Campbell Krystle, Gardner Aimee, Scott Daniel J, Johnson Jada, Harvey Jillian, Kazley Abby
UT Southwestern Simulation Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Healthcare Leadership and Management, College of Health Professions, Doctor of Health Administration, Medical University of South Carolina, Charleston, SC, USA.
Adv Simul (Lond). 2023 Oct 25;8(1):24. doi: 10.1186/s41077-023-00263-2.
Medical errors still plague healthcare. Operating Room Black Box (ORBB) and ORBB-simulation (ORBBSIM) are innovative emerging technologies which continuously capture as well as categorize intraoperative data, team information, and audio-visual files, in effort to improve objective quality measures. ORBB and ORBBSIM have an opportunity to improve patient safety, yet a paucity of implementation literature exists. Overcoming implementation barriers is critical. This study sought to obtain rich insights while identifying facilitators and barriers to adoption of ORBB and ORBBSIM in alignment with Donabedian's model of health services and healthcare quality. Enrichment themes included translational performance improvement and real-world examples to develop sessions.
Interprofessional OR staff were invited to complete two surveys assessing staff's perceptions using TeamSTEPPS's validated Teamwork Perceptions Questionnaire (T-TPQ) and open-ended questions. Descriptive statistics were calculated for quantitative variables, and inductive phenomenological content analysis was used for qualitative.
Survey 1 captured 71 responses from 334 invited (RR 21%) while survey 2 captured 47 responses from 157 (RR 29.9%). The T-TPQ score was 65.2, with Communication (70.4) the highest construct and Leadership (58.0) the lowest. Quality Improvement (QI), Patient Safety, and Objective Case Review were the most common perceived ORBB benefits. Trends suggested a reciprocal benefit of dual ORBB and ORBBSIM adoption. Trends also suggested that dual implementation can promote Psychological Safety, culture, trust, and technology comfort. The need for an implementation plan built on change management principles and a constructive culture were key findings.
Findings supported ORBB implementation themes from previous literature and deepened our understanding through the exploration of team culture. This blueprint provides a model to help organizations adopt ORBB and ORBBSIM. Outcomes can establish an empirical paradigm for future studies.
医疗差错仍然困扰着医疗保健领域。手术室黑匣子（ORBB）和ORBB模拟（ORBBSIM）是新兴的创新技术，它们不断捕获并分类术中数据、团队信息和视听文件，以努力改善客观质量指标。ORBB和ORBBSIM有机会提高患者安全，但关于其实施的文献却很少。克服实施障碍至关重要。本研究旨在获得丰富的见解，同时确定与唐纳贝迪安的卫生服务和医疗质量模型相一致的采用ORBB和ORBBSIM的促进因素和障碍。丰富的主题包括转化绩效改进和实际案例，以开展相关培训。
邀请跨专业的手术室工作人员完成两项调查，使用团队策略与工具提升绩效系统（TeamSTEPPS）经过验证的团队合作认知问卷（T-TPQ）和开放式问题来评估工作人员的认知。对定量变量进行描述性统计，对定性内容采用归纳现象学内容分析法。
调查1从334名受邀者中获得了71份回复（回复率21%），而调查2从157名受邀者中获得了47份回复（回复率29.9%）。T-TPQ分数为65.2，其中沟通（70.4）得分最高，领导能力（58.0）得分最低。质量改进（QI）、患者安全和客观病例审查是最常被认为的ORBB的益处。趋势表明，同时采用ORBB和ORBBSIM有相互促进的好处。趋势还表明，双重实施可以促进心理安全、文化、信任和技术适应性。基于变革管理原则制定实施计划以及营造建设性文化的必要性是关键发现。
研究结果支持了先前文献中关于ORBB实施的主题，并通过对团队文化的探索加深了我们的理解。这个蓝图提供了一个模型，以帮助组织采用ORBB和ORBBSIM。研究结果可以为未来的研究建立一个实证范式。
