Factors Influencing Team Behaviors in Surgery: A Qualitative Study to Inform Teamwork Interventions

Abstract

BackgroundSurgical excellence demands teamwork. Poor team behaviors negatively affect team performance and are associated with adverse events and worse outcomes. Interventions to improve surgical teamwork focusing on frontline team members’ nontechnical skills have proliferated but shown mixed results. Literature on teamwork in organizations suggests that team behaviors are also contingent on psychosocial, cultural, and organizational factors. This study examined factors influencing surgical team behaviors to inform more contextually sensitive and effective approaches to optimizing surgical teamwork.MethodsThis qualitative study of cardiac surgical teams in a large United States teaching hospital included 34 semistructured interviews. Thematic network analysis was used to examine perceptions of ideal teamwork and factors influencing team behaviors in the operating room.ResultsPerceptions of ideal teamwork were largely shared, but team members held discrepant views of which team and leadership behaviors enhanced or undermined teamwork. Other factors affecting team behaviors were related to the local organizational culture, including management of staff behavior, variable case demands, and team members’ technical competence, and fitness of organizational structures and processes to support teamwork. These factors affected perceptions of what constituted optimal interpersonal and team behaviors in the operating room.ConclusionsTeam behaviors are contextually contingent and organizationally determined, and beliefs about optimal behaviors are not necessarily shared. Interventions to optimize surgical teamwork require establishing consensus regarding best practice, ability to adapt as circumstances require, and organizational commitment to addressing contextual factors that affect teams.

Decreasing Room Traffic in Orthopedic Surgery: A Quality Improvement Initiative

“…For instance, multiple studies have evaluated factors that influence surgical team behaviors and found that many OR team members may hold dissimilar beliefs and goals related to which behaviors enhance teamwork in the OR. [25][26][27] In addition, others have suggested that QI and awareness campaigns are vital to changing OR behavior as it relates to adherence to infection control practices in the OR. 26,28 Moreover, despite differences in team dynamics, studies indicate that positive behavior change in the OR is possible.…”

Interprofessional working during the COVID-19 pandemic: sociological insights

“…Instead, we are developing a greater appreciation of the wide range of contextual factors that influence interprofessional interactions, and the resulting variability in the nature of these interactions. Research in various clinical contexts, including intensive care, emergency, and surgery, show how professional and patient-related characteristics, technology, organizational culture, structures and processes, and policy priorities all impact on the nature and conditions of interprofessional practice (Aveling et al, 2018;Broom et al, 2015;Liberati, 2017;Lindberg et al, 2017;Xyrichis et al, 2017). For example, in a study in the intensive care unit, staff seniority and urgency of work influenced jurisdictional boundaries and professional interactions (Xyrichis et al, 2017).…”

“…For example, in a study in the intensive care unit, staff seniority and urgency of work influenced jurisdictional boundaries and professional interactions (Xyrichis et al, 2017). In the operating room setting, a range of factors including technical demands of the case, patient acuity, trainee turnover and nurse scheduling influenced interprofessional interactions (Aveling et al, 2018). At a policy level, we have seen how a policy about antimicrobial resistance impacted on professional negotiations amongst pharmacists and physicians in hospital settings (Broom et al, 2015).…”

Challenges to the improvement of obstetric care in maternity hospitals of a large Brazilian city: an exploratory qualitative approach on contextual issues

“…Professional training shortfalls were highlighted, and it is important to consider the need for greater interaction with the Universities, and training and regulatory organizations of the mid-level and higher-level professionals involved. Technical competence is strongly valued in building trusting relationships for teamwork [ 29 ]. At the same time, issues such as teamwork, coordination of services and communication are still insufficiently incorporated in the curricula [ 21 – 23 ].…”