Leach Linda Searle, Myrtle Robert C, Weaver Fred A, Dasu Sriram
University of California Los Angeles, School of Nursing, Los Angeles, CA, USA.
Health Care Manage Rev. 2009 Jan-Mar;34(1):29-41. doi: 10.1097/01.HMR.0000342977.84307.64.
High-performing and high-reliability teams are an important component of service delivery. With a focused emphasis on safety in acute care hospitals, understanding the nature of surgical teams and team performance is an essential component to achieving high-quality surgical care. More information is needed about the challenges to effective team functioning in the operating room, the influence of working conditions, and the environmental context on surgical team performance.
The purpose of this study is to describe the nature of surgical teams and how they perform in the operating room to contribute to a broader knowledge about high-performing and high-reliability teams in health care settings.
METHODOLOGY/APPROACH: We conducted a qualitative study involving direct observation and semistructured interviews. Field observations of 10 high-complexity surgeries and face-to-face interviews with 26 members of surgical teams were completed at one university medical center. A conceptual framework derived from the literature was developed to guide the selection of surgeries and surgical teams to be observed. Data were transcribed and analyzed to identify the factors and different conditions that influence the performance of these surgical teams.
The type of coordination and the degree of independent and interdependent coordination vary among the seven observed stages of the surgical process. Most of the surgical teams were ad hoc teams and as such, further challenged by consistently frequent "hand-offs" for break relief. Additional role demands influence the situational dynamics which can alter the adaptive capacity of the team.
The surgical event evokes a changing degree of coordination and adaptation to complexity and uncertainty. In such environments, relational coordination through leadership can contribute to a successful surgical result, improvement of the overall process, including error reduction, and enhanced knowledge creation and dissemination, particularly germane in research university teaching hospitals.
高效能和高可靠性团队是服务提供的重要组成部分。鉴于急性护理医院对安全的重点关注，了解手术团队的性质和团队绩效是实现高质量手术护理的关键要素。关于手术室中有效团队运作面临的挑战、工作条件的影响以及环境背景对手术团队绩效的作用，还需要更多信息。
本研究的目的是描述手术团队的性质以及他们在手术室中的表现，以增进对医疗环境中高效能和高可靠性团队的广泛认识。
方法/途径：我们开展了一项定性研究，包括直接观察和半结构化访谈。在一所大学医学中心完成了对10台高复杂性手术的现场观察以及与26名手术团队成员的面对面访谈。基于文献构建了一个概念框架，以指导手术和手术团队的观察选择。对数据进行转录和分析，以确定影响这些手术团队绩效的因素和不同条件。
在手术过程观察的七个阶段中，协调类型以及独立和相互依赖协调的程度各不相同。大多数手术团队是临时团队，因此，持续频繁的轮班交接带来了进一步挑战。额外的角色需求会影响情境动态，进而改变团队的适应能力。
手术事件引发了协调程度的变化以及对复杂性和不确定性的适应。在这种环境中，通过领导力进行关系协调有助于取得成功的手术结果、改善整体流程（包括减少错误）以及加强知识创造和传播，这在研究型大学教学医院中尤为重要。
