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Learning Objective 1: understand the team communication environment within the operating room with an emphasis on nurse-physician communication.
Learning Objective 2: understand how to design, develop, and implement a multi-site acute care qualitative study.
This is an IRB aproved study and is an unfolding of the socially constructioned reality of communication as seen through the perspectives of 68 operating room team members accross 6 acute healthcare sites at OSF Healthcare in the Midwest. The sites range from small community to large university settings. To develop this study I borrowed from the traditions of ethnography, and narrative interviewing. In addtion, I am developing a relatively new framework in research known as the Coordinated Management of Meaning(CMM) which explores individual and group experince through communication within the context of the culture, the individual and the experience.
Within the frame of culture and relationships I wanted to understand how the operating room team members perceive their communication as related to creating a culture of safety. Specifically, this was a search for information as related to the social construction of team interactions in healthcare within the context of the medical hierarchy and communication, does the team sense that there are specific communication patterns due to the hierarchy, and how do they think these patterns may alter potential patient outcomes.
Therefore, this study described communication patterns among team members in an operating room in an acute care medical center. The participants included nurses, physicians, technologists, and non-clinical personnel. Drawing on ideas from the traditions of ethnography, narrative interviewing, and CMM the data were analyzed both by thematic coding and using some of the heuristics from the theory of the Coordinated Management of Meaning (CMM).
The themes revealed that to develop a culture of safety, the healthcare environment and team relationships needs to be free of intimidation and avoidance, where communication flows openly and that all of the voices on the team need to be heard in an atmosphere of equality. Most important in the creation of a culture of safety, is that patients should always be the prime focus of all team members. Another large factor is the team often has limited or no time to develop as collaborative partners.
An important notion is that in healthcare the medical hierarchy holds in place a constrictive and suppressive communication environment. To understand and potential change this paradigm we need to share our stories. In exploring team communications and learning to have an appreciation of individual expertise and knowledge, healthcare professionals can begin to dissolve the ineffective boundaries that exist within the context of the medical hierarchy and communication. These are the ineffective boundaries which are not conducive to the creation of collaborative healthcare professional partnerships and the continued development of a culture of safety.
Thus, the findings suggest that to develop a culture of safety, professionals in healthcare need to increase their abilities to partner, trust each other as a care delivery team, treat each other with respect, and to develop collaborative meaning making in an effort to deliver safe patient care.
Using the findings we have embarked on practical applications of curriculum development for teams in the space of simulation. And, have two studies in progress using simulation as a platform for team communication development. In addition, I have implemented what I am calling a CMM summit to develop shared meaning making with team members, and to understand this within the context of collaborative partnerships in the operating room environment between team members for the continued development of a culture of safety.
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