Department of Anaesthesia, Sinai Health Systems, University of Toronto, Toronto, ON, Canada.
University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, BC, Canada.
Br J Anaesth. 2019 Feb;122(2):233-244. doi: 10.1016/j.bja.2018.10.056. Epub 2018 Dec 1.
Multidisciplinary care teams exist throughout healthcare systems. In the operating room (OR), effective communication between teams is essential, especially during crisis situations where patient safety can be in acute danger. An often-neglected skillset in educational curriculums is challenging authority. This narrative synthesis aims to explore the literature on challenging authority in the OR environment. A systematic search of Medline, EBM reviews and PsycINFO was conducted using terms related to challenging authority, speaking up, communication, patient safety, gradients and hierarchy. The initial search identified 4822 publications, out of which 31 studies were included. The data synthesis of the included studies was grouped into three distinct categories following a meta-aggregative approach: discussion and review articles, observational or qualitative studies, and studies identifying the role of specific barriers or investigating the effect of educational interventions. Themes emerging from expert beliefs, what reality tells us and what we test are consistent. Hierarchy, organisational culture and education are the most frequently observed and tested themes. Simulation research has been successful in eliciting and confirming the role of specific barriers to speaking up. Barriers and enablers are largely modifiable within institutions however, education regarding the importance of speaking up will need to accompany these modifications for any significant changes to occur.
多学科护理团队存在于整个医疗保健系统中。在手术室（OR）中，团队之间的有效沟通至关重要，特别是在患者安全可能处于急性危险的危机情况下。在教育课程中，一个经常被忽视的技能是挑战权威。本叙述性综合旨在探讨 OR 环境中挑战权威的文献。使用与挑战权威、直言不讳、沟通、患者安全、梯度和等级相关的术语，对 Medline、EBM 综述和 PsycINFO 进行了系统搜索。最初的搜索确定了 4822 篇出版物，其中包括 31 项研究。对纳入研究的数据进行综合分析，采用元聚合方法分为三个不同类别：讨论和综述文章、观察性或定性研究以及确定特定障碍作用或调查教育干预效果的研究。专家的信念、现实告诉我们的和我们测试的结果是一致的。等级制度、组织文化和教育是最常观察和测试的主题。模拟研究成功地引出和证实了直言不讳的具体障碍的作用。障碍和促进因素在很大程度上可以在机构内部进行修改，但是，关于直言不讳重要性的教育需要伴随这些修改，以便发生任何重大变化。
