Perspectives on Psychological Safety in the Operating Room: Investigating the Factors That Influence the Culture of Safety in the Operating Room

Abstract

INTRODUCTION: Psychological safety (PS) is the concept where members of a team are empowered to ask questions, report errors, and speak up without fear of repercussion. PS is particularly important in the operating room (OR), which demands high-level performance from all members of the team, under multiple stressors. There are limited studies looking at PS in the OR from the perspectives of each highly specialized team member. Therefore, we are investigating each members’ perspectives about the factors that contribute to and retract from establishing PS in the OR. METHODS: We conducted semi-structured interviews and focus groups with operative team members at Baylor Scott and White Memorial Hospital, including surgeons, surgical residents, circulating nurses, surgical technologists, anesthesiologists, and nurse anesthetists. The interviews were sorted by role, transcribed, and de-identified for confidentiality. The transcribed data is being coded and analyzed by two investigators independently. The codes will then be put into categories and themes. RESULTS: There were 21 participants, including 7 surgeons, 4 surgical residents, 2 anesthesiologists, 4 nurse anesthetists, 3 surgical technologists, and 1 circulating nurse. We are currently in the process of codifying and analyzing the data. Preliminary themes include non-physician vs physician perspectives on roles and responsibilities, and internal vs external influences on team dynamics (Table). CONCLUSION: We sought to capture perceptions and lived experiences that will shed light on what strengthens or weakens psychological safety within the OR. And, ultimately build a stronger culture of safety for the benefit of all OR team members and their patients. Table 1. - Questions asked during individual interviews and focused group to guide discussion. Interview/Focus Group Questions 1. Describe an operating room (OR) where you feel completely at home. 2. Aside from clinical aspects, what are the biggest challenges facing the operating team? 3. Has there been an event in the OR where you felt that you wanted to say or do something, but didn’t? Why?a. Sub-question: What are your thoughts on the MIDAS incident reporting tool? 4. What does Psychological Safety (PS) in the OR look like to you? 5. What do you think are things that would support PS in the OR for you? 6. What do you think are things that would act as barriers to achieving PS in the OR for you? 7. How do lead operating surgeons (attending or chief resident) contribute to or retract from PS in the OR?