Team communications in surgery – creating a culture of safety

Abstract

As a key department within a healthcare organisation, the operating room is a hazardous environment, where the consequences of errors are high, despite the relatively low rates of occurrence. Team performance in surgery is increasingly being considered crucial for a culture of safety. The aim of this study was to describe team communication and the ways it fostered or threatened safety culture in surgery. Ethnography was used, and involved a 6-month fieldwork period of observation and 19 interviews with 24 informants from nursing, anaesthesia and surgery. Data were collected during 2009 in the operating rooms of a tertiary care facility in Queensland, Australia. Through analysis of the textual data, three themes that exemplified teamwork culture in surgery were generated: "building shared understandings through open communication"; "managing contextual stressors in a hierarchical environment" and "intermittent membership influences team performance". In creating a safety culture in a healthcare organisation, a team's optimal performance relies on the open discussion of teamwork and team expectation, and significantly depends on how the organisational culture promotes such discussions.

Respecting as a basic teamwork process in the operating theatre - A qualitative study of theatre nurses who work in interdisciplinary surgical teams of what they see as important factors in this collaboration

“…The theatre nurses may be reluctant to speak up about safety concerns and patient safety may be negatively affected (1). The hierarchy threatened safety because less powerful members had limited input in decision making, and were reluctant to speak up (15,33,39). In our study the theatre nurses feel they lose their concentration and focus when communication is not respectful in the team.…”

Systematic review of methods for quantifying teamwork in the operating theatre

“…Operating theatre staff also implicated the ‘role of the institution’ in teamwork and communication. Perceived barriers to effective teamwork included a lack of ‘open communication’ and ‘dominance and hierarchy’54. Field notes of observed communication exchanges in the operating theatre showed themes such as ‘mimicry’ (for example, junior surgeons mimicking the behaviours of fellows and consultant), ‘withdrawal’ (typically juniors withdrawing from tense communication between other team members), and ‘association’ (attitudes towards a certain individual being extended to members of their professional subteam)54.…”

“…The frequent occurrence of behaviours such as ‘mimicry’ and ‘association’ substantiate this. Junior staff belonging to a specialty often mimic the negative teamwork behaviours of their seniors, and members of other specialties associate juniors with negative traits of seniors54. It appears challenging for individuals in theatre subteams adequately to assess themselves and their colleagues from other professions.…”

Exploring the importance of team psychological safety in the development of two interprofessional teams

“…Common sense suggests that these activities necessitate recurring interaction between individuals. It has also been shown that a lack of face-to-face contact can lead to reduced trust and co-operation (Gillespie, Gwinner, Chaboyer & Fairweather, 2013 There are a number of limitations that must be taken into account in this study. The study is over five years old, thus some of the issues reported may have changed.…”