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- Rydenfält, Christofer
(författare)
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A Study of a Hospital Operating Unit as a Foundation for Future Improvements
- 2011
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The main objective of the research presented was to gain an understanding of how the dynamics between professionals, tools and objectives work in an operating unit in order to obtain knowledge useful when designing the operating unit of the future with emphasis on the work environment, effectiveness and patient safety. By investigating how different professions in the operating theatre view their work and its dynamics, as well as observing how the work is actually carried out, it is possible to get a conception of the dynamics and motives that determine how the work is constituted. This research explores how different professions view their work by means of an interview study, and how the work is carried out in practice by means of a direct observation study. Together, the results of the studies provide two different perspectives on operating theatre work. In both studies, the perspectives of the professionals play an important role. How something is perceived influences how we decide to act. To increase the potential for improvement, widening those perspectives plays a central role. By doing so, the practice will in turn appear more complex to the practitioners; there will be more aspects to take into consideration. More contradictions and options will be visible. To improve the practitioners’ capability to handle this increased complexity, trust is identified as an important tool. Trust is a mechanism that can suspend doubt or complexity in such a way that it is possible to make effective decisions even when the number of options is too large to handle. Previous research indicates that surgical teams are not as cohesive as could be expected and that communication failures frequently occur in the operating theatre. The first study presented in this thesis elaborates on how this can come about. It investigates how different healthcare professions in the surgical team orientate themselves towards their task and how this can be affected by the organizational and social context. Virtual reality supported semi-structured interviews were conducted with 15 participants recruited from all personnel categories of the surgical team. Activity theory was used as a theoretical framework to analyze the interviews. The results indicated that poor team functionality to some degree can be explained by different activity orientations between professions, which leads to different views on work activities and tension between them. Social and organizational support structures in the daily practice are pointed out as a means to facilitate trust and experience sharing between professions. This can promote the establishment of a common view among different professionals in the operating team and increase interprofessional communication, hence overcoming communication thresholds in the operating theatre. To improve safety in the operating theatre, checklists have gained considerable support in recent years, often in the form of a pre-operative timeout. The World Health Organization (WHO) has developed its own timeout checklist, which has been adopted by several Swedish operating units. Previous research indicates that timeout checklists reduce complications from surgery and can even improve the safety attitude of the team members. Thus, the effects of the checklist have been studied, but little research has been carried out on how the checklist is actually used in practice. This is investigated in the second study included in this thesis to determine how the surgical team uses and relates to the checklist as well as to identify and explain deviations from it. Twenty-four timeout procedures of four different, but common, operations were video recorded and analyzed according to a predefined protocol based on the WHO checklist instructions. The results showed that compliance varied between questions. The questions with the best compliance appeared to be the ones that made the most sense and were perceived as the most important by the participants. In half of the observed procedures, personal presentations did not occur and in five of those cases, they were postponed. This indicates that these questions, intended to facilitate communication between team members, were not perceived as contributing to patient safety in any meaningful way. The results also showed that surgeons and anesthesiology personnel dominated much of the timeout. It is likely that the positive effects on patient safety attributed to the checklist can be improved by making the connection between the checklist, communication and teamwork more explicit and by altering the checklist so that the different professions more equally involved.
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- Rydenfält, Christofer, et al.
(författare)
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Compliance with the WHO Surgical Safety Checklist: deviations and possible improvements.
- 2013
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1464-3677 .- 1353-4505. ; 25:2, s. 182-187
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: /st>Previous research suggests that the World Health Organization Surgical Safety Checklist time-out reduces communication failures and medical complications and supports development of better safety attitudes. Previous research also indicates that different values can affect the implementation of interventions. OBJECTIVE: /st>To investigate the actual usage of the checklist in practice and to catalogue deviations for the purpose of identifying improvements. DESIGN: /st>Twenty-four surgical procedures were video recorded. The time-out was analysed quantitatively assessing compliance with a predefined observational protocol based on the checklist and qualitatively to describe reasons for non-compliance. SETTING: /st>The operating unit of a Swedish county hospital. MAIN OUTCOME MEASURES: /st>Compliance with checklist items and the participation of different personnel groups. Activities were conducted during the time-out. RESULTS: /st>Highest compliance was associated with patient ID, type of procedure and antibiotics; the worst with site of incision, theatre nurse team reviews and imaging information. Team member introductions occurred in half of the operations. Surgeons and the anaesthesia team dominated the time-out. CONCLUSION: /st>The checklist is not always applied as intended. The components that facilitate communication are often neglected. The time-out does not appear to be conducted as a team effort. It is plausible that the personnel's conception of risk and the perceived importance of different checklist items are factors that influence checklist usage. To improve compliance and involve the whole team, the concept of risk and the perceived relevance of checklist items for all team members should be addressed.
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- Rydenfält, Christofer, et al.
(författare)
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Social structures in the operating theatre: how contradicting rationalities and trust affect work.
- 2012
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402. ; 68:4, s. 783-795
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This article is a report of a study of how healthcare professionals involved in surgery orientate themselves to their common task, and how this orientation can be affected by the social and organizational context. Background. Previous research indicates that surgical teams are not as cohesive as could be expected and that communication failures frequently occur. However, little is known about how these problems are related to their social, cultural and organizational context. Methods. Semi-structured interviews were conducted with 15 healthcare professionals, representing all personnel categories of the surgical team. During the interview, a virtual model, visualizing a real operating theatre, was used to facilitate reflection. The interviews were conducted in 2009. Themes were created from the interviews, with a focus on similarities and differences. An activity analysis was conducted based on the themes. Findings. Poor team functionality and communication failures in the operating theatre can to some degree be explained by differences in activity orientation between professions and by insufficient support from social and organizational structures. Differences in activity orientation resulted in different views between professional groups in their perceptions of work activities, resulting in tension. Insufficient support resulted in communication thresholds that inhibited the sharing of information. Conclusion. Organizing work to promote cross-professional interaction can help the creation of social relations and norms, providing support for a common view. It can also help to decrease communication thresholds and establish stronger relations of trust. How this organization structure should be developed needs to be further investigated.
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- Rydenfält, Christofer
(författare)
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Teamarbete på operationssal, organisationsdesign och patientsäkerhet
- 2014
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Ingår i: Uppdukat. - 1101-5624. ; 26:4, s. 21-24
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Teamarbete är vanligt inom hälso- och sjukvården. I mitt avhandlingsarbete har jag studerat teamarbete på operationssal med fokus på hur det praktiska arbetet faktiskt går till. Avhandlingens delstudier berör sådant som den praktiska användningen av formella rutiner (WHOs checklista för säker kirurgi), ledarskap på operationssal, olika professioners syn på det gemensamma arbetet, testning av en metod för att förbättra arbetet, samt riktlinjer för hur man kan organisera för teamarbete. Resultaten visar bl.a. på variation i följsamhet mellan frågor på checklistan vilket leder till nya frågeställningar. Resultaten visar också på att ledarskapet är något som distribueras över hela teamet i operationssalen. Stabilare team, tillfällen till kommunikation samt ett flexibelt ledarskap, lyfts fram som organisatoriska principer som främjar teamarbete.
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- Rydenfält, Christofer
(författare)
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Teamwork in the operating room - The role of organizational design and implications for patient safety
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The topic of this thesis is teamwork in healthcare. Healthcare is often described as complex. This description is more appropriate now than ever with the extensive specialization that has taken place in recent decades resulting in increasingly specialized physicians and nurses. While this specialization has made it possible to cure even sicker patients, it has also resulted in less overlapping knowledge and thus larger gaps between the different specialties’ areas of expertise. The method prescribed to overcome these challenges is often interprofessional teamwork. It is almost taken for granted that teamwork can make healthcare more efficient and that it is important for patient safety. Surgery in the operating room is an area where this is particularly prevalent. In the operating room anesthesiologists, anesthetist nurses, circulating nurses, scrub nurses and surgeons meet together as a team, in different constellations, to provide surgery for the patient. This thesis is concerned with the interprofessional team in the operating room, on how team members understand their common work, on how they concretely work together, and on how their practice and teamwork capabilities can be improved through organizational means. The thesis consists of five studies. The main methods used to collect data are interviews and observations using video. The video observations consisted of surgical procedures and group meetings. Depending on the purpose, the analysis of video data differed from more open exploratory bottom-up methodologies to top-down approaches, such as the usage of predefined observation protocols. The results indicate that the operating team is not as cohesive as might be assumed and that contradicting rationalities held among team members from different professions can at times result in tension in the team. A complementary alternative to the popular team training approach to improve teamwork is suggested in organizing for teamwork. The three organizational principles of team stability, occasions for communication and an adaptive approach to leadership are identified as important in order to organize for teamwork. As teamwork is associated with patient safety, this can potentially have implications for patient safety as well. The results also show that a popular routine to improve patient safety, the WHO Surgical Safety Checklist, is not actually used in reality as prescribed in the routine. This can lead to new risks if its correct usage is taken for granted and other behaviors are adapted accordingly. The perceived importance of different Checklist items and the conception of risk among its users should be considered in future efforts to improve Checklist usage. It is also shown that leadership in the operating room is distributed rather than something associated with a specific leader. This challenges traditional leader-centered perspectives on leadership in the operating room. An action oriented group method to facilitate organizational development and innovation was tested at the operating unit. The results show that the method worked well in the group and that the group managed to initiate a successful change project, but that the group’s anchoring at their organizational unit should be ensured. The studies in which this thesis is based show that practice in the operating room does not always look as expected. Methodologically, this means that methods that are capable of capturing the actual practice, such as observations, are valuable tools when studying complex healthcare settings, such as work in an operating room.
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