Hearts and minds in the operating room: co-constructing a shared mental model with surgery teams for more predictable and more highly reliable collaborative voice and response
Date
2024
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Abstract
Overview: This qualitative case study explored nontechnical human factors—values, beliefs, attitudes, and behaviors—that make it easier or more difficult for surgeons, as team leaders, to encourage team members to voice safety concerns, clinical opinions, and learning questions; for team members to actually speak up; and for surgeons to respond collaboratively. Research site and participants: The research site was a major academic hospital in the western United States. Five surgeons and five anesthesiologists volunteered to participate. Perioperative nurses and surgical technologists were recruited but did not participate. Purpose, methodology, and methods: The purpose of the study was to co-construct, with participants, a shared mental model for collaborative voice and response. The study followed the constructivist inquiry paradigm and methodology, which posits that individuals and groups construct, co-construct, and can reconstruct their social realities. Using adaptive work theory and methods, semi-structured interviews were used to gather data on what values, beliefs, attitudes, and behaviors participants perceived to be essential versus expendable for more collaborative, predictable, and highly reliable voice and response. Thematic content analysis identified six themes, from which a proposed shared mental model was constructed by the researcher. Member checking with participants confirmed that the themes were accurate and comprehensive; that the proposed shared mental model comprehensively reflected the themes; and that, used in practice, the shared mental model could help collaborative voice and response be more predictable and more highly reliable. Results: Themes were let's be best-in-class; respect and be kind to all; value patient safety and well-being of all team members; explicitly encourage and appreciate voice; do speak up; and am I really that approachable? The proposed shared mental model constructed from the themes was represented by the mnemonic REVAT, the first letters of each component: Respect and be kind to all, Encourage voice, Voice (do speak up), Appreciate voice, and Thrive (all of us). The study also identified two subthemes, hierarchical abuses of power and production pressures or time pressures that hinder collaborative voice and response; and should also be understood and well-managed, so that patient safety and clinician well-being are less at risk. Conclusion: Well-being is essential for clinicians' own sakes, for patient safety, and for clinical performance and outcomes. REVAT, the proposed shared mental model for collaborative voice and response, is simply stated as "respect, encourage, voice, appreciate, and thrive." As such, it is a "simple rule" much like "first do no harm," that could help caregivers better succeed in their goals and thrive.
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Subject
collaborative communications
patient safety
surgery teams
health care
clinician well-being
shared mental model