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Slowey C, Abernathy J. Team-based care of the thoracic surgical patient. Curr Opin Anaesthesiol 2024; 37:79-85. [PMID: 38085860 DOI: 10.1097/aco.0000000000001324] [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: 12/20/2023]
Abstract
PURPOSE OF REVIEW Although team-based care has been shown in many sectors to improve outcomes, very little work has been done with the thoracic surgical patient. This review article focuses on this and, extrapolating from other closely related surgical fields, teamwork in thoracic surgery will be reviewed for outcome efficacy and substance. RECENT FINDINGS The optimal team has been shown to display behaviors that allow them to model future needs, predict disaster, be adaptable to change, and promote team cohesiveness all with a positive effect on perioperative outcome. The suboptimal team will have transactional leadership, poor communication, ineffective conflict resolution, and hold rigid beliefs about other team members. SUMMARY To improve outcome, the thoracic surgical team, centered on the anesthesiologist and surgeon, will display the 'Big 5' attributes of highly effective teams. There are attributes of poor teams, which the dyad should avoid in order to increase the team's function and thus outcome.
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Affiliation(s)
- Charlie Slowey
- Department of Anesthesiology and Critical Care, Orleans Street, Baltimore, Maryland, USA
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Hallet J, Sutradhar R, Jerath A, d’Empaire PP, Carrier FM, Turgeon AF, McIsaac DI, Idestrup C, Lorello G, Flexman A, Kidane B, Kaliwal Y, Chan WC, Barabash V, Coburn N, Eskander A. Association Between Familiarity of the Surgeon-Anesthesiologist Dyad and Postoperative Patient Outcomes for Complex Gastrointestinal Cancer Surgery. JAMA Surg 2023; 158:465-473. [PMID: 36811886 PMCID: PMC9947805 DOI: 10.1001/jamasurg.2022.8228] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/23/2022] [Indexed: 02/24/2023]
Abstract
Importance The surgeon-anesthesiologist teamwork and relationship is crucial to good patient outcomes. Familiarity among work team members is associated with enhanced success in multiple fields but rarely studied in the operating room. Objective To examine the association between surgeon-anesthesiologist dyad familiarity-as the number of times working together-with short-term postoperative outcomes for complex gastrointestinal cancer surgery. Design, Setting, and Participants This population-based retrospective cohort study based in Ontario, Canada, included adults undergoing esophagectomy, pancreatectomy, and hepatectomy for cancer from 2007 through 2018. The data were analyzed January 1, 2007, through December 21, 2018. Exposures Dyad familiarity captured as the annual volume of procedures of interest done by the surgeon-anesthesiologist dyad in the 4 years before the index surgery. Main Outcomes and Measures Ninety-day major morbidity (any Clavien-Dindo grade 3 to 5). The association between exposure and outcome was examined using multivariable logistic regression. Results Seven thousand eight hundred ninety-three patients with a median age of 65 years (66.3% men) were included. They were cared for by 737 anesthesiologists and 163 surgeons who were also included. The median surgeon-anesthesiologist dyad volume was 1 (range, 0-12.2) procedures per year. Ninety-day major morbidity occurred in 43.0% of patients. There was a linear association between dyad volume and 90-day major morbidity. After adjustment, the annual dyad volume was independently associated with lower odds of 90-day major morbidity, with an odds ratio of 0.95 (95% CI, 0.92-0.98; P = .01) for each incremental procedure per year, per dyad. The results did not change when examining 30-day major morbidity. Conclusions and Relevance Among adults undergoing complex gastrointestinal cancer surgery, increasing familiarity of the surgeon-anesthesiologist dyad was associated with improved short-term patient outcomes. For each additional time that a unique surgeon-anesthesiologist dyad worked together, the odds of 90-day major morbidity decreased by 5%. These findings support organizing perioperative care to increase the familiarity of surgeon-anesthesiologist dyads.
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Affiliation(s)
- Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Angela Jerath
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Pablo Perez d’Empaire
- Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - François M. Carrier
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, Québec, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Alexis F. Turgeon
- CHU de Québec–Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma– Emergency–Critical Care Medicine, Université Laval, Québec City, Québec, Canada
- Departments of Anesthesiology & Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daniel I. McIsaac
- Department of Anesthesiology and The Wilson Centre, University Health Network–Toronto Western Hospital, Toronto, Ontario, Canada
| | - Chris Idestrup
- Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gianni Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alana Flexman
- Section of Thoracic Surgery, Departments of Surgery and of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Anesthesiology, St Paul’s Hospital/Providence Health Care, Vancouver, British Columbia, Canada
| | - Biniam Kidane
- Department of Anesthesiology, St Paul’s Hospital/Providence Health Care, Vancouver, British Columbia, Canada
| | | | | | - Victoria Barabash
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- Odette Cancer Centre, Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Anesthesiology, St Paul’s Hospital/Providence Health Care, Vancouver, British Columbia, Canada
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Tekïn M, Uysal İ, Toraman Ç, Akman C, Aytuğ Koşan AM, Postaci ES. The effect of social interaction on decision making in emergency ambulance teams: a statistical discourse analysis. BMC MEDICAL EDUCATION 2023; 23:121. [PMID: 36803591 PMCID: PMC9942383 DOI: 10.1186/s12909-023-04091-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION This study examined the effects of social interaction, cognitive flexibility, and seniority on the correct response among emergency ambulance teams during case intervention. METHODS The research, structured with the sequential exploratory mixed method, was conducted with 18 emergency ambulance personnel. The approach process of the teams working on the scenario was video recorded. The records were transcribed by the researchers, including gestures and facial expressions. Discourses were coded and modeled with regression. RESULTS The number of discourses was higher in groups with high correct intervention scores. As the level of cognitive flexibility or seniority increased, the correct intervention score tended to decrease too. Informing has been identified as the only variable that positively affects the correct response to the emergency case, especially in the first period, which is directed toward case intervention preparation. CONCLUSION Within the findings of the research, it is recommended that activities and scenario-based training practices that will increase the intra-team communication of the emergency ambulance personnel should be included in the medical education and in-service training.
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Affiliation(s)
- Murat Tekïn
- Department of Medical Education, Çanakkale Onsekiz Mart University, Çanakkale, Turkey.
| | - İbrahim Uysal
- Department of First and Emergency Aid, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Çetin Toraman
- Department of Medical Education, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Canan Akman
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | | | - Emine Sevïnç Postaci
- Department of First and Emergency Aid, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
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Kämmer JE, Ehrhard S, Kunina-Habenicht O, Weber-Schuh S, Hautz SC, Birrenbach T, Sauter TC, Hautz WE. What factors affect team members' evaluation of collaboration in medical teams? Front Psychol 2023; 13:1031902. [PMID: 36710771 PMCID: PMC9877456 DOI: 10.3389/fpsyg.2022.1031902] [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: 08/30/2022] [Accepted: 12/20/2022] [Indexed: 01/14/2023] Open
Abstract
Introduction Perceived teamwork quality is associated with numerous work-related outcomes, ranging from team effectiveness to job satisfaction. This study explored what situational and stable factors affect the perceived quality of teamwork during a specific team task: when a medical team comprising a senior (supervisor) and a junior (trainee) physician diagnoses a patient. Methods During a field study in an emergency department, multisource data describing the patients, the diagnosing physicians, and the context were collected, including physicians' ratings of their teamwork. The relationships between perceived teamwork quality and situational (e.g., workload) and stable (e.g., seniority) factors were estimated in a latent regression model using the structural equation modeling (SEM) approach. Results Across the N = 495 patients included, SEM analyses revealed that the patient-specific case clarity and urgency influenced the perceived teamwork quality positively, whereas the work experience of the supervisor influenced the perceived teamwork quality of both supervisor and trainee negatively, albeit to different degrees. Discussion Our findings shed light on the complex underpinnings of perceived teamwork quality, a performance-relevant factor that may influence work and organizational effectiveness in healthcare settings.
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Affiliation(s)
- Juliane E. Kämmer
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Simone Ehrhard
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland,*Correspondence: Simone Ehrhard, ✉
| | | | - Sabine Weber-Schuh
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Stefanie C. Hautz
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Tanja Birrenbach
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas C. Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Wolf E. Hautz
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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Arad D, Finkelstein A, Rozenblum R, Magnezi R. Patient safety and staff psychological safety: A mixed methods study on aspects of teamwork in the operating room. Front Public Health 2022; 10:1060473. [PMID: 36620282 PMCID: PMC9816421 DOI: 10.3389/fpubh.2022.1060473] [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: 10/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives To predict the amount of teamwork that takes place throughout a surgery, based on performing a preoperative safety standards (surgical safety checklist and surgical count) and to explore factors affecting patient safety and staff psychological safety during a surgery, based on interprofessional teamwork. Methods This mixed methods study included quantitative and qualitative analyses. Quantitative data included 2,184 direct observations of surgical cases with regard to the performance of safety standards during surgeries in 29 hospitals, analyzed using multivariate binary logistic regressions. Qualitative data were obtained from an analysis of 25 semi-structured interviews with operating room (OR) clinicians and risk managers, using an inductive thematic analysis approach. Results Analysis of the OR observations revealed that a lack of teamwork in the preoperative "sign-in" phase doubled the chances of there being a lack of teamwork during surgery [odds ratio = 1.972, 95% confidence interval (CI) 1.741, 2.233, p < 0.001] and during the "time-out" phase (odds ratio = 2.142, 95% CI 1.879, 2.441, p < 0.001). Consistent presence of staff during surgery significantly increased teamwork, by 21% for physicians and 24% for nurses (p < 0.05), but staff turnover significantly decreased teamwork, by 73% for physicians (p < 0.05). Interview data indicated that patient safety and staff psychological safety are related to a perception of a collaborative team role among OR staff, with mutual commitment and effective interprofessional communication. Conclusions Healthcare organizations should consider the key finding of this study when trying to identify factors that affect teamwork during a surgery. Effective preoperative teamwork positively affects intraoperative teamwork, as does the presence of more clinicians participating in a surgery, with no turnover. Other factors include working in a fixed, designated team, led by a surgeon, which functions with effective interprofessional communication that promotes patient safety and staff psychological safety.
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Affiliation(s)
- Dana Arad
- Health System Management Department, Bar-Ilan University, Ramat Gan, Israel,Patient Safety Division, Ministry of Health, Jerusalem, Israel,*Correspondence: Dana Arad ✉
| | - Adi Finkelstein
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Ronen Rozenblum
- Brigham and Women's Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
| | - Racheli Magnezi
- Health System Management Department, Bar-Ilan University, Ramat Gan, Israel
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Abstract
We judge each other every day using demographic characteristics (such as gender and race/ethnicity), and these social identities shape our lives in profound ways. The impacts of demographic diversity in perioperative teams are poorly understood, and mixed results are reported in other team-based work settings. Drawing from decades' worth of organizational behavior literature, the authors propose a model of critical factors related to interplays between diversity, communication, and conflict, all which take place in a hierarchical environment influenced by power differences. Evidence-based recommendations are provided, aimed at maximizing benefits of diversity in perioperative teams while minimizing negative consequences.
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Affiliation(s)
- Rebecca D Minehart
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ 440, Boston MA 02114, USA.
| | - Erica Gabrielle Foldy
- Wagner School of Public Service, New York University, 295 Lafayette Street, New York, NY 10012, USA
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van Dalen ASHM, Jansen M, van Haperen M, van Dieren S, Buskens CJ, Nieveen van Dijkum EJM, Bemelman WA, Grantcharov TP, Schijven MP. Implementing structured team debriefing using a Black Box in the operating room: surveying team satisfaction. Surg Endosc 2020; 35:1406-1419. [PMID: 32253558 PMCID: PMC7886753 DOI: 10.1007/s00464-020-07526-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
Background Surgical safety may be improved using a medical data recorder (MDR) for the purpose of postoperative team debriefing. It provides the team in the operating room (OR) with the opportunity to look back upon their joint performance objectively to discuss and learn from suboptimal situations or possible adverse events. The aim of this study was to investigate the satisfaction of the OR team using an MDR, the OR Black Box®, in the OR as a tool providing output for structured team debriefing. Methods In this longitudinal survey study, 35 gastro-intestinal laparoscopic operations were recorded using the OR Black Box® and the output was subsequently debriefed with the operating team. Prior to study, a privacy impact assessment was conducted to ensure alignment with applicable legal and regulatory requirements. A structured debrief model and an OR Back Box® performance report was developed. A standardized survey was used to measure participant’s satisfaction with the team debriefing, the debrief model used and the performance report. Factor analysis was performed to assess the questionnaire’s quality and identified contributing satisfaction factors. Multivariable analysis was performed to identify variables associated with participants’ opinions. Results In total, 81 team members of various disciplines in the OR participated, comprising 35 laparoscopic procedures. Mean satisfaction with the OR Black Box® performance report and team debriefing was high for all 3 identified independent satisfaction factors. Of all participants, 98% recommend using the OR Black Box® and the outcome report in team debriefing. Conclusion The use of an MDR in the OR for the purpose of team debriefing is considered to be both beneficial and important. Team debriefing using the OR Black Box® outcome report is highly recommended by 98% of team members participating. Electronic supplementary material The online version of this article (10.1007/s00464-020-07526-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A S H M van Dalen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M van Haperen
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S van Dieren
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C J Buskens
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T P Grantcharov
- International Centre for Surgical Safety, St Michael's Hospital, Toronto, Canada
| | - M P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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8
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Woltenberg LN, Ballard JA, Gnonhossou DA, Norton JC, Burkhart PV, Kuperstein J. Interprofessional identity development within a brief shadowing experience: An exploratory case study. J Interprof Care 2019:1-10. [PMID: 31852375 DOI: 10.1080/13561820.2019.1687430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
The Deans' Interprofessional Honors Colloquium (DIHC) is an honors-level interprofessional elective course that provides a seminar-based forum for students from eleven academic programs to explore the characteristics and implications of collaborative interprofessional practice around a contemporary health topic. This project-based course combines didactic presentations, interactive group learning, and an interprofessional shadowing experience with a corresponding written reflection paper. Ten semesters of Interprofessional Shadowing Reflections (n = 401) were studied via thematic and content analyses to examine the extent to which a brief interprofessional shadowing experience influenced interprofessional identity development. Interprofessional socialization framework was employed as a lens to refine themes and to track students' trajectory in developing a dual professional identity. This exploratory case study indicated that nearly all participants' reflections included content indicative of the second stage (interprofessional role learning) of the interprofessional socialization framework, and many progressed toward the third stage (dual identity development). Major themes included emergent role learning, increased differentiation among roles and care models, and increased appreciation for other professionals. The experience provided an opportunity for correction of misconceptions and improved understanding of the role and practice of other professions. Nearly all of the participating students (1) reflected on the benefits of interprofessional collaboration and (2) indicated a desire to work interprofessionally in the future, an early indication of dual identity formation. Findings indicated that the interprofessional shadowing experience and written reflection were highly valuable elements of the DIHC and provided a critical opportunity for interprofessional identity development.
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Affiliation(s)
- Leslie N Woltenberg
- Department of Physician Assistant Studies, University of Kentucky, Lexington, Kentucky, USA
| | - J A Ballard
- Center for Interprofessional Health Education, University of Kentucky, Lexington, Kentucky, USA
| | - D A Gnonhossou
- Department of Family Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - J C Norton
- Center for Interprofessional Health Education, University of Kentucky, Lexington, Kentucky, USA
| | - P V Burkhart
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - J Kuperstein
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky, USA
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Keller S, Tschan F, Semmer NK, Timm-Holzer E, Zimmermann J, Candinas D, Demartines N, Hübner M, Beldi G. "Disruptive behavior" in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams. PLoS One 2019; 14:e0226437. [PMID: 31830122 PMCID: PMC6907803 DOI: 10.1371/journal.pone.0226437] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/26/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tense communication and disruptive behaviors during surgery have often been attributed to surgeons' personality or hierarchies, while situational triggers for tense communication were neglected. Goals of this study were to assess situational triggers of tense communication in the operating room and to assess its impact on collaboration quality within the surgical team. METHODS AND FINDINGS The prospective observational study was performed in two university hospitals in Europe. Trained external observers assessed communication in 137 elective abdominal operations led by 30 different main surgeons. Objective observations were related to perceived collaboration quality by all members of the surgical team. A total of 340 tense communication episodes were observed (= 0.57 per hour); mean tensions in surgeries with tensions was 1.21 per hour. Individual surgeons accounted for 24% of the variation in tensions, while situational aspects accounted for 76% of variation. A total of 72% of tensions were triggered by coordination problems; 21.2% by task-related problems and 9.1% by other issues. More tensions were related to lower perceived teamwork quality for all team members except main surgeons. Coordination-triggered tensions significantly lowered teamwork quality for second surgeons, scrub technicians and circulators. CONCLUSIONS Although individual surgeons differ in their tense communication, situational aspects during the operation had a much more important influence on the occurrence of tensions, mostly triggered by coordination problems. Because tensions negatively impact team collaboration, surgical teams may profit from improving collaboration, for instance through training, or through reflexivity.
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Affiliation(s)
- Sandra Keller
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
- Virginia Tech, Blacksburg, VA, United States of America
| | - Franziska Tschan
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | | | - Eliane Timm-Holzer
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Jasmin Zimmermann
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland
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Müller P, Tschan F, Keller S, Seelandt J, Beldi G, Elfering A, Dubach B, Candinas D, Pereira D, Semmer NK. Assessing Perceptions of Teamwork Quality Among Perioperative Team Members. AORN J 2018; 108:251-262. [PMID: 30156726 DOI: 10.1002/aorn.12343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Successful surgery depends on collaboration and mutual trust among interdisciplinary team members. We compared teamwork quality as perceived by surgeons, anesthesia care providers, and perioperative nurses using two surveys in the same hospital. The general survey sent to the homes of the OR personnel revealed teamwork climate scores in the medium to high range. Attending surgeons were significantly more satisfied than perioperative nurses and resident surgeons; anesthesiologists were significantly more satisfied than perioperative nurses. A second single-item survey administered immediately after elective open abdominal surgical procedures also showed relatively high satisfaction with teamwork. Results of the second survey, however, showed that attending surgeons were significantly less satisfied than the members of all the other professions, and perioperative nurses were significantly more satisfied than the members of all the other professions. We conclude that general surveys about teamwork quality among members of surgical teams may not necessarily reflect teamwork quality during actual surgical procedures.
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11
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Cooper JB. Critical Role of the Surgeon-Anesthesiologist Relationship for Patient Safety. J Am Coll Surg 2018; 227:382-386. [PMID: 30055849 DOI: 10.1016/j.jamcollsurg.2018.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/22/2018] [Indexed: 11/15/2022]
Abstract
Teamwork is now recognized as important for safe, high-quality perioperative care. The relationship in each surgeon-anesthesiologist dyad is perhaps the most critical element of overall team performance. A well-functioning relationship is conducive to safe, effective care. A dysfunctional relationship can promote unsafe conditions and contribute to an adverse outcome. Yet, there is little research about this relationship, about what works well or not well, what can be done to optimize it. This article explores functional and dysfunctional aspects of the relationship, identifies some negative stereotypes each profession has of the other and calls for research to better characterize and understand how to improve working relationships. Suggestions are given for what an ideal relationship might be and actions that surgeons and anesthesiologists can take to improve how they work together. The goal is safer care for patients, and more joy and meaning in work for surgeons and anesthesiologists.
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Affiliation(s)
- Jeffrey B Cooper
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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12
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Almghairbi DS, Marufu TC, Moppett IK. Conflict resolution in anaesthesia: systematic review. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 5:1-7. [DOI: 10.1136/bmjstel-2017-000264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 06/16/2018] [Indexed: 11/04/2022]
Abstract
BackgroundConflict is a significant and recurrent problem in most modern healthcare systems. Given its ubiquity, effective techniques to manage or resolve conflict safely are required.ObjectiveThis review focuses on conflict resolution interventions for improvement of patient safety through understanding and applying/teaching conflict resolution skills that critically depend on communication and improvement of staff members’ ability to voice their concerns.MethodsWe used the Population-Intervention-Comparator-Outcome model to outline our methodology. Relevant English language sources for both published and unpublished papers up to February 2018 were sourced across five electronic databases: the Cochrane Library, EMBASE, MEDLINE, SCOPUS and Web of Science.ResultsAfter removal of duplicates, 1485 studies were screened. Six articles met the inclusion criteria with a total sample size of 286 healthcare worker participants. Three training programmes were identified among the included studies: (A) crisis resource management training; (B) the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training; and (C) the two-challenge rule (a component of TeamSTEPPS), and two studies manipulating wider team behaviours. Outcomes reported included participant reaction and observer rating of conflict resolution, speaking up or advocacy-inquiry behaviours. Study results were inconsistent in showing benefits of interventions.ConclusionThe evidence for training to improve conflict resolution in the clinical environment is sparse. Novel methods that seek to influence wider team behaviours may complement traditional interventions directed at individuals.
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Nguyen N, Watson WD, Dominguez E. An Event-Based Approach to Design a Teamwork Training Scenario and Assessment Tool in Surgery. JOURNAL OF SURGICAL EDUCATION 2016; 73:197-207. [PMID: 26774937 DOI: 10.1016/j.jsurg.2015.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/02/2015] [Accepted: 10/08/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Simulation is a technique recommended for teaching and measuring teamwork, but few published methodologies are available on how best to design simulation for teamwork training in surgery and health care in general. The purpose of this article is to describe a general methodology, called event-based approach to training (EBAT), to guide the design of simulation for teamwork training and discuss its application to surgery. DESIGN The EBAT methodology draws on the science of training by systematically introducing training exercise events that are linked to training requirements (i.e., competencies being trained and learning objectives) and performance assessment. The EBAT process involves: RESULTS Of the 4 teamwork competencies endorsed by the Agency for Healthcare Research Quality and Department of Defense, "communication" was chosen to be the focus of our training efforts. A total of 5 learning objectives were defined based on 5 validated teamwork and communication techniques. Diagnostic laparoscopy was chosen as the clinical context to frame the training scenario, and 29 KSAs were defined based on review of published literature on patient safety and input from subject matter experts. Critical events included those that correspond to a specific phase in the normal flow of a surgical procedure as well as clinical events that may occur when performing the operation. Similar to the targeted KSAs, targeted responses to the critical events were developed based on existing literature and gathering input from content experts. Finally, a 29-item EBAT-derived checklist was created to assess communication performance. CONCLUSION Like any instructional tool, simulation is only effective if it is designed and implemented appropriately. It is recognized that the effectiveness of simulation depends on whether (1) it is built upon a theoretical framework, (2) it uses preplanned structured exercises or events to allow learners the opportunity to exhibit the targeted KSAs, (3) it assesses performance, and (4) it provides formative and constructive feedback to bridge the gap between the learners' KSAs and the targeted KSAs. The EBAT methodology guides the design of simulation that incorporates these 4 features and, thus, enhances training effectiveness with simulation.
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Affiliation(s)
- Ngan Nguyen
- Ohio Health Learning, Riverside Methodist Hospital, Columbus, Ohio
| | - William D Watson
- Ohio Health Learning, Riverside Methodist Hospital, Columbus, Ohio
| | - Edward Dominguez
- Department of Medical Education, Riverside Methodist Hospital, Columbus, Ohio.
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Effects of disruptive surgeon behavior in the operating room. Am J Surg 2015; 209:65-70. [DOI: 10.1016/j.amjsurg.2014.09.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/11/2014] [Accepted: 09/10/2014] [Indexed: 11/19/2022]
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Abstract
BACKGROUND Decision-making and assessment in emergency situations are complex and result many times in ethical conflicts between different healthcare professionals. AIM To analyse and describe situations that can generate ethical conflict among nurses working in emergency situations. METHODS Qualitative analysis. A total of 16 emergency nurses took part in interviews and a focus group. ETHICAL CONSIDERATIONS Organisational approval by the University Hospital, and informed consent and confidentiality were ensured before conducting the research. RESULT/CONCLUSION Two categories emerged: one in 'ethical issues' and one in 'emotions and feelings in caring'. The four ethical subcategories are presented: Autonomy, the first sub category: first, the nurse's ability to practise care on an emergency ward and, second, to support the patient and/or relatives in terms of care and medical treatment. The conflicts arise when the nurse ends up in the middle between the patient and the physician responsible for the diagnosis and treatment from a nature scientific perspective. Reification of injured body: patient was often reified and fragmented, becoming just a leg or arm. Different factors contributed in this perspective. Pain: pain relief was often inadequate but more effectively treated in the emergency medical services than at the emergency department. The nurses highlighted the phenomenon of suffering because they felt that pain was only an object, forgetting the patients' care need, like separating mind from body. Death: the nurses felt that the emergency services are only prepared to save lives and not to take care of the needs of patients with 'end-of-life' care. Another issue was the lack of ethical guidelines during a cardiac arrest. Resuscitation often continues without asking about the patient's 'previous wishes' in terms of resuscitation or not. In these situations, the nurses describe an ethical conflict with the physician in performing their role as the patient's advocate. The nurses express feelings of distress, suffering, anger and helplessness.
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Watson BM, Jones L, Cretchley J. Time as a Key Topic in Health Professionals' Perceptions of Clinical Handovers. Glob Qual Nurs Res 2014; 1:2333393614550162. [PMID: 28462291 PMCID: PMC5342289 DOI: 10.1177/2333393614550162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/13/2014] [Indexed: 12/01/2022] Open
Abstract
Clinical handovers are an essential part of the daily care and treatment of hospital patients. We invoked a language and social psychology lens to investigate how different health professional groups discussed the communication problems and strengths they experienced in handovers. We conducted in-depth interviews with three different health professional groups within a large metropolitan hospital. We used Leximancer text analytics software as a tool to analyze the data. Results showed that time was of concern to all groups in both similar and diverse ways. All professionals discussed time management, time pressures, and the difficulties of coordinating different handovers. Each professional group had its own unique perceptions and priorities about handovers. Our findings indicated that health professionals understood what was required for handover improvement but did not have the extra capacity to alter their current environment. Hospital management, with clinicians, need to implement handover schedule processes that prioritize interprofessional representation.
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Affiliation(s)
| | - Liz Jones
- Griffith University, Brisbane, Queensland, Australia
| | - Julia Cretchley
- The University of Queensland, Brisbane, Queensland, Australia
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Cochran A, Elder WB. A model of disruptive surgeon behavior in the perioperative environment. J Am Coll Surg 2014; 219:390-8. [PMID: 25067803 DOI: 10.1016/j.jamcollsurg.2014.05.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/08/2014] [Accepted: 05/28/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgeons are the physicians with the highest rates of documented disruptive behavior. We hypothesized that a unified conceptual model of disruptive surgeon behavior could be developed based on specific individual and system factors in the perioperative environment. STUDY DESIGN Semi-structured interviews were conducted with 19 operating room staff of diverse occupations at a single institution. Interviews were analyzed using grounded theory methods. RESULTS Participants described episodes of disruptive surgeon behavior, personality traits of perpetrators, environmental conditions of power, and situations when disruptive behavior was demonstrated. Verbal hostility and throwing or hitting objects were the most commonly described disruptive behaviors. Participants indicated that surgical training attracts and creates individuals with particular personality traits, including a sense of shame. Interviewees stated this behavior is tolerated because surgeons have unchecked power, have strong money-making capabilities for the institution, and tend to direct disruptive behavior toward the least powerful employees. The most frequent situational stressors were when something went wrong during an operation and working with unfamiliar team members. Each factor group (ie, situational stressors, cultural conditions, and personality factors) was viewed as being necessary, but none of them alone were sufficient to catalyze disruptive behavior events. CONCLUSIONS Disruptive physician behavior has strong implications for the work environment and patient safety. This model can be used by hospitals to better conceptualize conditions that facilitate disruptive surgeon behavior and to establish programs to mitigate conduct that threatens patient safety and employee satisfaction.
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Affiliation(s)
- Amalia Cochran
- University of Utah Department of Surgery, Salt Lake City, UT.
| | - William B Elder
- University of Utah Department of Surgery, Salt Lake City, UT
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Weller J, Boyd M. Making a Difference Through Improving Teamwork in the Operating Room: A Systematic Review of the Evidence on What Works. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0050-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Wahr JA, Prager RL, Abernathy JH, Martinez EA, Salas E, Seifert PC, Groom RC, Spiess BD, Searles BE, Sundt TM, Sanchez JA, Shappell SA, Culig MH, Lazzara EH, Fitzgerald DC, Thourani VH, Eghtesady P, Ikonomidis JS, England MR, Sellke FW, Nussmeier NA. Patient safety in the cardiac operating room: human factors and teamwork: a scientific statement from the American Heart Association. Circulation 2013; 128:1139-69. [PMID: 23918255 DOI: 10.1161/cir.0b013e3182a38efa] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Cullati S, Le Du S, Raë AC, Micallef M, Khabiri E, Ourahmoune A, Boireaux A, Licker M, Chopard P. Is the Surgical Safety Checklist successfully conducted? An observational study of social interactions in the operating rooms of a tertiary hospital. BMJ Qual Saf 2013; 22:639-46. [DOI: 10.1136/bmjqs-2012-001634] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Despite knowledge that most surgical adverse events occur in the operating room (OR), understanding of the intraoperative phase of care is incomplete; most studies measure surgical safety in terms of preoperative risk or postoperative morbidity and mortality. Because of the OR's complexity, human factors engineering provides an ideal methodology for studies of intraoperative safety. This article reviews models of error and resilience as delineated by human factors experts, correlating them to OR performance. Existing methodologies for studying intraoperative safety are then outlined, focusing on video-based observational research. Finally, specific human and system factors examined in the OR are detailed.
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Burford B. Group processes in medical education: learning from social identity theory. MEDICAL EDUCATION 2012; 46:143-52. [PMID: 22239328 DOI: 10.1111/j.1365-2923.2011.04099.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
CONTEXT The clinical workplace in which doctors learn involves many social groups, including representatives of different professions, clinical specialties and workplace teams. This paper suggests that medical education research does not currently take full account of the effects of group membership, and describes a theoretical approach from social psychology, the social identity approach, which allows those effects to be explored. METHODS The social identity approach has a long history in social psychology and provides an integrated account of group processes, from the adoption of group identity through a process of self-categorisation, to the biases and conflicts between groups. This paper outlines key elements of this theoretical approach and illustrates their relevance to medical education. RESULTS The relevance of the social identity approach is illustrated with reference to a number of areas of medical education. The paper shows how research questions in medical education may be usefully reframed in terms of social identity in ways that allow a deeper exploration of the psychological processes involved. Professional identity and professionalism may be viewed in terms of self-categorisation rather than simply attainment; the salience of different identities may be considered as influences on teamwork and interprofessional learning, and issues in communication and assessment may be considered in terms of intergroup biases. CONCLUSIONS Social identity theory provides a powerful framework with which to consider many areas of medical education. It allows disparate influences on, and consequences of, group membership to be considered as part of an integrated system, and allows assumptions, such as about the nature of professional identity and interprofessional tensions, to be made explicit in the design of research studies. This power to question assumptions and develop deeper and more meaningful research questions may be increasingly relevant as the nature and role of the medical profession change.
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Affiliation(s)
- Bryan Burford
- Medical Education Research Group, Durham University, Durham, UK.
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Preoperative Surgical Briefings Do Not Delay Operating Room Start Times and Are Popular With Surgical Team Members. J Patient Saf 2011; 7:139-43. [DOI: 10.1097/pts.0b013e31822a9fbc] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rogers D, Lingard L, Boehler ML, Espin S, Klingensmith M, Mellinger JD, Schindler N. Teaching operating room conflict management to surgeons: clarifying the optimal approach. MEDICAL EDUCATION 2011; 45:939-945. [PMID: 21848722 DOI: 10.1111/j.1365-2923.2011.04040.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT Conflict management has been identified as an essential competence for surgeons as they work in operating room (OR) teams; however, the optimal approach is unclear. Social science research offers two alternatives, the first of which recommends that task-related conflict be managed using problem-solving techniques while avoiding relationship conflict. The other approach advocates for the active management of relationship conflict as it almost always accompanies task-related conflict. Clarity about the optimal management strategy can be gained through a better understanding of conflict transformation, or the inter-relationship between conflict types, in this specific setting. The purpose of this study was to evaluate conflict transformation in OR teams in order to clarify the approach most appropriate for an educational conflict management programme for surgeons. METHODS A constructivist grounded theory approach was adopted to explore the phenomenon of OR team conflict. Narratives were collected from focus groups of OR nurses and surgeons at five participating centres. A subset of these narratives involved transformation between and within conflict types. This dataset was analysed. RESULTS The results confirm that misattribution and the use of harsh language cause conflict transformation in OR teams just as they do in stable work teams. Negative emotionality was found to make a substantial contribution to responses to and consequences of conflict, notably in the swiftness with which individuals terminated their working relationships. These findings contribute to a theory of conflict transformation in the OR team. CONCLUSIONS There are a number of behaviours that activate conflict transformation in the OR team and a conflict management education programme should include a description of and alternatives to these behaviours. The types of conflict are tightly interwoven in this setting and thus the most appropriate management strategy is one that assumes that both types of conflict will exist and should be managed actively.
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Affiliation(s)
- David Rogers
- Department of Surgery, Faculty of School of Medicine, Southern Illinois University, Springfield, IL 67294, USA.
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Rydenfält C, Johansson G, Larsson PA, Åkerman K, Odenrick P. Social structures in the operating theatre: how contradicting rationalities and trust affect work. J Adv Nurs 2011; 68:783-95. [DOI: 10.1111/j.1365-2648.2011.05779.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee BT, Tobias AM, Yueh JH, Bar-Meir ED, Darrah LM, Guglielmi CL, Wood ER, Carr JM, Moorman DW. Design and impact of an intraoperative pathway: a new operating room model for team-based practice. J Am Coll Surg 2008; 207:865-73. [PMID: 19183533 DOI: 10.1016/j.jamcollsurg.2008.08.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 08/07/2008] [Accepted: 08/13/2008] [Indexed: 01/01/2023]
Abstract
BACKGROUND The concept of a team-based model for delivery of care has been critical at our institution for improving efficiency and safety. Despite these measures, difficulties continue to occur during lengthy operating room procedures. Using a novel team-based practice model, a multidisciplinary team was organized to improve efficiency in microsurgical breast reconstruction. We describe development of an intraoperative pathway for deep inferior epigastric perforator (DIEP) flap breast reconstruction and its impact on various outcomes. STUDY DESIGN We evaluated 150 patients who underwent DIEP flap breast reconstruction at Beth Israel Deaconess Medical Center from 2005 to 2008. Patient groups were subdivided into 50 unilateral and 50 bilateral procedures before the intraoperative pathway and 25 unilateral and 25 bilateral procedures after. Outcomes measured included operative time, complications, operating room and hospital costs, proper administration of prophylactic antibiotics and heparin, and staff satisfaction surveys. RESULTS Mean operative times decreased after pathway implementation in both unilateral (8.2 hours to 6.9 hours; p < 0.001) and bilateral groups (12.8 hours to 10.6 hours; p < 0.001) and complication rates were unchanged. Mean operating room costs decreased in the unilateral group by 10.2% (p = 0.018). Prophylactic heparin administration showed substantial improvements, although antibiotic administration and redosing of antibiotics trended upward. Staff surveys showed improved interdisciplinary communication, transition guidelines, and enhanced efficiency through standardization. CONCLUSIONS Implementation of an intraoperative pathway led to improvements in operative time, cost, quality measures, and staff satisfaction. Refinement of the pathway with team resolution of variances might continue to improve outcomes. Complex, multi-team procedures can derive benefits from standardization and intraoperative pathway development.
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Affiliation(s)
- Bernard T Lee
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Abstract
PURPOSE OF REVIEW Quality and safety of healthcare depend on team performance. Conflicts decrease team performance. A number of studied factors involved in the development and solution of conflicts are discussed. RECENT FINDINGS An operating team consists of individuals, with specific roles requiring specific expertise and skills, performing interdependent tasks with patient treatment as a common goal. Teams are prone to conflicts: a dispute, disagreement or difference of opinion related to patient management, requiring some decision or action. Many factors determine the character of the conflicts, and these vary between different countries, hospitals and teams. Factors include culture, professional social status, personality of members, etc. Conflicts can induce innovation, but can also result in job dissatisfaction. They even can affect the functioning of the hospital. On average, four conflicts can be observed per operation, which are mostly solved immediately. Communication in an open atmosphere is a major issue in dealing with conflicts. If conflicts are unresolved they grow into relationship conflicts, which are difficult to handle. Understanding the factors that contribute to the conflict is important for mediators. Most conflicts arise about theatre management, case acceptation, unexpected changes in the team or incapability of one of its members. SUMMARY There are many possible inductors of conflicts. Conflicts should be immediately resolved by open communication and respectful discussion.
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Affiliation(s)
- Leo H D J Booij
- Institute for Teaching and Learning in Medicine, Dentistry and Biomedical Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
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