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Prospective sensemaking in the operating theatre

Abstract

This paper reports a study of sensemaking in operating theatres. We explored the role of sensemaking processes in the safe and efficient performance of surgical procedures. The study is based on observations, semi-structured interviews, and informal conversations with surgeons, anaesthetists, operating nurses, and anaesthetic nurses. We found that the members of the operating team paid great attention to what might happen during the next seconds, minutes, and hours. They thus built a capacity for anticipation which enabled them to collaborate smoothly and prepared them to handle undesired but foreseeable occurrences. According to Karl Weick, organisational sensemaking is retrospective in the sense that we make sense of our actions and experience after they have occurred. However, our findings suggest that prospective sensemaking is a precondition for safe and successful completion of surgical procedures. Instead of waiting for things to happen and making sense of them in retrospect, the operating team constructed plausible projections of what might happen and how they might handle such plausible futures. Prospective sensemaking is thus less event-driven than retrospective sensemaking. We argue that safe and efficient performance of surgical procedures depends on the quality of prospective sensemaking. We comment on how technology (including procedures) can support prospective sensemaking. Finally, we discuss the relationships between “prospective sensemaking” and related terms, such as “heedful interrelating”, “mindfulness”, “situation awareness”, and “anticipatory thinking”.

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Notes

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    An intracranial aneurysm is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localised dilation or ballooning of the blood vessel.

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Acknowledgments

This research was funded by the Center for Integrated Operations in the Petroleum Industry, Norway. The preparation of the paper was also partly funded by the Research Council of Norway through the project Learning from Successful Operations, which is sponsored by the PETROMAKS research programme. The study was made possible by collaboration with Operating Room of the Future, St. Olavs Hospital, Trondheim University Hospital (FOR—”Fremtidens operasjonsrom”). FOR was a partner in the project. They introduced us to the two surgical departments and gave us access to their research infrastructure during the project period. The authors thank Tor Olav Grøtan for valuable comments to a draft of the paper.

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Correspondence to Ragnar Rosness.

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Ethical approval

Our most important ethical considerations were (1) to make sure that we did not interfere with the work of the operating teams in any way that might have adverse consequences for the patients, and (2) that we respected the privacy of patients and personnel involved. We were seated in a corner of the operating room and left to the operating team to decide when and how much they would communicate with us, e.g. by explaining the procedures. We took care to comply with the local hygiene rules. With a few exceptions, one of them discussed in this paper, the surgical interventions took place under general anaesthesia, and we were present in the operating theatre only when the patient was asleep. No names or other information that could identity patients or personnel were recorded. The personnel involved were informed in advance about the purpose of the study. Nobody had reservations against our presence in the operating theatre. The feedback meetings gave the personnel an opportunity to pinpoint accounts or interpretations that they might find erroneous or biased. The observation routines and reporting routines of the study were discussed with and approved by Operating Rooms of the Future and the involved departments before the observations started.

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Rosness, R., Evjemo, T.E., Haavik, T. et al. Prospective sensemaking in the operating theatre. Cogn Tech Work 18, 53–69 (2016). https://doi.org/10.1007/s10111-015-0346-y

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Keywords

  • Sensemaking
  • Safety
  • Organisations
  • Operating theatre