Towards safer interprofessional communication: Constructing a model of “utility” from preoperative team briefings

Abstract

“Improved team communication” is broadly advocated in the discourse on safety but rarely supported by a precise understanding of the relationship between specific communication practices and concrete improvements in collaborative work processes. We sought to improve such understanding by analyzing the discourse arising from structured preoperative team briefings among surgeons, nurses, and anesthesiologists prior to general surgery procedures. Analysis of observers' fieldnotes from 302 briefings yielded a two-part model of communicative “utility”, defined as the visible impact of communication on team awareness and behavior. “Informational utility” occurred when team awareness or knowledge was improved by provision of new information, explicit confirmation, reminders, or education. “Functional utility” represented direct communication – work connections: many briefings identified problems, prompting decision-making and follow-up actions. The crux of the model is an elaboration of the causal pathway between a specific communication practice (the team briefing), intermediary processes such as enhanced knowledge and purposeful action, and the quality and safety of collaborative care processes. Modeling this pathway is a critical step in promoting change, as it renders visible both the latent dangers present in current team communication systems and the specific ways in which altered communication patterns can impact team awareness and behaviors.

Keywords:

• Communication
• safety
• operating room
• teams
• interprofessional practice

Notes

1. In this treatment of surgery and anesthesia as two distinct “professions” on the interprofessional OR team, we reflect the interactionist perspective on conceptualizing the term “profession” (Abbott, [1988]; Crompton, [1990]). In this view, professions are conceptualized as part of a broader classification of occupations, with differences of degree, not kind. This approach assists in grappling with distinctive cultures that exist within a profession such as medicine. Anesthesia and surgery are distinctive medical cultures which, while they share key professional attributes such as control over training/accreditation processes and self-regulation of autonomous practice, differ intensely in their models of care, their safety culture, and their relations with other healthcare professions, such as nursing. To perceive these two cultures as one, unified profession within the OR team would be to belie these formative differences and their impact on the team's collaborative care processes.

2. Often, the anesthesia staff oversaw two operating theatres and the senior anesthesia trainee acted as the lead anesthesiologist.