Exploring stakeholder perceptions around implementation of the Operating Room Black Box for patient safety research: a qualitative study using the theoretical domains framework

Etherington, Nicole; Usama, Aya; Patey, Andrea M.; Trudel, Chantal; Przybylak-Brouillard, Antoine; Presseau, Justin; Grimshaw, Jeremy; Boet, Sylvain

doi:10.1136/bmjoq-2019-000686

Cited by 16 publications

(35 citation statements)

References 26 publications

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“…Our qualitative study of stakeholder perceptions regarding the Operating Room Black Box was approved by the OHSN-REB, Protocol #20170117-01H. This study was reported separately elsewhere [ 28 ]. In short, interviews were conducted with 15 patients across 3 hospital campuses (5 patients each), 17 perioperative clinicians, and 9 hospital administrators.…”

Section: Resultsmentioning

confidence: 99%

“…A full description of the methodology has been published elsewhere [ 28 ]. Briefly, participants were recruited across each of the 3 campuses of our center, either in-person (patients) or via email (clinicians and administrators).…”

Section: Methodsmentioning

confidence: 99%

“…Belief statements were generated based on these themes in order to represent common meaning across participant responses [ 27 ]. Domain relevance (ie, whether the domain/belief should be considered during implementation) was determined based on the perceived impact of the beliefs, the presence of conflicting beliefs within a specific domain, and the relative frequency of the beliefs across participant interviews [ 28 ]. Disagreements were resolved through consensus or consultation with a third researcher.…”

Section: Methodsmentioning

confidence: 99%

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Implementation of the Operating Room Black Box Research Program at the Ottawa Hospital Through Patient, Clinical, and Organizational Engagement: Case Study

Boet¹,

Etherington²,

Lam³

et al. 2021

J Med Internet Res

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Background A large proportion of surgical patient harm is preventable; yet, our ability to systematically learn from these incidents and improve clinical practice remains limited. The Operating Room Black Box was developed to address the need for comprehensive assessments of clinical performance in the operating room. It captures synchronized audio, video, patient, and environmental clinical data in real time, which are subsequently analyzed by a combination of expert raters and software-based algorithms. Despite its significant potential to facilitate research and practice improvement, there are many potential implementation challenges at the institutional, clinician, and patient level. This paper summarizes our approach to implementation of the Operating Room Black Box at a large academic Canadian center. Objective We aimed to contribute to the development of evidence-based best practices for implementing innovative technology in the operating room for direct observation of the clinical performance by using the case of the Operating Room Black Box. Specifically, we outline the systematic approach to the Operating Room Black Box implementation undertaken at our center. Methods Our implementation approach included seeking support from hospital leadership; building frontline support and a team of champions among patients, nurses, anesthesiologists, and surgeons; accounting for stakeholder perceptions using theory-informed qualitative interviews; engaging patients; and documenting the implementation process, including barriers and facilitators, using the consolidated framework for implementation research. Results During the 12-month implementation period, we conducted 23 stakeholder engagement activities with over 200 participants. We recruited 10 clinician champions representing nursing, anesthesia, and surgery. We formally interviewed 15 patients and 17 perioperative clinicians and identified key themes to include in an information campaign run as part of the implementation process. Two patient partners were engaged and advised on communications as well as grant and protocol development. Many anticipated and unanticipated challenges were encountered at all levels. Implementation was ultimately successful, with the Operating Room Black Box installed in August 2018, and data collection beginning shortly thereafter. Conclusions This paper represents the first step toward evidence-guided implementation of technologies for direct observation of performance for research and quality improvement in surgery. With technology increasingly being used in health care settings, the health care community should aim to optimize implementation processes in the best interest of health care professionals and patients.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Implementation of the Operating Room Black Box Research Program at the Ottawa Hospital Through Patient, Clinical, and Organizational Engagement: Case Study

Boet¹,

Etherington²,

Lam³

et al. 2021

J Med Internet Res

Self Cite

View full text Add to dashboard Cite

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“…[31][32][33] The only other published qualitative study of the video review technology to date was conducted by Etherington et al on the implementation of the operating room (OR) "Black Box" in Ottawa, Ontario. 34 They also found that while most stakeholders were supportive of the OR Black Box and would agree to be recorded, there are many areas that need to be addressed including ensuring all stakeholders have adequate and accurate information about the OR Black Box system and research goals and that the OR Black Box is positioned as a patient safety initiative for learning from and improving everyday practice across the whole team.…”

Section: Discussionmentioning

confidence: 99%

Staff perceptions of the implementation of a trauma video review program at a level I trauma center

Dainty

Seaton

McGowan³

et al. 2021

AEM Education and Training

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Objectives: Successful implementation of any new technology requires extensive engagement with front-line staff. We explored the perceptions of emergency department and trauma staff about a trauma video review program (TVR) prior to implementation of the first such program in Canada at our level I trauma center. Methods:We conducted semi-structured individual interviews and in situ small group interviews with 35 multidisciplinary ED and trauma staff members of a teaching and research hospital in Toronto, Canada. We sought maximum variation in the sample of purposively selected participants. Interviews were recorded with audiotapes or detailed field notes, transcribed verbatim, coded, and analyzed using standard thematic analysis techniques.Results: Participants expressed overall support for the concept of TVR, but there is a core sense of unease that influenced overall staff perceptions. Despite several departmental presentations, very few participants actually had a solid understanding of how the TVR worked. Many were apprehensive about their own professional privacy, deeply concerned about vulnerable patients being filmed without consent, and questioned how video data would be used. Despite significant hesitancy, ED and trauma staff identified positive opportunities that TVR could bring, including providing an evidence base for quality improvement. Conclusions:TVR is an evolving approach to evaluate quality and patient safety in the trauma bay. As such it brings with it natural concerns and apprehension from staff regarding privacy, confidentiality, and how data will be captured and used. There is opportunity for these types of concerns to be addressed with a robust knowledge translation plan and engagement of staff throughout the implementation process.

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“…28 In general, whereas patients were as a whole supportive and comfortable by its use in the operating room, physicians were more concerned about the consent process, security, and medicolegal issues. 29,30 Ultimately, surgical data recording technologies vary in the amount and types of data collected, degree of technology integration, and related utility in the clinical setting. However, because data recording technologies may capture audio, video, patient, and provider data associated with sensitive protected health information, they inherently carry medicolegal questions.…”

Section: Legal and Regulatory Consideration For Black Box Usementioning

confidence: 99%

An Interdisciplinary Review of Surgical Data Recording Technology Features and Legal Considerations

2019

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Surgical data recording technology has great promise to generate patient safety and quality data that can be utilized to potentially reduce medical errors. Variations of these systems aim to improve surgical technique, develop better training simulation, and promote adverse event investigation similar to the aims of black box technology utilized in other industries. However, many unknowns remain for surgical data recording utilization in operating rooms and clinical settings in the United States. This includes the need to appropriately design systems so they collect meaningful and useful data that can be discussed by surgical team members in an open and safe environment to optimize clinical care processes. In order to better understand the clinical and regulatory environment for surgical data recording systems, we conducted an interdisciplinary review to identify key technology approaches, and assess legal and regulatory implications associated with this potentially disruptive technology. We found technology ranging from audio and visual data, to systems utilizing mobile applications, and kinematic data capture. The data collected present legal questions over ownership of information and privacy, along with regulatory issues at the federal and state levels. The benefits of these data should be balanced with the need to develop appropriate policies and regulations that protect the interests of both clinicians and patients in order to encourage further innovation and better realize the potential of surgical data recording technology to improve clinical decision making and patient safety outcomes.

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Exploring stakeholder perceptions around implementation of the Operating Room Black Box for patient safety research: a qualitative study using the theoretical domains framework

Cited by 16 publications

References 26 publications

Implementation of the Operating Room Black Box Research Program at the Ottawa Hospital Through Patient, Clinical, and Organizational Engagement: Case Study

Implementation of the Operating Room Black Box Research Program at the Ottawa Hospital Through Patient, Clinical, and Organizational Engagement: Case Study

Staff perceptions of the implementation of a trauma video review program at a level I trauma center

An Interdisciplinary Review of Surgical Data Recording Technology Features and Legal Considerations

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