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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Research article

Communication and relationship dynamics in surgical teams in the operating room: an ethnographic study

Authors: Birgitte Tørring, Jody Hoffer Gittell, Mogens Laursen, Bodil Steen Rasmussen, Erik Elgaard Sørensen

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

In surgical teams, health professionals are highly interdependent and work under time pressure. It is of particular importance that teamwork is well-functioning in order to achieve quality treatment and patient safety. Relational coordination, defined as “communicating and relating for the purpose of task integration,” has been found to contribute to quality treatment and patient safety. Relational coordination has also been found to contribute to psychological safety and the ability to learn from mistakes. Although extensive research has been carried out regarding relational coordination in many contexts including surgery, no study has explored how relational coordination works at the micro level. The purpose of this study was to explore communication and relationship dynamics in interdisciplinary surgical teams at the micro level in contexts of variable complexity using the theory of relational coordination.

Methods

An ethnographic study was conducted involving participant observations of 39 surgical teams and 15 semi-structured interviews during a 10-month period in 2014 in 2 orthopedic operating units in a university hospital in Denmark. A deductively directed content analysis was carried out based on the theory of relational coordination.

Results

Four different types of collaboration in interdisciplinary surgical teams in contexts of variable complexity were identified representing different communication and relationship patterns: 1) proactive and intuitive communication, 2) silent and ordinary communication, 3) inattentive and ambiguous communication, 4) contradictory and highly dynamic communication. The findings suggest a connection between communication and relationship dynamics in surgical teams and the level of complexity of the surgical procedures performed.

Conclusion

The findings complement previous research on interdisciplinary teamwork in surgical teams and contribute to the theory of relational coordination. The findings offer a new typology of teams that goes beyond weak or strong relational coordination to capture four distinct patterns of relational coordination. In particular, the study highlights the central role of mutual respect and presents proposals for improving relational coordination in surgical teams.
Literature
1.
Lingard L, Espin S, Whyte S, et al. Communication failures in the operating room: an observational classification of recurrent types and effects. JQual Saf Health Care. 2004;13:330–4.CrossRef
2.
Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ. 2000;320(7237):745–9.CrossRef
3.
Mitchell L, Flin R, Yule S, Mitchell J, Coutts K, Youngston G. Thinking ahead of the surgeon. An interview to identify scrub nurses´ non-technical skills. Int J Nurs Stud. 2011;48(7):818–28.CrossRef
4.
Gittell JH, Fairfield KM, Bierbaum B, Head W, Jackson R, Kelly M, et al. Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: a nine-hospital study of surgical patients. Med Care. 2000;38(8):808–19.CrossRef
5.
Fletcher GCL, McGeorge P, Flin RH, Glavin RJ, Maran NJ. The role of non-technical skills in anaesthesia: a review of current literature. Br J Anaesth. 2002;88(3):418–29.CrossRef
6.
Yule S, Flin R, Paterson-Brown F, Maran A. Non-technical skills for surgeon in the operating room: a review of the literature. Surgery. 2006;139(2):140–9.CrossRef
7.
Mitchell L, Flin R. Non-technical skills of the operating theatre scrub nurse: literature review. J Adv Nurs. 2008;63(1):15–24.CrossRef
8.
Yule S, Flin R, Maran N, Rowley D, Youngston G. Surgeons’ non-technical skills in the operating room: reliability testing of the NOTSS behavior rating system. World J Surg. 2008;32(4):548–56.CrossRef
9.
Lyk-Jensen HT, Jepsen RMHG, Spanager L, Dieckmann P, Østergaard D. Assessing nurse Anaesthetists´ non-technical skills in the operating room. Acta Anaesthesiol Scand. 2014;58:794–801.CrossRef
10.
Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R. Rating non-technical skills: developing a behavioural marker system for use in anaesthesia. Cogn Tech Work. 2004;6:165–71.CrossRef
11.
Flin R, Patey R. Non-technical skills for anaesthetists: developing and applying ANTS. Best Pract Res Clin Anaesthesiol. 2011;25:215–27.CrossRef
12.
Awad SS, Fagan SP, Bellows C, Albo D, Green-Rashad B, De la Garza M, et al. Bridging the communication gap in the operating room with medical team training. Am J Surg. 2005;190:770–4.CrossRef
13.
Østergaard D, Dieckmann P, Lippert A. Simulation and CRM. Best Pract Res Clin Anaesthesiol. 2011;25:239–49.CrossRef
14.
Forse R, Bramble D, McQuillan R. Team training can improve operating room performance. Surgery. 2011;150(4):771–8.CrossRef
15.
Courtright S, Stewart GL, Ward M. Applying research to save lives: learning form team training approaches in aviation and health care. Organ Dyn. 2012;41(4):291–301.CrossRef
16.
Sørensen EE, Olsen IØ, Tewes M, Uhrenfeldt L. Perioperative nursing in public university hospitals: An ethnography. BMC Nurs. 2014;13:45.CrossRef
17.
Cannon-Bowers JA, Salas E, Converse S. Shared mental models in expert team decision making. In: Castellan NJ, Hillsdale NJ, Lawrence E, editors. Individual and group decision making: current issues. New York: Psychology Press; 2009.
18.
Burtscher MJ, Manser T. Team mental models and their potential to improve teamwork and safety: a review and implications for future research in healthcare. Saf Sci. 2012;50(5):1344–54.CrossRef
19.
Bogdanovic J, Perry J, Guggenheim M, Manser T. Adaptive coordination in surgical teams: an interview study. BMC Health Serv Res. 2015;15:128.CrossRef
20.
Sørensen EE. Bag masker og lukkede døre. En etnografisk undersøgelse af operationsassisterende funktioner i dansk hospitalsvæsen, [Behind masks and closed doors], 2011. ISBN: 978-87-90880-36-1.
21.
Leach L, Myrtle R, Dasu S. Assessing the performance of surgical teams. Health Care Manag Rev. 2009;34(1):29–41.CrossRef
22.
Gillespie B, Chaboyer W, Fairweather N. Interruptions and miscommunications in surgery: an observational study. AORN J. 2012;95(5):576–90.CrossRef
23.
Kurmann A, Tschan F, Semmer NK, Seelandt J, Candinas D. Human factors in the operating room – the surgeons view. Trends Anaesthesia Crit Care. 2012;2(5):24–7.CrossRef
24.
Gittell JH. Relationships between service providers and their impact on customers. J Serv Res. 2002;4(4):299–311.CrossRef
25.
Gittell JH. High performance healthcare. Using the power of relationships to achieve quality, efficiency, and resilience. New York: McGraw-Hill; 2009.
26.
Carmeli A, Gittell JH. High-quality relationship, psychological safety, and learning from failures in organizations. J Organ Behav. 2009;30(6):709–29.CrossRef
27.
28.
Havens D, Vasey J, Gittell JH. Relational coordination among nurses and other providers: impact on the quality of patient care. J Nurs Manag. 2010;18:926–37.CrossRef
29.
Hammersley M, Atkinson P. Ethnography. Principles in practice. 3rd ed. London: Routledge; 2007.CrossRef
30.
Spradley JP. Participant observation. Belmont: Wadsworth; 1980.
31.
Emerson RM, Fretz RI, Shaw LL. Writing ethnographic Fieldnotes. 2nd ed. Chicago: The University of Chicago Press; 2011.CrossRef
32.
Spradley JP. The ethnographic interview. Belmont: Wadsworth; 1979.
33.
Bryman A. Social research methods. 4th ed. Oxford: Oxford University Press; 2012.
34.
Hsieh H, Shannon S. Three approaches to qualitative content analysis. Qual Health Res. 2015;15(9):1277–88.CrossRef
35.
Høyer K. Hvad er teori, og hvordan forholder teori sig til metode? [what is theory and how does theory relate to method?]. In Vallgårda S, Koch L (Eds.), Forskningsmetoder i folkesundhedsvidenskab [research methods in public health science], 4. Udgave. København: Munksgaard; 2015.
36.
Gittell JH. New directions for relational coordination theory. In: Cameron KS, Spreitzer G, editors. The Oxford Handbook of Positive Organizational Scholarship. New York: Oxford University Press; 2012. p. 400–11.
37.
Tavory I, Timmermans S. Abductive analysis. Theorizing qualitative research. Chicago: The University of Chicago Press; 2014.CrossRef
38.
Vincent C, Moorthy K, Sarker SK, Chang A, Darzi AW. Systems approaches to surgical quality and safety from concept to measurement. Ann Surg. 2004;239(4):475–82.CrossRef
39.
Lyk-Jensen HT, Dieckmann P, Konge L, Jepsen R, Spanager L, Østergaard D. Using a structured assessment tool to evaluate nontechnical skills of nurse anesthetists. AANA J. 2016;84(2):122–27.
40.
Passauer-Baierl S, Hull L, Miskovic D, Russ S, Sevdalis N, Weigl M. Re-validating the observational teamwork assessment for surgery tool (OTAS-D): cultural adaptation, refinement, and psychometric evaluation. World J Surg. 2014;38(2):305–13.CrossRef
41.
Russ S, Hull L, Rout S, Vincent C, Darzi A, Sevdalis N. Observational teamwork assessment for surgery: feasibility of clinical and nonclinical assessor calibration with short-term training. Ann Surg. 2012;255(4):804–9.CrossRef
42.
Nawaz H, Edmondson AC, Tzeng TH, Saleh JK, Bozic KJ, Saleh KJ. Teaming: an approach to the growing complexities in health care. J Bone Joint Surg. 2014;96(21):e184.CrossRef
43.
Kurmann A, Keller S, Tschan-Semmer F, Seelandt J, Semmer NK, Candinas D, et al. Impact of team familiarity in the operating room on surgical complications. World J Surg. 2014;38(12):3047–52.CrossRef
44.
Edmondson A. Teaming: how organizations learn, innovate, and compete in the knowledge economy: Harvard Business School. San Fransisco: Jossey-Bass; 2012.
45.
Edmondson A. The fearless organization, Harvard business school. Hoboken: Wiley; 2019.
46.
Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, Healy GB. Perspective: a culture of respect, part 1: the nature and causes of disrespectful behavior by physicians. Acad Med. 2012;87(7):845–52.CrossRef
47.
Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, Healy GB. Perspective: a culture of respect, part 2: creating a culture of respect. Acad Med. 2012;87(7):853–8.CrossRef
48.
Kaldheim HKA, Slettebø Å. Respecting as a basic teamwork process in the operating theatre - a qualitative study of theatre nurses who work in interdisciplinary surgical teams of what they see as important factors in this collaboration. Nordisk Sygeplejeforskning. 2016;6(1):49–64.CrossRef
49.
Flyvbjerg B. Five misunderstandings about case-study research. Qual Inq. 2006;12(2):219–245.CrossRef
50.
Flyvbjerg B. Making social science matter: why social inquiry fails and how it can succeed again. Cambridge: Cambridge University Press; 2001.CrossRef
51.
Delmar C. “Generalizability” as recognition: reflections on a foundational problem in qualitative research. Qual Stud. 2010;1(2):115–28.CrossRef
52.
Tørring B. Transforming communication and relationships in interdisciplinary surgical teams: a mixed methods study. [dissertation]. Aalborg: Aalborg University; 2018.
53.
SSN (Sykepleiernes Samarbeid i Norden). ´Etiske retningslinjer for sygeplejeforskning i Norden´ [NNF, The Northern Nurses´ Federation] ´Ethical guidelines for nursing research in the Nordic countries´. Denmark: DSR; 2003.
Metadata
Title
Communication and relationship dynamics in surgical teams in the operating room: an ethnographic study
Authors
Birgitte Tørring
Jody Hoffer Gittell
Mogens Laursen
Bodil Steen Rasmussen
Erik Elgaard Sørensen
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4362-0

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