Paradoxical effects of interprofessional briefings on OR team performance
- 302 Downloads
- 2 Citations
Abstract
Our recent research has found that structured preoperative team briefings can reduce communication failures, improve the knowledge and practice of operating room (OR) team members, and garner broad support from surgeons, nurses, and anesthesiologists. However, we have also encountered challenges and unexpected, negative effects. Using qualitative analysis of fieldnotes from 302 preoperative team briefings, we identified five paradoxical findings: team briefings could mask knowledge gaps, disrupt positive communication, reinforce professional divisions, create tension, and perpetuate a problematic culture. Fifteen percent of the briefings exhibited only these paradoxical effects without any apparent utility. We describe these paradoxical findings and analyze them in relation to educational, functional, structural, and cultural factors. This analysis is instructive not only for re-engineering the briefing process, but also for revealing dynamics that may continue to impede optimal interprofessional performance.
Keywords
Operating room Interprofessional communication Team briefing Checklist Patient safetyNotes
Acknowledgments
This research was funded by the Canadian Institutes of Health Research (CIHR) and by the physicians of Ontario through the P.S.I. Foundation. Lorelei Lingard is supported by a CIHR New Investigator Award and as the BMO Financial Group Professor in Health Professions Education Research. Glenn Regehr is supported as the Richard and Elizabeth Currie Chair in Health Professions Education Research.
References
- Amalberti R, Auroy Y, Berwick D, Barach P (2005) Five system barriers to achieving ultrasafe health care. Ann Intern Med 142:756–764Google Scholar
- Burke K (1966) Language as symbolic action. Essays on life, literature and method. University of California Press, BerkeleyGoogle Scholar
- Checkoffs play key role in SICU improvement: checklist helps team follow care plan (2003) HealthCare Benchmarks and Quality Improvement 10(10):113–115. http://findarticles.com/p/articles/mi_m0NUZ/is_10_10/ai_109026749. Retrieved May 14 2007
- Degani A, Wiener EL (1993) Cockpit checklists: concepts, design, and use. Hum Factors 35(2):345–359Google Scholar
- Lingard L, Espin S, Rubin B, Whyte S, Colmenares M, Baker GR, Doran D, Grober E, Orser B, Bohnen J, Reznick R (2005) Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR. Qual Saf Health Care 14:340–346CrossRefGoogle Scholar
- Lingard L, Whyte S, Espin S, Baker GR, Orser B, Doran D (2006) Towards safer interprofessional communication: constructing a model of “utility” from preoperative team briefings. J Interprof Care 20(5):471–483CrossRefGoogle Scholar
- Lingard L, Regehr G, Orser B, Reznick R, Baker GR, Doran D, Espin S, Bohnen J, Whyte S (2007) A preoperative checklist and team briefing among surgeons, nurses, and anesthesiologists reduces failures in communication. Arch Surg (in press)Google Scholar
- Pronovost P, Berenholtz S, Dorman T, Lipsett P, Simmonds T, Haraden C (2003) Improving communication in the ICU using daily goals. J Crit Care 18(2):71–75CrossRefGoogle Scholar
- QI experts say ‘automatic’ handoffs could cause errors: don’t complete checklists without thinking (2006) Hospital case management 14(2):24–26Google Scholar
- Reason JT (1990) Human error. Cambridge University Press, New YorkGoogle Scholar
- Salas E, Wilson KA, Burke CS, Wightman DC (2006) Does crew resource management training work? An update, an extension, and some critical needs. Hum Factors 48(2):392–412CrossRefGoogle Scholar
- Strauss A, Corbin J (1990) Basics of qualitative research: Technique and procedures for developing grounded theory (2nd ed). Sage, Thousand OaksGoogle Scholar