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A Study of a Hospital Operating Unit as a Foundation for Future Improvements

Rydenfält, Christofer LU (2011)
Abstract (Swedish)
Popular Abstract in Swedish

Det huvudsakliga syftet med den presenterade forskningen var att bygga en förståelse för hur dynamiken mellan professioner, verktyg och objekt fungerar på en operationsavdelning, som ett led i framtagandet av kunskap användbar vid design av framtidens operationsavdelning med fokus på arbetsmiljö, effektivitet och patient säkerhet. Igenom att undersöka hur olika professioner i operationssalen ser på sitt arbete och dess dynamik samt igenom att observera hur arbetet faktiskt utförs, är det möjligt att få en förståelse för den dynamik och de motiv som bestämmer hur arbetet konstitueras. Forskningen undersöker hur olika professioner ser på sitt arbete i en intervjustudie och hur arbetet faktiskt... (More)
Popular Abstract in Swedish

Det huvudsakliga syftet med den presenterade forskningen var att bygga en förståelse för hur dynamiken mellan professioner, verktyg och objekt fungerar på en operationsavdelning, som ett led i framtagandet av kunskap användbar vid design av framtidens operationsavdelning med fokus på arbetsmiljö, effektivitet och patient säkerhet. Igenom att undersöka hur olika professioner i operationssalen ser på sitt arbete och dess dynamik samt igenom att observera hur arbetet faktiskt utförs, är det möjligt att få en förståelse för den dynamik och de motiv som bestämmer hur arbetet konstitueras. Forskningen undersöker hur olika professioner ser på sitt arbete i en intervjustudie och hur arbetet faktiskt utförs i praktiken med direkt observation. Tillsammans utgör resultaten två olika perspektiv på arbetet i operationssal.

I båda studierna spelar de studerade yrkesutövarnas perspektiv en viktig roll. Hur något uppfattas påverkar hur vi väljer att agera. För att öka potentialen för förbättring behöver dessa perspektiv vidgas. Därigenom kommer praktiken att te sig mer komplex för yrkesutövarna, det kommer att vara fler aspekter att ta hänsyn till. Fler dilemman och valmöjligheter kommer att vara synliga. För att förbättra de yrkesutövandes förmåga att hantera den ökade komplexiteten, identifieras förtroende som ett viktigt verktyg. Förtroende är en mekanism som tillfälligt kan upphäva det tvivel som en ökad komplexitet för med sig, och på så sätt göra det möjligt att ta effektiva beslut även när antalet alternativ är för stort för att hantera uttömmande.

Tidigare forskning visar på att operationslag inte är så sammanhängande som det kan förväntas och att det ofta uppstår kommunikationsproblem i operationssalen. Den första studien presenterad i denna avhandling undersöker hur det kan bli så. Den undersöker hur olika professioner i operationslaget orienterar sig själva i relation till sin uppgift och hur denna orientering kan påverkas av den organisatoriska och sociala kontexten. En semistrukturerad intervju genomfördes med 15 deltagare rekryterade ifrån alla personalkategorier i operationslaget. I intervjun användes en virtuell modell av en operationssal som diskussionsunderlag. Verksamhetsteori användes som ett teoretiskt ramverk för att analysera intervjuerna. Resultaten pekar på att dålig team funktionalitet till viss del kan förklaras av olika verksamhetsorientering mellan professioner, vilket leder till olika syn på aktiviteter i arbetet och därmed till spänningar mellan olika professioner. Sociala och organisatoriska stödstrukturer pekas ut som medel för att skapa förtroende och ökat utbyte av erfarenheter mellan professioner. Detta kan i sin tur stödja upprättandet av en gemensam syn på arbetet över professionsgränserna i operationslaget och öka den interprofessionella kommunikationen och därigenom överkomma kommunikationströsklar i operationssalen.

För att förbättra patientsäkerheten i operationssalen har checklistor vunnit ansenligt stöd de senaste åren. Ofta i form av en timeout som genomförs innan operationen startar. Världshälsoorganisationen (WHO) har utvecklat sin egen timeout checklista och denna har implementerats på flera svenska operationsavdelningar. Tidigare forskning indikerar att timeout checklistor minskar komplikationerna vid kirurgiska ingrepp och till och med kan förbättra operationslagets säkerhetsattityd. Effekterna av checklistan har med andra ord studerats men lite forskning har gjorts på hur checklistan faktiskt används i praktiken. Detta undersöks i den andra studien inkluderad i denna avhandling för att skaffa en uppfattning om hur operationslaget använder sig av och relaterar till checklistan samt att förklara eventuella avvikelser från den. Tjugofyra timeouter från fyra olika, men vanliga, kirurgiska ingrepp, videofilmades och analyserades enligt ett fördefinierat protokoll baserat på instruktionerna för WHO:s timeout checklista. Resultaten visar på att överensstämmelsen varierade mellan de olika frågorna. De frågor som hade bäst överensstämmelse verkade vara de som uppfattades som mest viktiga av deltagarna. I hälften av fallen genomfördes ingen personlig presentation av deltagarna och i fem av de fall som där presentation genomfördes sköts den fram till senare i timeouten. Detta tyder på att dessa frågor, med syftet att underlätta kommunikation mellan medlemmarna i operationslaget, inte uppfattas som bidragande till patientens säkerhet på något meningsfullt sätt. Resultaten visade också på att anestesiologi personalen och kirurgen i stort dominerade timeouten. Det är troligt att de positiva effekterna på patientsäkerheten associerade med timeout checklistan kan förbättras ytterligare om kopplingen mellan checklista, samarbete och kommunikation görs tydligare och mer explicit samt genom att checklistan förändras så att de olika professionerna i operationslaget blir mer jämlikt involverade. (Less)
Abstract
The main objective of the research presented was to gain an understanding of how the dynamics between professionals, tools and objectives work in an operating unit in order to obtain knowledge useful when designing the operating unit of the future with emphasis on the work environment, effectiveness and patient safety. By investigating how different professions in the operating theatre view their work and its dynamics, as well as observing how the work is actually carried out, it is possible to get a conception of the dynamics and motives that determine how the work is constituted. This research explores how different professions view their work by means of an interview study, and how the work is carried out in practice by means of a... (More)
The main objective of the research presented was to gain an understanding of how the dynamics between professionals, tools and objectives work in an operating unit in order to obtain knowledge useful when designing the operating unit of the future with emphasis on the work environment, effectiveness and patient safety. By investigating how different professions in the operating theatre view their work and its dynamics, as well as observing how the work is actually carried out, it is possible to get a conception of the dynamics and motives that determine how the work is constituted. This research explores how different professions view their work by means of an interview study, and how the work is carried out in practice by means of a direct observation study. Together, the results of the studies provide two different perspectives on operating theatre work.

In both studies, the perspectives of the professionals play an important role. How something is perceived influences how we decide to act. To increase the potential for improvement, widening those perspectives plays a central role. By doing so, the practice will in turn appear more complex to the practitioners; there will be more aspects to take into consideration. More contradictions and options will be visible. To improve the practitioners’ capability to handle this increased complexity, trust is identified as an important tool. Trust is a mechanism that can suspend doubt or complexity in such a way that it is possible to make effective decisions even when the number of options is too large to handle.

Previous research indicates that surgical teams are not as cohesive as could be expected and that communication failures frequently occur in the operating theatre. The first study presented in this thesis elaborates on how this can come about. It investigates how different healthcare professions in the surgical team orientate themselves towards their task and how this can be affected by the organizational and social context. Virtual reality supported semi-structured interviews were conducted with 15 participants recruited from all personnel categories of the surgical team. Activity theory was used as a theoretical framework to analyze the interviews. The results indicated that poor team functionality to some degree can be explained by different activity orientations between professions, which leads to different views on work activities and tension between them. Social and organizational support structures in the daily practice are pointed out as a means to facilitate trust and experience sharing between professions. This can promote the establishment of a common view among different professionals in the operating team and increase interprofessional communication, hence overcoming communication thresholds in the operating theatre.

To improve safety in the operating theatre, checklists have gained considerable support in recent years, often in the form of a pre-operative timeout. The World Health Organization (WHO) has developed its own timeout checklist, which has been adopted by several Swedish operating units. Previous research indicates that timeout checklists reduce complications from surgery and can even improve the safety attitude of the team members. Thus, the effects of the checklist have been studied, but little research has been carried out on how the checklist is actually used in practice. This is investigated in the second study included in this thesis to determine how the surgical team uses and relates to the checklist as well as to identify and explain deviations from it. Twenty-four timeout procedures of four different, but common, operations were video recorded and analyzed according to a predefined protocol based on the WHO checklist instructions. The results showed that compliance varied between questions. The questions with the best compliance appeared to be the ones that made the most sense and were perceived as the most important by the participants. In half of the observed procedures, personal presentations did not occur and in five of those cases, they were postponed. This indicates that these questions, intended to facilitate communication between team members, were not perceived as contributing to patient safety in any meaningful way. The results also showed that surgeons and anesthesiology personnel dominated much of the timeout. It is likely that the positive effects on patient safety attributed to the checklist can be improved by making the connection between the checklist, communication and teamwork more explicit and by altering the checklist so that the different professions more equally involved. (Less)
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author
supervisor
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Ergonomics Healthcare Operating units Organizational design Work environment Patient Safety
pages
78 pages
publisher
Lund University - Design Sciences - Ergonomics and Aerosol Technology
ISBN
978-91-7473-132-3
language
English
LU publication?
yes
id
b0863580-4e84-4a67-b2b1-5e0c6d0d2086 (old id 2223637)
date added to LUP
2011-12-06 14:56:32
date last changed
2016-09-19 08:45:06
@misc{b0863580-4e84-4a67-b2b1-5e0c6d0d2086,
  abstract     = {The main objective of the research presented was to gain an understanding of how the dynamics between professionals, tools and objectives work in an operating unit in order to obtain knowledge useful when designing the operating unit of the future with emphasis on the work environment, effectiveness and patient safety. By investigating how different professions in the operating theatre view their work and its dynamics, as well as observing how the work is actually carried out, it is possible to get a conception of the dynamics and motives that determine how the work is constituted. This research explores how different professions view their work by means of an interview study, and how the work is carried out in practice by means of a direct observation study. Together, the results of the studies provide two different perspectives on operating theatre work. <br/><br>
In both studies, the perspectives of the professionals play an important role. How something is perceived influences how we decide to act. To increase the potential for improvement, widening those perspectives plays a central role. By doing so, the practice will in turn appear more complex to the practitioners; there will be more aspects to take into consideration. More contradictions and options will be visible. To improve the practitioners’ capability to handle this increased complexity, trust is identified as an important tool. Trust is a mechanism that can suspend doubt or complexity in such a way that it is possible to make effective decisions even when the number of options is too large to handle. <br/><br>
Previous research indicates that surgical teams are not as cohesive as could be expected and that communication failures frequently occur in the operating theatre. The first study presented in this thesis elaborates on how this can come about. It investigates how different healthcare professions in the surgical team orientate themselves towards their task and how this can be affected by the organizational and social context. Virtual reality supported semi-structured interviews were conducted with 15 participants recruited from all personnel categories of the surgical team. Activity theory was used as a theoretical framework to analyze the interviews. The results indicated that poor team functionality to some degree can be explained by different activity orientations between professions, which leads to different views on work activities and tension between them. Social and organizational support structures in the daily practice are pointed out as a means to facilitate trust and experience sharing between professions. This can promote the establishment of a common view among different professionals in the operating team and increase interprofessional communication, hence overcoming communication thresholds in the operating theatre.<br/><br>
To improve safety in the operating theatre, checklists have gained considerable support in recent years, often in the form of a pre-operative timeout. The World Health Organization (WHO) has developed its own timeout checklist, which has been adopted by several Swedish operating units. Previous research indicates that timeout checklists reduce complications from surgery and can even improve the safety attitude of the team members. Thus, the effects of the checklist have been studied, but little research has been carried out on how the checklist is actually used in practice. This is investigated in the second study included in this thesis to determine how the surgical team uses and relates to the checklist as well as to identify and explain deviations from it. Twenty-four timeout procedures of four different, but common, operations were video recorded and analyzed according to a predefined protocol based on the WHO checklist instructions. The results showed that compliance varied between questions. The questions with the best compliance appeared to be the ones that made the most sense and were perceived as the most important by the participants. In half of the observed procedures, personal presentations did not occur and in five of those cases, they were postponed. This indicates that these questions, intended to facilitate communication between team members, were not perceived as contributing to patient safety in any meaningful way. The results also showed that surgeons and anesthesiology personnel dominated much of the timeout. It is likely that the positive effects on patient safety attributed to the checklist can be improved by making the connection between the checklist, communication and teamwork more explicit and by altering the checklist so that the different professions more equally involved.},
  author       = {Rydenfält, Christofer},
  isbn         = {978-91-7473-132-3},
  keyword      = {Ergonomics
Healthcare
Operating units
Organizational design
Work environment
Patient Safety},
  language     = {eng},
  pages        = {78},
  publisher    = {ARRAY(0xad2c9f0)},
  title        = {A Study of a Hospital Operating Unit as a Foundation for Future Improvements},
  year         = {2011},
}