Safe work practices in interdisciplinary surgical teamwork : model development and validation
MetadataShow full item record
- PhD theses (SV-IH) 
Original versionSafe work practices in interdisciplinary surgical teamwork : model development and validation by Sindre Høyland, Stavanger : University of Stavanger, 2013 (PhD thesis UiS, no. 200)
This thesis identifies needs in health research literature on quality and safety to explore the nature of teamwork and develop models that can be applied to, and integrate findings from, such explorations. This triggers an interest in exploring how safe work practices are achieved in interdisciplinary surgical teamwork, and also a related interest in developing and validating a model for such explorations. Accordingly, surgical operations are explored by means of observations, conversations, and interviews. As part of this exploration, a literature review process produces a framework for exploring safe work practices, comprising a knowledge and system dimension. These dimensions are operationalized through a field research protocol and a semi-structured interview guide to serve as a general frame of reference during the fieldwork. The emergent findings from the exploration, in turn, establish a scientific model by refining and validating the dimensions of the framework. The exploration and model development and validation efforts are supported by a balanced methodology, emphasizing both structure/transparency and in-depth descriptions in the gathering, analysis, and presentation of data. This thesis finds that safe work practices are achieved through the ability and variety that individuals demonstrate in handling multiple sources of information before reaching a particular decision; the variety of ways in which awareness or anticipation of future events are expressed; and the different ways in which the individual team members handle sudden and unexpected situations. Safe work practices are also achieved by means of the team’s ability to compensate, through system buffers and experience from exclusive exposure to one section, for vulnerabilities and disruptions that arise through various combinations of system factors. Finally, safe work practices are achieved through the individual’s ability to disregard stress/pressure and properly apply the time and considerations necessary for the job, and sense and communicate patient-related problems, and the team’s reliance on the individual’s competency and ability to plan and improvise when challenged by a problem or unforeseen situation during an operation. Safe work practices can be defined as the dynamic and continuous effort by each individual team member and the overall team to combine and draw upon explicit and tacit knowledge repertoires to achieve a successful operation with minimal errors and complications. Safe work practices also can be viewed as the overall organization’s ability to maintain inner and outer (system) conditions that are strong enough to support individual and team abilities to combine and draw upon knowledge repertoires. This thesis’ theoretical contribution to safety research lies in establishing a scientific model for exploring safe work practices in teamwork that is of broad enough design to include existing findings and concepts, as well as new findings. By applying the model as a frame for exploration during a qualitative study, this thesis also contributes to safety research by producing a broader understanding of how safe work practices are achieved in surgical teamwork. The main implication is that safety researchers should emphasize the design of broader models to facilitate systemizing existing findings. The thesis also suggests that a broader model increases the potential for generalizability and transferability of model aspects, implying that safety researchers should consider research quality during model development. These contributions and related implications answer the identified needs for explorations into the nature of teamwork and for developing models that can be applied to, and integrate findings from, such explorations. Given the identified lack of explorations into the nature of teamwork within the health care sector, this thesis’ practical contributions lie in the broad yet in-depth approach to safety in surgical teamwork. This is potentially relevant to policy-makers, managers, researchers, and practitioners. Implications include system conditions that should be established to facilitate safe work practices in surgical teamwork, such as buffers in terms of personnel, operating rooms, and equipment and forums/seminars for sharing knowledge. Systems should also be established to formalize different types of tacit knowledge, such as by incorporating questions into checklists that trigger sharp-end/local reflections. Establishing favorable system conditions, not only physically (buffers) but also in terms of knowledge-sharing and formalizing, can reduce the likelihood of adverse events and improve patient safety.
PhD thesis in Health, medicine and welfare
Has partsHøyland, S., Aase, K. & Hollund, J. G. (2011). Exploring varieties of knowledge in safe work practices – An ethnographic study of surgical teams. Patient Safety in Surgery, 5(21). URL: http://www.pssjournal.com/content/5/1/21
Høyland, S., Aase, K. & Hollund, J. G. (2011). Understanding thesystem in relation to safe medical work practices. Safety ScienceMonitor, 15(1). URL: http://ssmon.chb.kth.se/vol15/5_hoyland_aase.pdf
Høyland, S. (2011). Exploring safe work practices in surgicaloperations – The role of time, patient, and operation. In S. Albolino etal. (Eds): Healthcare Systems Ergonomics and Patient Safety 2011:Risks in OR, ICU and ER (pp. 430–435). Leiden, Netherlands: CRCPress/Balkema.
Høyland, S. (2012). Developing and validating a scientific model forexploring safe work practices in interdisciplinary teams. SafetyScience, 50(2), 316–325. URL: http://www.sciencedirect.com/science/article/pii/S0925753511002451