Exploring varieties of knowledge in safe work practices - an ethnographic study of surgical teams

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Abstract

Background

Within existing research in health and medicine, the nature of knowledge on how teams conduct safe work practices has yet to be properly explored.

Methods

We address this concern by exploring the varieties in which knowledge is expressed during interdisciplinary surgical operations. Specifically, the study was conducted in a surgical section of a Norwegian regional general hospital, between January and April of 2010, by means of an ethnographic design combining detailed non-participant observations, conversations and semi-structured interviews.

Results

Based on an analysis of the gathered data, we identify three particular themes in how knowledge is expressed by operating room personnel: (i) the ability and variety individuals demonstrate in handling multiple sources of information, before reaching a particular decision, (ii) the variety of ways awareness or anticipation of future events is expressed, and (iii) the different ways sudden and unexpected situations are handled by the individual team members.

Conclusions

We conclude that these facets of knowledge bring different insights into how safe work practices are achieved at an individual and team level in surgical operations, thus adding to the existing understanding of the nature of knowledge in safe work practices in surgical operations. Future research should focus on exploring and documenting the relationships between various elements of knowledge and safe work practices, in different surgical settings and countries.

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Most cited references 29

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Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project.

John C Morey, Robert A. Simon, Gregory Jay … (2002)

To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. Nine teaching and community hospital EDs. A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination Course (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions. Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level. A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training (p = .012). Subjective workload was not affected by the intervention (p = .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group (p = .039). In the experimental group, the ED staffs' attitudes toward teamwork increased (p = .047) and staff assessments of institutional support showed a significant increase (p = .040). Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals.

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Does team training improve team performance? A meta-analysis.

Kevin C Stagl, Deborah DiazGranados, Elizabeth S. Halpin … (2008)

This research effort leveraged the science of training to guide a taxonomic integration and a series of meta-analyses to gauge the effectiveness and boundary conditions of team training interventions for enhancing team outcomes. Disparate effect sizes across primary studies have made it difficult to determine the true strength of the relationships between team training techniques and team outcomes. Several meta-analytic integrations were conducted to examine the relationships between team training interventions and team functioning. Specifically, we assessed the relative effectiveness of these interventions on team cognitive, affective, process, and performance outcomes. Training content, team membership stability, and team size were investigated as potential moderators of the relationship between team training and outcomes. In total, the database consisted of 93 effect sizes representing 2650 teams. The results suggested that moderate, positive relationships exist between team training interventions and each of the outcome types. The findings of moderator analyses indicated that training content, team membership stability, and team size moderate the effectiveness of these interventions. Our findings suggest that team training interventions are a viable approach organizations can take in order to enhance team outcomes. They are useful for improving cognitive outcomes, affective outcomes, teamwork processes, and performance outcomes. Moreover, results suggest that training content, team membership stability, and team size moderate the effectiveness of team training interventions. Applications of the results from this research are numerous. Those who design and administer training can benefit from these findings in order to improve the effectiveness of their team training interventions.

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Effect of a 19-item surgical safety checklist during urgent operations in a global patient population.

Thomas G. Weiser, Alex Haynes, Gerald Dziekan … (2010)

To assess whether implementation of a 19-item World Health Organization (WHO) Surgical Safety Checklist in urgent surgical cases would improve compliance with basic standards of care and reduce rates of deaths and complications. Use of the WHO Surgical Safety Checklist has been shown to be associated with significant reductions in complications and deaths. Before evaluation of this safety tool, concern was raised about whether its use would be practical or beneficial during urgent surgical procedures. We prospectively collected clinical process and outcome data for 1750 consecutively enrolled patients 16 years of age or older undergoing urgent noncardiac surgery before and after introduction of the WHO Surgical Safety Checklist in 8 diverse hospitals around the world; 842 underwent urgent surgery-defined as an operation required within 24 hours of assessment to be beneficial-before introduction of the checklist and 908 after introduction of the checklist. The primary end point was the rate of complications, including death, during hospitalization up to 30 days following surgery. The complication rate was 18.4% (n=151) at baseline and 11.7% (n=102) after the checklist was introduced (P=0.0001). Death rates dropped from 3.7% to 1.4% following checklist introduction (P=0.0067). Adherence to 6 measured safety steps improved from 18.6% to 50.7% (P<0.0001). Implementation of the checklist was associated with a greater than one-third reduction in complications among adult patients undergoing urgent noncardiac surgery in a diverse group of hospitals. Use of the WHO Surgical Safety Checklist in urgent operations is feasible and should be considered.

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Author and article information

Journal

Journal ID (nlm-ta): Patient Saf Surg

Title: Patient Safety in Surgery

Publisher: BioMed Central

ISSN (Electronic): 1754-9493

Publication date Collection: 2011

Publication date (Electronic): 13 September 2011

Volume: 5

Page: 21

Affiliations

[1 ]Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway

[2 ]Department of Anesthesia, Stavanger University Hospital, Stavanger, Norway

Article

Publisher ID: 1754-9493-5-21

DOI: 10.1186/1754-9493-5-21

PMC ID: 3182878

PubMed ID: 21914183

SO-VID: e628c16b-ae44-40c0-8a98-2c805e9edf80

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Exploring varieties of knowledge in safe work practices - an ethnographic study of surgical teams

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Abstract

Background

Methods

Results

Conclusions

Related collections

Indigenous Knowledge

Most cited references 29

Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project.

Does team training improve team performance? A meta-analysis.

Effect of a 19-item surgical safety checklist during urgent operations in a global patient population.

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