Safe work practices in interdisciplinary surgical teamwork : model development and validation

PhD thesis in Health, medicine and welfareThis 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

A holistic perspective on continuing care for substance use and dependence: Results and implications from an in-depth study of a Norwegian continuing care establishment

This article explores, systematically and in depth, users’ perceptions of participating in a Norwegian non-profit establishment that provides a continuing care programme for substance use and dependence. Identified results are linked to a holistic system perspective, where human, technology, and organisation (HTO), as well as external environment, are viewed as intertwined. At the establishment level, i.e., where the continuing care programme is delivered, we find that a clear holistic and user-oriented profile – comprising combined interventions including physical and social activities – can create a safe and stable environment that exerts a positive mental and physical influence on the user and thereby promotes abstinence from substances. However, our results suggest that the internal environment needs to connect more strongly with the external environment, such as a substance-free network, close family, and working life. At the establishment level, we conclude that there is a need to develop an explicit strategy and practice for collaborating with the external environment, built on systemisation and application of individual users’ insights into the design of the current interventions. Further research should explore the presence and absence of interplays between elements of human, technology, and organisation and the external environment, and the associated consequences for intervention processes and users’ health outcomes. Our holistic system model, empirically informed by data from a Norwegian context, can represent a starting point for such endeavours. The holistic system model also constitutes an original and novel contribution to research on continuing care interventions.publishedVersio

Exploring varieties of knowledge in safe work practices - an ethnographic study of surgical teams

<p>Abstract</p> <p>Background</p> <p>Within existing research in health and medicine, the nature of knowledge on how teams conduct safe work practices has yet to be properly explored.</p> <p>Methods</p> <p>We address this concern by exploring the varieties in which knowledge is expressed during interdisciplinary surgical operations. Specifically, the study was conducted in a surgical section of a Norwegian regional general hospital, between January and April of 2010, by means of an ethnographic design combining detailed non-participant observations, conversations and semi-structured interviews.</p> <p>Results</p> <p>Based on an analysis of the gathered data, we identify three particular themes in how knowledge is expressed by operating room personnel: (i) the ability and variety individuals demonstrate in handling multiple sources of information, before reaching a particular decision, (ii) the variety of ways awareness or anticipation of future events is expressed, and (iii) the different ways sudden and unexpected situations are handled by the individual team members.</p> <p>Conclusions</p> <p>We conclude that these facets of knowledge bring different insights into how safe work practices are achieved at an individual and team level in surgical operations, thus adding to the existing understanding of the nature of knowledge in safe work practices in surgical operations. Future research should focus on exploring and documenting the relationships between various elements of knowledge and safe work practices, in different surgical settings and countries.</p

Resultater fra utforskning av Dolley trallen ved UNN - NFR FORREGION prosjekt 333752

Innovasjonsprosjektet «Utvikling, testing og tilpasning av Dolley» omhandler utforskning av en tralle til oppbevaring av pasientenes personlige eiendeler og håndbagasje for enkel håndtering og forflytning på sykehus og/eller institusjoner. Prosjektet har en forskningsdel som utledes om i denne rapporten. Ideen funderes på at det ved dagens sykehus ikke finnes hjelpemidler som kan avhjelpe pasientene med de mest enkle oppgaver som å ha en plass å legge veske, klær, personlige eiendeler og lignende, og samtidig kunne frakte disse med seg rundt på avdelingen. Hovedmålsetning for prosjektet er å utvikle en protype av trallen til en endelig løsning for sykehusmiljøet som tar høyde for spekteret av tilpasningsbehov definert av samtlige involverte/berørte aktører med spenn fra pasienter/brukere via ansatte til ledelsen ved sykehuset.publishedVersio

A System Perspective on Implementation and Usage of the Da Vinci Technology at a Large Norwegian Regional Hospital

The aim of this research paper is to identify advantages and barriers to implementation and usage of robotic-assisted surgery (RAS), specifically the Da Vinci robot, at a larger regional hospital in Norway and from a multiple stakeholder perspective. The identified advantages and barriers are connected to the socio-technical system framework SEIPS, thereby establishing a broader contextual system perspective on RAS implementation and usage. Our findings both align and extend upon existing human factors and ergonomics (HFE) knowledge on RAS in the operating room. In terms of specific future directions, we believe that a pressing concern for both management and current HFE research involving RAS implementation and usage relates to exploring and accounting for the close connections between the organization itself and the external stakeholders that exert a considerable influence on the internal work system and processes and the ability to achieve cost-efficiency and safety levels. We further conclude that the SEIPS framework can be a powerful tool in drawing or eliciting the larger contextual picture of RAS implementation and usage, and we encourage further HFE research to explore its application in different contexts to improve the current knowledge base.publishedVersio

A cross‐sector systematic review and synthesis of knowledge on telemedicine interventions in chronic wound management—Implications from a system perspective

Based on initially identified needs for further telemedicine (TM) and chronic wound management research, the objective of this article is twofold: to conduct a systematic review of existing knowledge on TM interventions in chronic wound management—including barriers and opportunities—across the specialist and primary care sectors, and to incorporate the review findings into a system framework that can be further developed and validated through empirical data. We conclude that there is a pressing need for broader and more comprehensive empirical explorations into quality improvement and integration of TM in chronic wound management, including using system frameworks that can capture cross‐sector system perspectives and associated implications. Of practical consideration, we suggest that the design and execution of TM improvement interventions and associated research projects should be conducted in close cooperation with managers and practitioners knowledgeable about barriers and opportunities that can influence the implementation of important interventions within chronic wound management

A Contribution to Empirical Revitalization of the Samfunnssikkerhet Concept

Current research of the Norwegian samfunnssikkerhet concept appears to be lacking, with few scientific publications advancing the understanding of the concept. This weakness is addressed through the paper&rsquo;s empirical exploration of challenges in the work on samfunnssikkerhet (Paper aim #1), where the resulting insight informs an epistemological understanding of the concept of samfunnssikkerhet (Paper aim #2). The paper identifies four challenges in the work on samfunnssikkerhet, which suggest that samfunnssikkerhet is about mobilizing against both known and unknown threats through broad and border-crossing cooperation and about flexible methods and design approaches. It is concluded that the paper&rsquo;s empirical exploration of the samfunnssikkerhet concept contributes to a clarification and overall empirical revitalization of the concept. A recommendation to safety and security researchers is to further develop the empirical understanding of the samfunnssikkerhet concept, including through validation of the challenges identified in this paper and continuous mapping of additional and future challenges. This can give the samfunnssikkerhet concept, including its relation to concepts such as resilience, risk and societal security, a clearer meaning and consequently a stronger unifying role in efforts to prevent and manage today&rsquo;s dynamic threats both within and outside Norway

Forskningsresultater og implikasjoner for et helhetlig og brukerorientert kommunalt ettervernstilbud

I denne rapporten presenterer NORCE resultater fra forskningsdelen av prosjektet «Kommunalt ettervern på Jæren bygget på design- og effektstudier.» Prosjektet, bevilget av Regionalt forskningsfond Vestlandet, har løpt i perioden 01.09.2017 til 31.10.2020 med følgende samarbeidspartnere: Klepp kommune (prosjektansvarlig), Hå kommune, Time kommune og Gjesdal kommune, designbyrået Inventas AS, ettervernsvirksomheten EV (som ble studert, anonymisert) og Regionalt kompetansesenter for rusmiddelforskning i Helse Vest (KORFOR). Målsetninger for forskningsprosjektet har vært å kartlegge nasjonale og internasjonale effekter av ettervernstilbud knyttet til rusbruk- og avhengighet, innbefattet en spesifikk nasjonal ettervernsvirksomhet (EV), samt implikasjoner av effektene for utvikling av et helhetlig og brukerorientert kommunalt ettervernstilbud. Forskningsprosjektet har bestått av følgende komponenter/studier; (i) en nasjonal og internasjonal litteraturstudie, (ii) en nasjonal empirisk intervjustudie m/NVivo analyse, (ii) en kvantitativ studie av fysiske effektmål og (iv) en BrukerPlan analyse utført av KORFOR (som underleverandør til forskningsdelen av prosjektet).Regionalt forskningsfond Vestlande

A holistic perspective on continuing care for substance use and dependence: Results and implications from an in-depth study of a Norwegian continuing care establishment

This article explores, systematically and in depth, users’ perceptions of participating in a Norwegian non-profit establishment that provides a continuing care programme for substance use and dependence. Identified results are linked to a holistic system perspective, where human, technology, and organisation (HTO), as well as external environment, are viewed as intertwined. At the establishment level, i.e., where the continuing care programme is delivered, we find that a clear holistic and user-oriented profile – comprising combined interventions including physical and social activities – can create a safe and stable environment that exerts a positive mental and physical influence on the user and thereby promotes abstinence from substances. However, our results suggest that the internal environment needs to connect more strongly with the external environment, such as a substance-free network, close family, and working life. At the establishment level, we conclude that there is a need to develop an explicit strategy and practice for collaborating with the external environment, built on systemisation and application of individual users’ insights into the design of the current interventions. Further research should explore the presence and absence of interplays between elements of human, technology, and organisation and the external environment, and the associated consequences for intervention processes and users’ health outcomes. Our holistic system model, empirically informed by data from a Norwegian context, can represent a starting point for such endeavours. The holistic system model also constitutes an original and novel contribution to research on continuing care interventions

Nasjonale og internasjonale effekter av ettervern innen rusbruk og avhengighet

I denne rapporten presenterer NORCE resultater fra forskningsdelen av prosjektet «Kommunalt ettervern på Jæren bygget på design- og effektstudier.» Prosjektet, bevilget av Regionalt forskningsfond Vestlandet, har løpt i perioden 01.09.2017 til 31.10.2020 med følgende samarbeidspartnere: Klepp kommune (prosjektansvarlig), Hå kommune, Time kommune og Gjesdal kommune, designbyrået Inventas AS, ettervernsvirksomheten EV (som ble studert, anonymisert) og Regionalt kompetansesenter for rusmiddelforskning i Helse Vest (KORFOR). Målsetninger for forskningsprosjektet har vært å kartlegge nasjonale og internasjonale effekter av ettervernstilbud knyttet til rusbruk- og avhengighet, innbefattet en spesifikk nasjonal ettervernsvirksomhet (EV), samt implikasjoner av effektene for utvikling av et helhetlig og brukerorientert kommunalt ettervernstilbud. Forskningsprosjektet har bestått av følgende komponenter/studier; (i) en nasjonal og internasjonal litteraturstudie, (ii) en nasjonal empirisk intervjustudie m/NVivo analyse, (ii) en kvantitativ studie av fysiske effektmål og (iv) en BrukerPlan analyse utført av KORFOR (som underleverandør til forskningsdelen av prosjektet)