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

Abstract

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

Managing complexity in the operating room: a group interview study

“…Experienced colleagues were perceived by ORNs, as being more aware of the other team members' capacity, competence, and need for support which made it easier to make decisions, speak up, and follow the plan. In line with other studies in the OR [19,35,36] the RNAs' work experience was perceived as important for having the cognitive ability to anticipate risks, planning for the expected and unexpected, and be prepared both mentally and practically for the surgical procedure. Participants in this study had quite high mean experience which may predispose for degrees of freedom to be flexible and adapt to situations and opportunities are easier to be seen.…”

Gaining access to a research site and participants in medical and nursing research: a synthesis of accounts

“…The primary aim of the qualitative study at the orthopaedic surgical section was to explore how safety is achieved in surgical operations through observations, conversations and interviews . A secondary aim of the study was to use the field notes to document how access to the operating theatre (research site) and surgical teams (participants) was achieved.…”

“…The primary aim of the qualitative study at the orthopaedic surgical section was to explore how safety is achieved in surgical operations through observations, conversations and interviews. [45][46][47] A secondary aim of the study was to use the field notes to document how access to the operating theatre (research site) and surgical teams (participants) was achieved. These field notes were taken by the two researchers who performed the fieldwork: an experienced safety researcher (principal researcher, SH), and an experienced nurse anaesthetist (co-researcher, JGH) who had in-depth technical understanding of areas such as operating theatre procedures and terminology.…”

Addressing the tacit knowledge gap in knowledge systems across agential realism

“…Attaining such knowledge involves social embedding or social immersion in the specific social settings of the communities of practice in question. Examples range from the more taken-forgranted bike-riding in traffic [5] to dynamic and knowledge intensive examples such as multidisciplinary surgery teams dealing with non-typical situations [6,7]. Along similar lines, Leonard and Swap [4] argue that deep knowledge (or "deep smarts") which certain experts possess, that is something experts are especially good at after many years of experience, involves significant levels of tacit knowledge in the form of know-how and know-who which cannot be easily documented because of its highly contextual nature as well as in its difficulty to fully explicate.…”