Operating Room Teamwork among Physicians and Nurses: Teamwork in the Eye of the Beholder

doi:10.1016/j.jamcollsurg.2006.01.017

Journal of the American College of Surgeons

Volume 202, Issue 5, May 2006, Pages 746-752

Presented at the American College of Surgeons 91st Annual Clinical Congress, San Francisco, CA, October 2005.

https://doi.org/10.1016/j.jamcollsurg.2006.01.017 Get rights and content

Background

Teamwork is an important component of patient safety. In fact, communication errors are the most common cause of sentinel events and wrong-site operations in the US. Although efforts to improve patient safety through improving teamwork are growing, there is no validated tool to scientifically measure teamwork in the surgical setting.

Study design

Operating room personnel in 60 hospitals were surveyed using the Safety Attitudes Questionnaire. Surgeons, anesthesiologists, certified registered nurse anesthetists, and operating room nurses rated their own peers and each other using a 5-point Likert scale (1 = very low, 5 = very high).

Results

Overall response rate was 77.1% (2,135 of 2,769). Ratings of teamwork differed substantially by operating room caregiver type, with the greatest differences in ratings shown by physicians: surgeons (F[4, 2058] = 41.73, p < 0.001), and anesthesiologists (F[4, 1990] = 53.15, p < 0.001). The percent of operating room caregivers rating the quality of collaboration and communication as “high” or “very high” was different by caregiver role and whether they were rating a peer or another type of caregiver: surgeons rated other surgeons “high” or “very high” 85% of the time, and nurses rated their collaboration with surgeons “high” or “very high” only 48% of the time.

Conclusions

Considerable discrepancies in perceptions of teamwork exist in the operating room, with physicians rating the teamwork of others as good, but at the same time, nurses perceive teamwork as mediocre. Given the importance of communication and collaboration in patient safety, health care organizations should measure teamwork using a scientifically valid method. The Safety Attitudes Questionnaire can be used to measure teamwork, identify disconnects between or within disciplines, and evaluate interventions aimed at improving patient safety.

Section snippets

Methods

Our survey, the Safety Attitudes Questionnaire (SAQ)¹⁶ is a refinement of the Intensive Care Unit Management Attitudes Questionnaire.17, 18 The latter was adapted from the Flight Management Attitudes Questionnaire¹⁹ and its predecessor, the Cockpit Management Attitudes Questionnaire.²⁰ These surveys are reliable, sensitive to change,²¹ and the elicited attitudes shown to predict performance.7, 22, 23 There is a 25% overlap in item content between the SAQ and Flight Management Attitudes

Results

Of 2,769 questionnaires handed out in 60 hospitals (222 surgeons, 1,058 OR nurses, 564 surgical technicians, 170 anesthesiologists, and 121 CRNAs), a total of 2,135 surveys were returned, for an overall response rate of 77.1% (range across hospitals of 57% to 100%). OR nurses (79%) had the highest response rate and CRNAs had the lowest (67%) (Table 1). Average respondent was 43 years old with 10 years of experience at the current hospital. Surgeons (8.6% women) and anesthesiologists (12.7%

Discussion

Substantial discrepancies in perceptions of teamwork exist in the OR, with physicians rating the teamwork of others as good, and at the same time, nurses perceive teamwork as poor. These findings mirror similar results of discrepant attitudes about collaboration between physicians and nurses in intensive care units.¹⁸

Based on our findings, surgeons and anesthesiologists appear more satisfied with physician−nurse collaboration than nurses. Nurses did not reciprocate the high ratings of teamwork

Acknowledgment

We thank Andrew Knight from the University of Pennsylvania Wharton School for his work and expertise in data management and statistical analysis.

References (28)

C.R. Edmonds et al.
Two cases of a wrong-site peripheral nerve block and a process to prevent this complication
Reg Anesth Pain Med
(2005)
N.M. Saufl
Universal protocol for preventing wrong site, wrong procedure, wrong person surgery
J Perianesth Nurs
(2004)
M.R. de Leval et al.
Human factors and cardiac surgerya multicenter study
J Thorac Cardiovasc Surg
(2000)
H. Lu et al.
Job satisfaction among nursesa literature review
Int J Nurs Stud
(2005)
A.A. Gawande et al.
Risk factors for retained instruments and sponges after surgery
N Engl J Med
(2003)
V. Gibbs et al.
Sentinel eventsevaluating cause and planning improvement
(1998)
L. Kohn et al.
To err is humanbuilding a safer health system [Institute of Medicine Report]
(1999)
R.L. Helmreich et al.
Cockpit resource managementExploring the attitude-performance linkage
Aviat Space Environ Med
(1986)
J.G. Baggs et al.
Association between nurse-physician collaboration and patient outcomes in three intensive care units
Crit Care Med
(1999)

S.M. Shortell et al.

The performance of intensive care unitsdoes good management make a difference?

Med Care

(1994)

W.A. Knaus et al.

An evaluation of outcome from intensive care in major medical centers

Ann Intern Med

(1986)

J. DeFontes et al.

Preoperative safety briefing project

Permanente J

(2004)

B. Posner et al.

Perceived situation moderators of the relationship between role ambiguity, job satisfaction, and effectiveness

J Soc Psychol

(1979)

Cited by (496)

Investigating group formation: An experiment on the distribution of extraversion in educational settings
2024, Acta Psychologica
Group formation plays a crucial role in enhancing collaborative learning experiences. This study investigates the impact of extraversion as a criterion for group formation on collaborative learning outcomes. A total of 180 students participated in the experiment and were assigned to groups that were homogeneously or heterogeneously distributed in terms of extraversion. The groups met weekly and worked on group assignments throughout the semesters. The first hypothesis posed the outcomes to be explainable at the group-level. Surprisingly, the results show that groups with a homogeneous distribution of extraversion reported higher levels of group work satisfaction than those with a heterogeneous distribution, in contrast to the second hypothesis and the group hierarchy theory. These findings emphasize the potential of considering personality traits when forming groups and extend the existing literature on group formation. The study takes a critical stance by addressing normative definitions of leadership. Future research is suggested to further enhance collaborative learning experiences using similar interdisciplinary and experimental methods.
A Multifaceted Intervention to Improve Teamwork on an Inpatient Pediatric Neurosurgery Service
2024, Joint Commission Journal on Quality and Patient Safety
Increased safety reports related to interprofessional teamwork on an acute care unit at a quaternary children's hospital prompted a teamwork-focused improvement effort on the pediatric neurosurgery service.
An interprofessional workgroup was formed and met twice monthly throughout the project. A survey using modified validated items was disseminated to pediatric neurosurgery nurses, advanced practice providers (APPs), and physicians in March 2021 to identify opportunities for improvement. Structured debriefs on survey results promoted discourse on teamwork. The researchers implemented two interventions: (1) nursing-centered interprofessional education and (2) a rounding checklist before redistributing the survey in December 2021.
Baseline and follow-up survey response rates were 84.1% (58/69) and 71.4% (50/70), respectively. Nurses at baseline perceived lower teamwork scores for 12 items compared to physicians and APPs (p < 0.05). Nurse perceptions improved after interventions in: “using ‘we’ rather than ‘they’” (21.3% vs. 51.2% agree, p = 0.003), “I am confident that this team works effectively” (46.8% vs. 80.5%, p = 0.001), “shared understanding of each other's role on the team” (48.9% vs. 73.2% agree, p = 0.02), and “getting others on the team to listen” (46.8% vs. 75.6%, p = 0.004). Mean teamwork effectiveness improved from 4.12 to 5.25 (out of 7; p < 0.0001). Nurses ranked three interventions as most effective: interprofessional training (35/41, 85.4%), educational clinical pearls (14/41, 34.1%), and structured opportunities to discuss teamwork (10/41, 24.4%).
Interprofessional training, a teamwork survey, and structured debriefing improved nurse perceptions of teamwork. Interventions targeting social components of change can improve teamwork even without process changes.
Nurses' perceptions regarding the impact of teamwork on patient safety culture in the operating room: A qualitative study
2023, Perioperative Care and Operating Room Management
Patient safety culture is a significant concept that must be addressed by health care organizations to enhance patient safety. The complexity and pace of the operating room environment means that it is highly susceptible to healthcare errors. Successful surgery and health care, in general, depends on effective teamwork. Improvement of teamwork performance in the operating room should therefore lead to increased safety for surgical patients.
To explore the perceptions of nurses regarding teamwork and its impact on patient safety culture in the operating room of a Jordanian tertiary hospital.
A qualitative design was used involving semi-structured interviews with the operating room nurses. The study was conducted at a single tertiary hospital in Jordan. Purposive sampling of participants was used to capture multiple perspectives. The data were analysed using thematic analysis.
Teamwork that influences safety culture in the OR was categorized into two overarching themes: internal teamwork (within the OR), and external teamwork (between the OR and other units). Each theme was further categorized into subthemes. The respondents emphasized the role of internal and external teamwork in the operating room in establishing a patient safety culture and improving the safety and quality of surgeries.
The present study will have implications for hospitals and healthcare providers in Jordan for developing internal and external teamwork in the operating room, and to eliminate or decrease the occurrence of adverse events and improve the OR safety culture.
“My gut feeling is…”: An Ethnographic Study Exploring Interprofessional Communication About Children and Adolescents With Chronic Musculoskeletal Pain in Paediatric Rheumatology
2023, Journal of Pain
Interprofessional communication about inflammatory and non-inflammatory musculoskeletal conditions is an important component of assessment and management in paediatric rheumatology. Chronic pain is a feature of some of these conditions which likely influences the extent and type of communication about pain. Research investigating interprofessional communication about paediatric pain is limited but has found that communication is inclusive of the biopsychosocial context of children/adolescents as well as their families. The aim of this ethnographic study was to explore interprofessional communication about children and adolescents with chronic musculoskeletal pain in paediatric rheumatology. We observed forty-five healthcare professionals recruited from 3 UK paediatric rheumatology teams during thirty multi-disciplinary team meetings. Contemporaneous field notes created during observations were analysed using grounded theory procedures. Core processes identified in interprofessional communication involved describing, making sense of, and managing children/adolescents with pain and their families. Topic areas discussed within these core processes included healthcare professional perceptions about children’s and parents’ personality characteristics, as well as healthcare professionals’ familiarity with families. Underlying diagnoses and possible attributions of pain aetiology were also discussed. Interprofessional narratives included consideration of the potential anxieties and uncertainties about pain within families. Healthcare professionals communicated about strategies for managing expectations about pain. These findings characterise the nuances in interprofessional communication about pain and can be used to inform future work aimed at understanding and optimising the impact of interprofessional communication on clinical decisions and pain outcomes.
This study characterises the processes (series of actions), the function (purpose) and the content (topic areas) of interprofessional communication about paediatric pain in rheumatology settings. These findings should be used to inform interventions targeting both the appropriateness and effectiveness of this communication.
Team- and task-related knowledge in shared mental models in operating room teams: A survey study
2023, Heliyon
The operating room is a highly complex environment, where patient care is delivered by interprofessional teams. Unfortunately, issues with communication and teamwork occur, potentially leading to patient harm. A shared mental model is one prerequisite to function effectively as a team, and consists of task- and team-related knowledge. We aimed to explore potential differences in task- and team-related knowledge between the different professions working in the operating room. The assessed team-related knowledge consisted of knowledge regarding other professions’ training and work activities, and of perceived traits of a high-performing and underperforming colleague. Task-related knowledge was assessed by mapping the perceived allocation of responsibilities for certain tasks, using a Likert-type scale.
A single sample cross-sectional study.
The study was performed in three hospitals in the Netherlands, one academic center and two regional teaching hospitals.
106 health care professionals participated, of four professions. Most respondents (77%) were certified professionals, the others were still in training.
Participants generally were well informed about each other's training and work activities and nearly everyone mentioned the importance of adequate communication and teamwork. Discrepancies were also observed. The other professions knew on average the least about the profession of anesthesiologists and most about the profession of surgeons. When assessing the responsibilities regarding tasks we found consensus in well-defined and/or protocolized tasks, but variation in less clearly defined tasks.
Team- and task-related knowledge in the operating room team is reasonably well developed, but irregularly, with potentially crucial differences in knowledge related to patient care. Awareness of these discrepancies is the first step in further optimization of team performance.
Familiarity of surgical teams: Impact on laparoscopic procedure time
2022, American Journal of Surgery
Surgical performance is a team effort. We examine whether the familiarity among laparoscopic team members will influence the procedure time (PT).
A team familiarity score (TFS) and an Index of difficulty of surgery (IDS) was calculated for each of the 360 laparoscopic procedures. Simple linear, multiple linear regressions, and random forest regressions were used for data analyses.
Simple linear regression shows for every 1% increase in TFS, PT decreases by about 0.24% (p < 0.001); 7% of PT variability can be explained by TFS alone. Multiple linear regression reported that 49% of PT variability can be explained when considering IDS, team size, and TFS as influencing factors. Random forest regression reported that 52% of PT variability can be explained by taking TFS, Team Size, Patient Age, and IDS into the model.
Team familiarity makes a small but significant contribution to the enhancing of surgical team performance in laparoscopic procedure.

View all citing articles on Scopus

Competing Interests Declared: None.

Supported by the Agency for Healthcare Research and Quality, grant numbers 1UC1HS014246 and 1PO1HS1154401.

View full text

Original scientific articleOperating Room Teamwork among Physicians and Nurses: Teamwork in the Eye of the Beholder

Background

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acknowledgment

Reg Anesth Pain Med

J Perianesth Nurs

J Thorac Cardiovasc Surg

Int J Nurs Stud

Risk factors for retained instruments and sponges after surgery

N Engl J Med

Sentinel eventsevaluating cause and planning improvement

To err is humanbuilding a safer health system [Institute of Medicine Report]

Cockpit resource managementExploring the attitude-performance linkage

Aviat Space Environ Med

Association between nurse-physician collaboration and patient outcomes in three intensive care units

Crit Care Med

The performance of intensive care unitsdoes good management make a difference?

Med Care

An evaluation of outcome from intensive care in major medical centers

Ann Intern Med

Preoperative safety briefing project

Permanente J

Perceived situation moderators of the relationship between role ambiguity, job satisfaction, and effectiveness

J Soc Psychol

Original scientific article
Operating Room Teamwork among Physicians and Nurses: Teamwork in the Eye of the Beholder