Teaching and Sustaining a Shared Mental Model for Intraoperative Communication and Teamwork

Abstract

Faculty Advisor: Nancy Gaba, MD PURPOSE: To develop and implement a process to: 1) identify gynecology team-specific barriers to uptake of TeamSTEPPS and 2) design a curriculum that promotes a strategy for effective communication and teamwork in the operating room. BACKGROUND: TeamSTEPPS is a structured approach to operating room communication and teamwork to improve patient safety. Adherence to TeamSTEPPS procedures is low. METHODS: Attendings, fellows, residents, anesthesiologists, certified nurse anesthetists, nursing staff, and scrub technicians involved in Gynecology Operating Rooms (ORs) at a tertiary care hospital completed the validated Safety Attitudes Questionnaire – OR version (SAQ-OR). Quantitative and qualitative survey data analysis identified barriers to teamwork and communication. A curriculum was designed to teach a shared mental model for OR communication. RESULTS: The survey response rate was 64%. The leading identified barriers to teamwork and communication were lack of open communication, team cohesion, and familiarity with team as well as disruptions during cases. Mean scores for the six domains of the SAQ were low: teamwork climate 50.1%, safety climate 48%, job satisfaction 50.3%, stress recognition 39.7%, perceptions of management 48.5%, and working conditions 49%. The curriculum designed taught strategies for communication and teamwork focusing on the identified concerns. Daily adherence to these strategies was 75% at one month. The SAQ will be repeated at 9 months. DISCUSSION: Identifying department-specific barriers to teamwork and communication allowed for development of a curriculum to address the specific concerns of the team members and may lead to improved uptake of teamwork and communication strategies. This process will be repeated hospital system-wide.