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Teamwork in the operating room - The role of organizational design and implications for patient safety

Rydenfält, Christofer LU (2014) In EAT publications 50.
Abstract (Swedish)
Popular Abstract in Swedish

Teamarbete är en populär arbetsform inom hälso- och sjukvården och teamarbete anses kunna göra sjukvården både effektivare och säkrare. Detta gäller inte minst för arbete med kirurgi på operationssal. På operationssalen möts narkosläkare, narkossjuksköterskor, kirurger, operationssjuksköterskor och undersköterskor i olika konstellationer för att tillsammans behandla patienten, som ett team. Arbetet som operationsteamet utför tillsammans kan beskrivas som komplext, och utfallet beror inte bara på teamet i sig utan även på teamets samspel med sin omgivning så väl som på patientens tillstånd. Det övergripande syftet med den här avhandlingen är att ta fram ny kunskap om hur teamets arbete i... (More)
Popular Abstract in Swedish

Teamarbete är en populär arbetsform inom hälso- och sjukvården och teamarbete anses kunna göra sjukvården både effektivare och säkrare. Detta gäller inte minst för arbete med kirurgi på operationssal. På operationssalen möts narkosläkare, narkossjuksköterskor, kirurger, operationssjuksköterskor och undersköterskor i olika konstellationer för att tillsammans behandla patienten, som ett team. Arbetet som operationsteamet utför tillsammans kan beskrivas som komplext, och utfallet beror inte bara på teamet i sig utan även på teamets samspel med sin omgivning så väl som på patientens tillstånd. Det övergripande syftet med den här avhandlingen är att ta fram ny kunskap om hur teamets arbete i operationssalen går till i praktiken samt att ta fram metoder för hur teamarbete i operationssalar kan förbättras med organisatoriska åtgärder.

Avhandlingen bygger på fem delstudier och de huvudsakliga metoderna som använts för att samla in information i de olika delstudierna är intervjuer och videoobservationer. Bland annat så har videofilmer av det faktiska arbetet på operationsal använts.

Samarbetet på operationsal fungerar oftast bra men kan förbättras. Avhandlingens resultat visar på skillnader i perspektiv på arbetet mellan teammedlemmar med olika yrkesbakgrund, vilket kan leda till olika prioriteringar i arbetet. Detta visar att det finns en förbättringspotential. För att förbättra teamets arbete i operationsalen är det populärt att låta teamet gå kurser i teamarbete och mycket forskning har gjorts på denna typ av träning. I avhandlingen lyfts stabilare personalsammansättning i teamet, tillfällen till kommunikation och ett flexibelt ledarskap fram som organisatoriska principer som kan ge ett bra teamarbete på en operationssal. En handlingsorienterad gruppbaserad metod för organisationsutveckling och innovation testades också. Resultaten visar att metoden fungerade bra på den grupp som deltog i studien och att gruppen lyckades genomföra ett lyckat förändringsprojekt, men att gruppens förankring på sin egen operationsavdelning var dålig. Därför bör man arbeta mer med förankring vid framtida försök med liknande grupper.

Resultaten visar också, i samstämmighet med andra studier, att den praktiska användningen av en populär rutin för att förbättra patientsäkerheten, WHOs checklista för säker kirurgi, inte används som förväntat. Det betyder att man inte kan lita på att checklistan genomförts i sin helhet och det medför också risker i och med att vissa kan ta checklistans genomförande förgivet och anpassa sitt eget handlade därefter. Till exempel genom att rationalisera bort andra rutiner och vanor som checklistan upplevs ha ersatt. Det är vanligt att betrakta kirurgen som ledare i operationssalen, eftersom kirurgen har det medicinska huvudansvaret. Resultaten i den här avhandlingen visar att kirurgen är en av flera som leder arbetet, både operations- och narkossjuksköterskorna utövar också ett ledarskap.

Studierna som denna avhandling bygger på visar att arbete på operationssal inte alltid sker på det sättet som det förväntas. För att kunna förbättra en verksamhet är det viktigt att förstå hur den fungerar. Det innebär att metoder, till exempel observationer, som fångar den faktiska praktiska verksamheten är värdefulla. (Less)
Abstract
The topic of this thesis is teamwork in healthcare. Healthcare is often described as complex. This description is more appropriate now than ever with the extensive specialization that has taken place in recent decades resulting in increasingly specialized physicians and nurses. While this specialization has made it possible to cure even sicker patients, it has also resulted in less overlapping knowledge and thus larger gaps between the different specialties’ areas of expertise. The method prescribed to overcome these challenges is often interprofessional teamwork. It is almost taken for granted that teamwork can make healthcare more efficient and that it is important for patient safety. Surgery in the operating room is an area where this... (More)
The topic of this thesis is teamwork in healthcare. Healthcare is often described as complex. This description is more appropriate now than ever with the extensive specialization that has taken place in recent decades resulting in increasingly specialized physicians and nurses. While this specialization has made it possible to cure even sicker patients, it has also resulted in less overlapping knowledge and thus larger gaps between the different specialties’ areas of expertise. The method prescribed to overcome these challenges is often interprofessional teamwork. It is almost taken for granted that teamwork can make healthcare more efficient and that it is important for patient safety. Surgery in the operating room is an area where this is particularly prevalent. In the operating room anesthesiologists, anesthetist nurses, circulating nurses, scrub nurses and surgeons meet together as a team, in different constellations, to provide surgery for the patient.



This thesis is concerned with the interprofessional team in the operating room, on how team members understand their common work, on how they concretely work together, and on how their practice and teamwork capabilities can be improved through organizational means.



The thesis consists of five studies. The main methods used to collect data are interviews and observations using video. The video observations consisted of surgical procedures and group meetings. Depending on the purpose, the analysis of video data differed from more open exploratory bottom-up methodologies to top-down approaches, such as the usage of predefined observation protocols.



The results indicate that the operating team is not as cohesive as might be assumed and that contradicting rationalities held among team members from different professions can at times result in tension in the team. A complementary alternative to the popular team training approach to improve teamwork is suggested in organizing for teamwork. The three organizational principles of team stability, occasions for communication and an adaptive approach to leadership are identified as important in order to organize for teamwork. As teamwork is associated with patient safety, this can potentially have implications for patient safety as well.



The results also show that a popular routine to improve patient safety, the WHO Surgical Safety Checklist, is not actually used in reality as prescribed in the routine. This can lead to new risks if its correct usage is taken for granted and other behaviors are adapted accordingly. The perceived importance of different Checklist items and the conception of risk among its users should be considered in future efforts to improve Checklist usage. It is also shown that leadership in the operating room is distributed rather than something associated with a specific leader. This challenges traditional leader-centered perspectives on leadership in the operating room.



An action oriented group method to facilitate organizational development and innovation was tested at the operating unit. The results show that the method worked well in the group and that the group managed to initiate a successful change project, but that the group’s anchoring at their organizational unit should be ensured.



The studies in which this thesis is based show that practice in the operating room does not always look as expected. Methodologically, this means that methods that are capable of capturing the actual practice, such as observations, are valuable tools when studying complex healthcare settings, such as work in an operating room. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Elg, Mattias, Department of Management and Engineering, Linköping University, Linköping
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Interprofessional work, Leadership, Observation, Operating room, Organizational design, Patient safety, Teamwork
in
EAT publications
volume
50
pages
164 pages
publisher
Department of Design Sciences, Faculty of Engineering, Lund University
defense location
Stora Hörsalen, IKDC, Sölvegatan 26, Lund University Faculty of Enigneering
defense date
2014-05-09 10:15
ISSN
1650-9773
ISBN
978-91-7473-923-7
978-91-7473-924-4
language
English
LU publication?
yes
id
c8c69d78-42e3-4553-9dec-32edd0d701a9 (old id 4392707)
date added to LUP
2014-04-14 12:22:55
date last changed
2016-09-19 08:44:51
@phdthesis{c8c69d78-42e3-4553-9dec-32edd0d701a9,
  abstract     = {The topic of this thesis is teamwork in healthcare. Healthcare is often described as complex. This description is more appropriate now than ever with the extensive specialization that has taken place in recent decades resulting in increasingly specialized physicians and nurses. While this specialization has made it possible to cure even sicker patients, it has also resulted in less overlapping knowledge and thus larger gaps between the different specialties’ areas of expertise. The method prescribed to overcome these challenges is often interprofessional teamwork. It is almost taken for granted that teamwork can make healthcare more efficient and that it is important for patient safety. Surgery in the operating room is an area where this is particularly prevalent. In the operating room anesthesiologists, anesthetist nurses, circulating nurses, scrub nurses and surgeons meet together as a team, in different constellations, to provide surgery for the patient. <br/><br>
<br/><br>
This thesis is concerned with the interprofessional team in the operating room, on how team members understand their common work, on how they concretely work together, and on how their practice and teamwork capabilities can be improved through organizational means.<br/><br>
<br/><br>
The thesis consists of five studies. The main methods used to collect data are interviews and observations using video. The video observations consisted of surgical procedures and group meetings. Depending on the purpose, the analysis of video data differed from more open exploratory bottom-up methodologies to top-down approaches, such as the usage of predefined observation protocols.<br/><br>
<br/><br>
The results indicate that the operating team is not as cohesive as might be assumed and that contradicting rationalities held among team members from different professions can at times result in tension in the team. A complementary alternative to the popular team training approach to improve teamwork is suggested in organizing for teamwork. The three organizational principles of team stability, occasions for communication and an adaptive approach to leadership are identified as important in order to organize for teamwork. As teamwork is associated with patient safety, this can potentially have implications for patient safety as well.<br/><br>
 <br/><br>
The results also show that a popular routine to improve patient safety, the WHO Surgical Safety Checklist, is not actually used in reality as prescribed in the routine. This can lead to new risks if its correct usage is taken for granted and other behaviors are adapted accordingly. The perceived importance of different Checklist items and the conception of risk among its users should be considered in future efforts to improve Checklist usage. It is also shown that leadership in the operating room is distributed rather than something associated with a specific leader. This challenges traditional leader-centered perspectives on leadership in the operating room. <br/><br>
<br/><br>
An action oriented group method to facilitate organizational development and innovation was tested at the operating unit. The results show that the method worked well in the group and that the group managed to initiate a successful change project, but that the group’s anchoring at their organizational unit should be ensured.<br/><br>
 <br/><br>
The studies in which this thesis is based show that practice in the operating room does not always look as expected. Methodologically, this means that methods that are capable of capturing the actual practice, such as observations, are valuable tools when studying complex healthcare settings, such as work in an operating room.},
  author       = {Rydenfält, Christofer},
  isbn         = {978-91-7473-923-7},
  issn         = {1650-9773},
  keyword      = {Interprofessional work,Leadership,Observation,Operating room,Organizational design,Patient safety,Teamwork},
  language     = {eng},
  pages        = {164},
  publisher    = {Department of Design Sciences, Faculty of Engineering, Lund University},
  school       = {Lund University},
  series       = {EAT publications},
  title        = {Teamwork in the operating room - The role of organizational design and implications for patient safety},
  volume       = {50},
  year         = {2014},
}