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BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

Adaptive coordination in surgical teams: an interview study

Authors: Jasmina Bogdanovic, Juliana Perry, Merlin Guggenheim, Tanja Manser

Published in: BMC Health Services Research | Issue 1/2015

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Abstract

Background

Effective teamwork has been recognised as a major contributor to safe patient care in surgery. Previous research has highlighted the importance of adaptive coordination for effective performance in acute care settings. Expanding this line of research this study explores the coordination behaviours and adaptive coordination strategies employed by surgical teams and identifies relevant situational characteristics influencing those coordination processes.

Method

We conducted a qualitative content analysis of semi-structured interviews with 33 surgical team members (nurses and physicians) from different specialties and hospitals.

Results

We identified coordination behaviours (i.e. task management, information management, teaching and leadership) and adaptive coordination strategies triggered by varying requirements due to non-routine events, intraoperative complications and differing level of experience among operating room staff. Interviewees highlighted the importance of effectively managing challenging moments and the supporting effect of positive climate on teamwork.

Conclusions

This study complements previous research on the non-technical skills underpinning safe performance in surgical teams. It highlights the central role of coordination and points out the ways in which situational variability requires the team to behave adaptively.
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Literature
1.
2.
Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand. 2009;53(2):143–51.CrossRefPubMed
3.
Catchpole K, Mishra A, Handa A, McCulloch P. Teamwork and error in the operating room: analysis of skills and roles. Ann Surg. 2008;247(4):699–706.CrossRefPubMed
4.
Catchpole KR, Giddings AE, Wilkinson M, Hirst G, Dale T, de Leval MR. Improving patient safety by identifying latent failures in successful operations. Surgery. 2007;142(1):102–10.CrossRefPubMed
5.
Greenberg CC, Regenbogen SE, Studdert DM, Lipsitz SR, Rogers SO, Zinner MJ, et al. Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg. 2007;204(4):533–40.CrossRefPubMed
6.
Gawande AA, Studdert DM, Orav EJ, Brennan TA, Zinner MJ. Risk factors for retained instruments and sponges after surgery. N Engl J Med. 2003;348(3):229–35.CrossRefPubMed
7.
Flin RH, Mitchell L. Safer surgery: analysing behaviour in the operating Theatre. Farnham: Ashgate; 2009.
8.
Healey AN, Undre S, Sevdalis N, Koutantji M, Vincent CA. The complexity of measuring interprofessional teamwork in the operating theatre. J Interprof Care. 2006;20(5):485–95.CrossRefPubMed
9.
Schmutz J, Manser T. Do team processes really have an effect on clinical performance? A systematic literature review. Br J Anaesth. 2013;110(4):529–44.CrossRefPubMed
10.
Hull L, Arora S, Aggarwal R, Darzi A, Vincent C, Sevdalis N. The impact of nontechnical skills on technical performance in surgery: a systematic review. J Am Coll Surg. 2012;214(2):214–30.CrossRefPubMed
11.
Undre S, Sevdalis N, Healey A, Darzi A, Vincent C. Observational teamwork assessment for surgery: refinement and application in urological surgery. World journal of surgery. 2007;31(7):1373–81.CrossRefPubMed
12.
Flin RH, O‘Connor P, Crichton M. Safety at the sharp end: a guide to non-technical skills. Aldershot: Ashgate. 2008.
13.
Flanagan JC. The critical incident technique. Psychol Bull. 1954;51:27–358.CrossRef
14.
Entin EE, Serfaty D. Adaptive team coordination. Hum Factors. 1999;41(2):312–25.CrossRef
15.
Manser T, Howard SK, Gaba DM. Adaptive coordination in cardiac anaesthesia: a study of situational changes in coordination patterns using a new observation system. Ergonomics. 2008;51(8):1153–78.CrossRefPubMed
16.
Manser T, Howard SK, Gaba DM. Identifying characteristics of effective teamwork in complex medical work environments: Adaptive crew coordination in anaesthesia. In: Flin R, Mitchell L, editors. Safer Surgery: Analysing Behaviour in the Operating Theatre. edn. Farnham, Surrey: Ashgate; 2009. p. 223–39.
17.
Cannon-Bowers JA, Tannenbaum S, Salas E, CE V. Defining competencies and establishing team training requirements. In: Guzzo R, Salas E, editors. Team effectiveness and decision making in organizations. San Francisco: Jossey-Bass; 1995. p. 333–80.
18.
Burtscher MJ, Manser T, Kolbe M, Grote G, Grande B, Spahn DR, et al. Adaptation in anaesthesia team coordination in response to a simulated critical event and its relationship to clinical performance. Br J Anaesth. 2011;106(6):801–6.CrossRefPubMed
19.
Grote G, Kolbe M, Zala-Mezo E, Bienefeld-Seall N, Kunzle B. Adaptive coordination and heedfulness make better cockpit crews. Ergonomics. 2010;53(2):211–28.CrossRefPubMed
20.
Burtscher MJ, Wacker J, Grote G, Manser T. Managing nonroutine events in Anesthesia: The role of adaptive coordination. Hum Factors. 2010;52(2):282–94.CrossRefPubMed
21.
Manser T, Harrison TK, Gaba DM, Howard SK. Coordination patterns related to high clinical performance in a simulated anesthetic crisis. Anesth Analg. 2009;108(5):1606–15.CrossRefPubMed
22.
Denscombe M. The Good Research Guide: for small-scale social research projects. Berkshire: McGraw-Hill Education; 2010.
23.
24.
Mitchell L, Flin R, Yule S, Mitchell J, Coutts K, Youngson G. Thinking ahead of the surgeon. An interview study to identify scrub nurses‘ non-technical skills. Int J Nurs Studies. 2011;48(7):818–28.CrossRef
25.
Yule S, Flin R, Paterson-Brown S, Maran N, Rowley D. Development of a rating system for surgeons’ non-technical skills. Med Educ. 2006;40(11):1098–104.CrossRefPubMed
26.
Strauss AL, Corbin JM. Basics of qualitative research: grounded theory procedures and techniques. Thousand Oaks: Sage; 1990.
27.
Mayring P. Qualitative Inhaltsanalyse: Grundlagen und Techniken. Weinheim, Basel: Beltz; 2008.
28.
MAXQDA [computer program]. In., 10 edn: VERBI Software. Berlin: Consult. GmbH.; 2010.
29.
Fleiss JL, Levin B, Paik MC. Statistical Methods for Rates and Proportions. New Jersey: Wiley; 2004.
30.
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. 1993.
31.
Burtscher MJ, Manser T. Team mental models and their potential to improve teamwork and safety: a review and implications for future research in healthcare. Safety Sci. 2012;50(5):1344–54.CrossRef
32.
Endsley MR. Toward a theory of situation awareness in dynamic systems. Hum Factors. 1995;37(1):32–64.CrossRef
33.
Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a Global population. N Engl J Med. 2009;360(5):491–9.CrossRefPubMed
34.
Kolbe M, Künzle B, Zala-Mezö E, Burtscher MJ, Wacker J, Spahn DR, et al. The functions of team monitoring and ‘talking to the room” for performance in anesthesia teams. In: HFES Proc. 2010.
35.
Parker SH, Yule S, Flin R, McKinley A. Surgeons‘ leadership in the operating room: an observational study. Am J Surg. 2012;204(3):347–54.CrossRefPubMed
36.
Edmondson AC. Speaking up in the operating room: How team leaders promote learning in interdisciplinary action teams. J Manage Stud. 2003;40(6):1419–52.CrossRef
37.
Klein GA. Sources of Power: How People Make Decisions. Massachusetts: MIT Press; 1998.
38.
Wittenbaum GM, Stasser G, SI V. Coordination in task-performing groups. In: Tindale RS et al., editors. Theory and research on small groups. New York: Plenum; 1998.
39.
Boos M, Kolbe M, Strack M. An inclusive model of group coordination. In: Boos M et al., editors. Coordination in human and primate groups. Berlin: Springer; 2011.CrossRef
40.
Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al. Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention. BMJ Qual Safety. 2011;20(1):102–7.CrossRef
41.
Lingard L, Regehr G, Orser B, Reznick R, Baker GR, Doran D, et al. Evaluation of a preoperative checklist and team briefing among Surgeons, Nurses, and Anesthesiologists to reduce failures in communication. Arch Surg. 2008;143(1):12–7.CrossRefPubMed
42.
Cristancho SM, Vanstone M, Lingard L, LeBel ME, Ott M. When surgeons face intraoperative challenges: a naturalistic model of surgical decision making. Am J Surg. 2013;205(2):156–62.CrossRefPubMed
43.
Moulton CA, Regehr G, Lingard L, Merritt C, MacRae H. ‘Slowing down when you should’: Initiators and Influences of the transition from the routine to the effortful. J Gastrointest Surg. 2010;14:1019–26.CrossRefPubMed
44.
Moulton CA, Regehr G, Lingard L, Merritt C, MacRae H. Slowing down to stay out of trouble in the operating room: remaining attentive in automaticity. Acad Med J Assoc American Med Colleges. 2010;85(10):1571–7.CrossRef
45.
Xiao Y, Seagull FJ, Mackenzie C, Klein K. Adaptive leadership in trauma resuscitation teams: a grounded theory approach to video analysis. Cogn Tech Work. 2004;6(3):158–64.
46.
Yun S, Faraj S, Xiao Y, Sims Jr HP. Team leadership and coordination in trauma resuscitation. In: Beyerlein MM et al., editors. Team-based organizing. Oxford: Elsevier; 2003.
47.
Yun S, Faraj S, Sims Jr HP. Contingent leadership and effectiveness of trauma resuscitation teams. J Appl Psychol. 2005;90(6):1288–96.CrossRefPubMed
48.
Moulton CA, Regehr G, Lingard L, Merritt C, Macrae H. Operating from the other side of the table: control dynamics and the surgeon educator. J Am Coll Surg. 2010;210(1):79–86.CrossRefPubMed
49.
Mishra A, Catchpole K, McCulloch P. The Oxford NOTECHS system: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre. Qual Saf Health Care. 2009;18(2):104–8.CrossRefPubMed
50.
Mitchell L, Flin R, Yule S, Mitchell J, Coutts K, Youngson G. Development of a behavioural marker system for scrub practitioners‟ non-technical skills (SPLINTS system). J Eval Clin Pract. 2013;19:317–23.CrossRefPubMed
Metadata
Title
Adaptive coordination in surgical teams: an interview study
Authors
Jasmina Bogdanovic
Juliana Perry
Merlin Guggenheim
Tanja Manser
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0792-5

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