The who, what, and how of teamwork research in medical operating rooms: A scoping review

Raveendran, Lucshman; McGuire, Cailie S.; Gazmin, Stefanie; Beiko, Darren; Martin, Luc J.

doi:10.1080/13561820.2022.2058917

Cited by 7 publications

(6 citation statements)

References 92 publications

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“…The need to challenge steep hierarchical structures to achieve good team communication and performance in high‐risk healthcare is also reported by Green et al (2017). A more recent scoping review carried out by Raveendran et al (2023, p. 511) on teamwork research in medical operating rooms observed that ‘individual components of teamwork behaviors’ predominated in the literature, ‘rather than a holistic interpretation of teamwork based on multiple processes’, calling for the importance of ‘erties’ and ‘a framework to understand the nuanced nature of teamwork’ in operating rooms; … ‘to foster high functioning teams’ (Raveendran et al, 2023, p. 511). The need for a holistic interpretation of healthcare organisations resonates with this finding, notably at a whole organisational level.…”

Section: Introductionmentioning

confidence: 99%

A scoping review exploring the impact and negotiation of hierarchy in healthcare organisations

et al. 2023

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Healthcare organisations are hierarchical; almost all are organised around the ranking of individuals by authority or status, whether this be based on profession, expertise, gender or ethnicity. Hierarchy is important for several reasons; it shapes the delivery of care, what is prioritised and who receives care. It also has an impact on healthcare workers and how they work and communicate together in organisations. The purpose of this scoping review is to explore the qualitative evidence related to hierarchy in healthcare organisations defined broadly, to address gaps in macro‐level healthcare organisational research, specifically focusing on the (1) impact of hierarchy for healthcare workers and (2) how hierarchy is negotiated, sustained and challenged in healthcare organisations. After a search and screening, 32 papers were included in this review. The findings of this review detail the wide‐reaching impacts that hierarchy has on healthcare delivery and health workers. The majority of studies spoke to hierarchy's impact on speaking up, that is, how it shaped communication between staff with differential status: not only what was said, but how it had an impact on what was acceptable to say, by whom and at what time. Hierarchy was also noted to have substantial personal costs, impacting on the well‐being of those in less powerful positions. These findings also provide insight into the complex ways in which hierarchy was negotiated, challenged and reproduced. Studies not only detailed the way in which hierarchy was navigated day to day but also spoke to the reasons as to why hierarchy is often entrenched and difficult to shift. A number of studies spoke to the impact that hierarchy had in sustaining gender and ethnic inequalities, maintaining historically discriminatory practices. Importantly, hierarchy should not be reduced to differences between or within the professions in localised contexts but should be considered at a broad organisational level.

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Section: Introductionmentioning

confidence: 99%

A scoping review exploring the impact and negotiation of hierarchy in healthcare organisations

et al. 2023

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“…Despite this evidence, there remains a widespread lack of sustained team training in the perioperative space. A review by Raveendran et al (2023) noted that most current interventions address only a few teamwork constructs and called for perioperative training programs that comprehensively address teamwork competencies and measure interprofessional outcomes. In response to The Joint Commission's (2017) sentinel event alert, the Anesthesia Patient Safety Foundation created guidelines for the execution and research of perioperative handoffs, concluding that teamwork training and attitude/behavior changes are essential for successful perioperative handoff interventions (Agarwala et al, 2019).…”

Section: Importance Of Teamwork In Interprofessional Perioperative Ha...mentioning

confidence: 99%

“…Challenge 5: Creating supportive conditions to sustain behaviors Improving perioperative handoff safety requires an environment conducive to teamwork. Local interventions at the unit level are often insufficient without institutional support, and previous perioperative teamwork interventions and systematic reviews of this work have consistently identified this as a crucial obstacle to program success (Jowsey et al, 2019;Teunissen et al, 2020;Keebler et al, 2022;Turcotte et al, 2022;Raveendran et al, 2023). Team members will continue to encounter challenges that increase errors if institutional structures do not allocate time and resources to conducting safe team-based handoffs.…”

Section: Challenge 4: Comprehensively Evaluating Training Impactmentioning

confidence: 99%

Handoffs and the challenges to implementing teamwork training in the perioperative environment

et al. 2023

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Perioperative handoffs are high-risk events for miscommunications and poor care coordination, which cause patient harm. Extensive research and several interventions have sought to overcome the challenges to perioperative handoff quality and safety, but few efforts have focused on teamwork training. Evidence shows that team training decreases surgical morbidity and mortality, and there remains a significant opportunity to implement teamwork training in the perioperative environment. Current perioperative handoff interventions face significant difficulty with adherence which raises concerns about the sustainability of their impact. In this perspective article, we explain why teamwork is critical to safe and reliable perioperative handoffs and discuss implementation challenges to the five core components of teamwork training programs in the perioperative environment. We outline evidence-based best practices imperative for training success and acknowledge the obstacles to implementing those best practices. Explicitly identifying and discussing these obstacles is critical to designing and implementing teamwork training programs fit for the perioperative environment. Teamwork training will equip providers with the foundational teamwork competencies needed to effectively participate in handoffs and utilize handoff interventions. This will improve team effectiveness, adherence to current perioperative handoff interventions, and ultimately, patient safety.

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“…However, there is limited evidence for the value of sex diversity of teams in healthcare, with published reports 14–20 to date focusing on individual’s characteristics and their associations with outcomes. There is a paucity of data regarding the role of the team's sex diversity 6 , 21 . Because the performance of a team is known to surpass that of individuals, it is crucial to understand the relationship between sex diversity and patient outcomes at the team level 4 , 22 .…”

Section: Introductionmentioning

confidence: 99%

Association between anaesthesia–surgery team sex diversity and major morbidity

Hallet,

Sutradhar,

Flexman

et al. 2024

British Journal of Surgery

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Background Team diversity is recognized not only as an equity issue but also a catalyst for improved performance through diversity in knowledge and practices. However, team diversity data in healthcare are limited and it is not known whether it may affect outcomes in surgery. This study examined the association between anaesthesia–surgery team sex diversity and postoperative outcomes. Methods This was a population-based retrospective cohort study of adults undergoing major inpatient procedures between 2009 and 2019. The exposure was the hospital percentage of female anaesthetists and surgeons in the year of surgery. The outcome was 90-day major morbidity. Restricted cubic splines were used to identify a clinically meaningful dichotomization of team sex diversity, with over 35% female anaesthetists and surgeons representing higher diversity. The association with outcomes was examined using multivariable logistic regression. Results Of 709 899 index operations performed at 88 hospitals, 90-day major morbidity occurred in 14.4%. The median proportion of female anaesthetists and surgeons was 28 (interquartile range 25–31)% per hospital per year. Care in hospitals with higher sex diversity (over 35% female) was associated with reduced odds of 90-day major morbidity (OR 0.97, 95% c.i. 0.95 to 0.99; P = 0.02) after adjustment. The magnitude of this association was greater for patients treated by female anaesthetists (OR 0.92, 0.88 to 0.97; P = 0.002) and female surgeons (OR 0.83, 0.76 to 0.90; P < 0.001). Conclusion Care in hospitals with greater anaesthesia–surgery team sex diversity was associated with better postoperative outcomes. Care in a hospital reaching a critical mass with over 35% female anaesthetists and surgeons, representing higher team sex-diversity, was associated with a 3% lower odds of 90-day major morbidity.

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The who, what, and how of teamwork research in medical operating rooms: A scoping review

Cited by 7 publications

References 92 publications

A scoping review exploring the impact and negotiation of hierarchy in healthcare organisations

A scoping review exploring the impact and negotiation of hierarchy in healthcare organisations

Handoffs and the challenges to implementing teamwork training in the perioperative environment

Association between anaesthesia–surgery team sex diversity and major morbidity

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