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

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) p roactive and intuitive communication , 2) s ilent 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.

Teamwork in a Surgical Department

“…Open communication and effective coordination skills are required to avoid conflicts, confusion and overstepping boundaries or to resolve existing conflicts healthy [35]. Collaboration willingness is required to complete tasks on time and to share the workload fairly.…”

Social distancing: implications for the operating room in the face of COVID-19

“…For example, team members that perform the same activities together every day will know one another, and this decreases the likelihood of miscommunication. 17 During a pandemic, however, this is simply not realistic, particularly as team members will change secondary to infection, exposure, and burnout. Limiting speaking, and even the volume of our voices (which is associated with droplet and aerosol generation) 18,19 in the OR could be important.…”

“…We then describe three other communication styles observed in OR teams, and why they must be limited during a crisis. 17 Proactive, intuitive communication is characterized by broad, shared goals and mutual respect. This includes starting the surgical procedure in a timely manner, completing all necessary checklist items, and supporting the functions of other team members.…”

“…Par exemple, les membres d'une équipe qui réalisent les mêmes activités ensemble tous les jours se connaissent bien, ce qui réduit par conséquent la probabilité de mauvaise communication. 17 Toutefois, pendant une pandémie, ceci n'est tout simplement pas réaliste, particulièrement parce que les membres d'une équipe changeront en fonction de leur infection, de leur exposition, et de leur épuisement professionnel. En revanche, le fait de limiter nos communications, voire le volume de nos voix (lequel est associé à la génération de gouttelettes et d'aérosols) 18,19 en SOP pourrait être important.…”

“…Nous décrirons ensuite trois autres styles de communication observés dans les équipes de SOP, et expliquerons pourquoi ces styles devraient être limités en période de crise. 17 La communication proactive et intuitive se caractérise par des objectifs globaux et partagés et par le respect mutuel. Cela comprend le début de l'intervention chirurgicale à l'heure, la complétion de tous les éléments nécessaires énumérés sur des listes de contrôle, et le soutien aux rôles des autres membres de l'équipe.…”