression models were developed to reveal the significant predictors of high performance per hospital. Among the major findings revealed were 1) trust and performance were closely related 2) slight yet significant variations were observed between the University and the General Hospital and 3) trust level, years of previous experience and number of team members were among the key predictors of effective team performance. This study conveys new knowledge on trust and performance within health-care settings with limited resources and is expected to guide future interventions aiming to enhance team performance.
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Affiliation(s)
- Dimitra Sifaki-Pistolla
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Nilanjan Dey
- Department of Computer Science & Engineering, Bengal College of Engineering and Technology, Kolkata, India
| | - Vasiliki-Eirini Chatzea
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Olmos-Vega FM, Dolmans DHJM, Guzmán-Quintero C, Echeverri-Rodriguez C, Teunnissen PW, Stalmeijer RE. Disentangling residents' engagement with communities of clinical practice in the workplace. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:459-475. [PMID: 30659426 DOI: 10.1007/s10459-019-09874-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
Maximising the potential of the workplace as a learning environment entails understanding the complexity of its members' interactions. Although some articles have explored how residents engage with supervisors, nurses and pharmacists individually, there is little research on how residents enter into and engage with the broader community of clinical practice (CoCP). To this end, we designed a constructivist grounded theory study that took place at Universidad Javeriana in Bogotá, Colombia. We conducted semi-structured interviews with 13 residents from different training levels and disciplines during the first weeks of their new rotations. During the interviews, we used the Pictor technique as a visual aid to collect data. Using iterative data collection and analysis, constant comparison methods and theoretical sampling, we constructed the final results. When entering a CoCP, residents experienced recurring and intertwined processes including: exploring how their goals and interest are aligned with those of the CoCP; identifying the relevant CoCP members in the workplace environment; and understanding how these members could assist their successful engagement with the community's practices. Residents entered a CoCP with the intention of either having a central or a peripheral trajectory in it. The final resident participation and role resulted from negotiations between the resident and the CoCP members. Optimising workplace learning includes being mindful as to how each member of the healthcare team influence residents' engagement on practice, and on understanding the nuances of residents' participatory trajectories while interacting with them. Understanding such nuances could be key to align CoCPs' learning affordances and residents' goals and intentions.
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Affiliation(s)
- Francisco M Olmos-Vega
- Anaesthesiology Department, Faculty of Medicine, Pontificia Universidad Javeriana, Carrera 7 40-62, Fourth Floor, Bogotá, Colombia.
- Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Diana H J M Dolmans
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Carlos Guzmán-Quintero
- Anthropology Department, Social Sciences Faculty, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Camila Echeverri-Rodriguez
- Anaesthesiology Department, Faculty of Medicine, Pontificia Universidad Javeriana, Carrera 7 40-62, Fourth Floor, Bogotá, Colombia
| | - Pim W Teunnissen
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- VU University Medical Center, Amsterdam, The Netherlands
| | - Renée E Stalmeijer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Göras C, Olin K, Unbeck M, Pukk-Härenstam K, Ehrenberg A, Tessma MK, Nilsson U, Ekstedt M. Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study. BMJ Open 2019; 9:e026410. [PMID: 31097486 PMCID: PMC6530509 DOI: 10.1136/bmjopen-2018-026410] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR. DESIGN Prospective observational study using the Work Observation Method By Activity Timing tool. SETTING An OR department at a county hospital in Sweden. PARTICIPANTS OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9). RESULTS The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication. CONCLUSIONS The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system. TRIAL REGISTRATION NUMBER 2016/264.
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Affiliation(s)
- Camilla Göras
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Anaesthesia and Intensive Care Unit, Falu Hospital, Falun, Sweden
- Centre for Clinical Research, Falun, Dalarna, Sweden
| | - Karolina Olin
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Development Centre, Turku University Hospital, Turku, Finland
| | - Maria Unbeck
- Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Karin Pukk-Härenstam
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Paediatric Emergency Department, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Ehrenberg
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Mesfin Kassaye Tessma
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Ulrica Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Mirjam Ekstedt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- School of Health and Caring Sciences, Linneuniversitet, Kalmar, Sweden
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Kumar H, Morad R, Sonsati M. Surgical team: improving teamwork, a review. Postgrad Med J 2019; 95:334-339. [DOI: 10.1136/postgradmedj-2018-135943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 04/10/2019] [Accepted: 04/14/2019] [Indexed: 11/04/2022]
Abstract
Teams within surgery have been through countless cycles of refinement with an ever-increasing list of surgical team members. This results in a more dispersed team, making effective teamwork harder to achieve. Furthermore, the ad hoc nature of surgical teams means that team familiarity is not always given. The impact of this is seen across the field, with inadequacies leading to disastrous outcomes. This is a review of research that has been done into the topic of surgical teams. It will investigate barriers and consider the evidence available on how to improve the current system. Studies show an increased effectiveness of surgical teams with structures that allowed consistency in team members. The research advocates that advancements made in improving teamwork and efficiency can prove to be a low-cost but high-yield strategy for development. This can be in terms of simulated training, staff turnover management and fixed team allocation.
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Sandelin A, Kalman S, Gustafsson BÅ. Prerequisites for safe intraoperative nursing care and teamwork—Operating theatre nurses’ perspectives: A qualitative interview study. J Clin Nurs 2019; 28:2635-2643. [DOI: 10.1111/jocn.14850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/21/2018] [Accepted: 01/20/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Annika Sandelin
- Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Research, Development and Educational Unit, Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Sigridur Kalman
- Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Division for Anaesthesia and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Birgitta Åkesdotter Gustafsson
- Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Research, Development and Educational Unit, Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
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