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  • 1.
    Göras, Camilla
    Örebro University, School of Health Sciences.
    Open the door to complexity: Safety climate and work processes in the operating room2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A complex adaptive system such as the operating room (OR), consists of different safety cultures, sub-cultures and ways of working. When measuring, a strong safety climate has been associated with lower rates of surgical complications. Teamwork is an important factor of safety climate. Discrepancies among professionals’ perceptions of teamwork climate exists. Hence it seems crucial to explore if diversity exists in the perception of factors related to safety climate and between managers and front-line staff in the OR. Complex work processes including multitasking and interruptions are other challenges with potential effect on patient safety. However, multitasking and interruptions may have positive impact on patient safety, but are not well understood in clinical work. Despite challenges a lot of things go well in the OR. Thus, the overall aim of this thesis was to evaluate an instrument for assessing safety climate, to describe and compare perceptions of safety climate, and to explore the complexity of work processes in the OR.

    To evaluate the Safety Attitudes Questionnaire-operating room (SAQ-OR) version and elicit estimations of the surgical team a cross-sectional study design was used. How work was done was studied by observations using the Work Observation Method by Activity Timing and by group interviews with OR professionals.

    The results show that the SAQ-OR is a relatively acceptable instrument to assess perceptions of safety climate within Swedish ORs. OR professionals´ perceptions of safety climate showed variations and some weak areas which cohered fairly well with managers' estimations. Work in the OR was found to be complex and consisting of multiple tasks where communication was most frequent. Multitasking and interruptions, mostly followed by communication, were common. This reflects interactions and adaptations common for a complex adaptive system. Managing complexity and creating safe care in the OR was described as a process of planning and preparing for the expected and preparedness to be able to adapt to the unexpected.

  • 2.
    Göras, Camilla
    et al.
    Örebro University, School of Health Sciences. Department of Anesthesia and Intensive Care Unit, Falu Hospital, Falun, Sweden; Centre for Clinical Research, Falun, Dalarna, Sweden.
    Nilsson, Ulrica
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Perioperative Medicine and Intensive Care, Karolinska University Hospital, stockholm, Sweden.
    Ekstedt, Mirjam
    Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Unbeck, Maria
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.
    Ehrenberg, Anna
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Managing complexity in the operating room: a group interview studyManuscript (preprint) (Other academic)
  • 3.
    Göras, Camilla
    et al.
    Örebro University, School of Health Sciences. Department of Anaesthesia and Intensive Care Unit, Falu Hospital, Falun, Sweden; Centre for Clinical Research, Falun, Dalarna, Sweden.
    Olin, Karolina
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Unbeck, Maria
    Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Pukk-Härenstam, Karin
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Paediatric Emergency Department, Karolinska University Hospital, Stockholm, Sweden.
    Ehrenberg, Anna
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Kassaye Tessma, Mesfin
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Ulrica
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
    Ekstedt, Mirjam
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden.
    Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational studyManuscript (preprint) (Other academic)
  • 4.
    Göras, Camilla
    et al.
    Örebro University, School of Health Sciences. Department of Anaesthesia and Intensive Care Unit, Falu Hospital, Falun, Sweden; Centre for Clinical Research, Falun, Dalarna, Sweden.
    Olin, Karolina
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Development Centre, Turku University Hospital, Turku, Finland.
    Unbeck, Maria
    Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Pukk-Härenstam, Karin
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Paediatric Emergency Department, Karolinska University Hospital, Stockholm, Sweden.
    Ehrenberg, Anna
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Tessma, Mesfin Kassaye
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Ulrica
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
    Ekstedt, Mirjam
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; School of Health and Caring Sciences, Linneuniversitet, Kalmar, Sweden.
    Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e026410Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR.

    DESIGN: Prospective observational study using the Work Observation Method By Activity Timing tool.

    SETTING: An OR department at a county hospital in Sweden.

    PARTICIPANTS: OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9).

    RESULTS: The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication.

    CONCLUSIONS: The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system.

    TRIAL REGISTRATION NUMBER: 2016/264.

  • 5.
    Göras, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Orebro Univ, Sch Hlth Sci, Fac Med & Hlth, Orebro, Sweden;Falun Cent Hosp, Dept Anaesthesia, Falun, Sweden;Falun Cent Hosp, Intens Care Unit, Falun, Sweden.
    Olin, Karolina
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden;Turku Univ Hosp, Dev Ctr, Turku, Finland.
    Unbeck, Maria
    Karolinska Univ Hosp, Trauma & Reparat Med Theme, Stockholm, Sweden;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    Pukk-Härenstam, Karin
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden;Karolinska Univ Hosp, Paediat Emergency Dept, Stockholm, Sweden.
    Ehrenberg, Anna
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Tessma, Mesfin Kassaye
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden.
    Nilsson, Ulrica
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Perioperat Med & Intens Care, Stockholm, Sweden.
    Ekstedt, Mirjam
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden;Linneuniv, Sch lth & Caring Sci, Kalmar, Sweden.
    Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e026410Article in journal (Refereed)
    Abstract [en]

    Objectives The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR. Design Prospective observational study using the Work Observation Method By Activity Timing tool. Setting An OR department at a county hospital in Sweden. Participants OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9). Results The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication. Conclusions The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system. Trial registration number 2016/264.

  • 6.
    Göras, Camilla
    et al.
    Anesthesia and Intensive Care Unit, Falu Lasarett, Falun, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Wallentin, Fan Yang
    Uppsala University, Uppsala, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehrenberg, Anna
    School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Swedish translation and psychometric testing of the safety attitudes questionnaire (operating room version)2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, article id 104Article in journal (Refereed)
    Abstract [en]

    Background: Tens of millions of patients worldwide suffer from avoidable disabling injuries and death every year. Measuring the safety climate in health care is an important step in improving patient safety. The most commonly used instrument to measure safety climate is the Safety Attitudes Questionnaire (SAQ). The aim of the present study was to establish the validity and reliability of the translated version of the SAQ.

    Methods: The SAQ was translated and adapted to the Swedish context. The survey was then carried out with 374 respondents in the operating room (OR) setting. Data was received from three hospitals, a total of 237 responses. Cronbach's alpha and confirmatory factor analysis (CFA) was used to evaluate the reliability and validity of the instrument.

    Results: The Cronbach's alpha values for each of the factors of the SAQ ranged between 0.59 and 0.83. The CFA and its goodness-of-fit indices (SRMR 0.055, RMSEA 0.043, CFI 0.98) showed good model fit. Intercorrelations between the factors safety climate, teamwork climate, job satisfaction, perceptions of management, and working conditions showed moderate to high correlation with each other. The factor stress recognition had no significant correlation with teamwork climate, perception of management, or job satisfaction.

    Conclusions: Therefore, the Swedish translation and psychometric testing of the SAQ (OR version) has good construct validity. However, the reliability analysis suggested that some of the items need further refinement to establish sound internal consistency. As suggested by previous research, the SAQ is potentially a useful tool for evaluating safety climate. However, further psychometric testing is required with larger samples to establish the psychometric properties of the instrument for use in Sweden.

1 - 6 of 6
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