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Hallet J, Sutradhar R, Flexman A, McIsaac DI, Carrier FM, Turgeon AF, McCartney C, Chan WC, Coburn N, Eskander A, Jerath A, Perez d’Empaire P, Lorello G. Association between anaesthesia-surgery team sex diversity and major morbidity. Br J Surg 2024; 111:znae097. [PMID: 38747328 PMCID: PMC11094651 DOI: 10.1093/bjs/znae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Team diversity is recognized not only as an equity issue but also a catalyst for improved performance through diversity in knowledge and practices. However, team diversity data in healthcare are limited and it is not known whether it may affect outcomes in surgery. This study examined the association between anaesthesia-surgery team sex diversity and postoperative outcomes. METHODS This was a population-based retrospective cohort study of adults undergoing major inpatient procedures between 2009 and 2019. The exposure was the hospital percentage of female anaesthetists and surgeons in the year of surgery. The outcome was 90-day major morbidity. Restricted cubic splines were used to identify a clinically meaningful dichotomization of team sex diversity, with over 35% female anaesthetists and surgeons representing higher diversity. The association with outcomes was examined using multivariable logistic regression. RESULTS Of 709 899 index operations performed at 88 hospitals, 90-day major morbidity occurred in 14.4%. The median proportion of female anaesthetists and surgeons was 28 (interquartile range 25-31)% per hospital per year. Care in hospitals with higher sex diversity (over 35% female) was associated with reduced odds of 90-day major morbidity (OR 0.97, 95% c.i. 0.95 to 0.99; P = 0.02) after adjustment. The magnitude of this association was greater for patients treated by female anaesthetists (OR 0.92, 0.88 to 0.97; P = 0.002) and female surgeons (OR 0.83, 0.76 to 0.90; P < 0.001). CONCLUSION Care in hospitals with greater anaesthesia-surgery team sex diversity was associated with better postoperative outcomes. Care in a hospital reaching a critical mass with over 35% female anaesthetists and surgeons, representing higher team sex-diversity, was associated with a 3% lower odds of 90-day major morbidity.
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Affiliation(s)
- Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Cancer Program, ICES, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Cancer Program, ICES, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Alana Flexman
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Anesthesiology, St Paul’s Hospital/Providence Health Care, Vancouver, British Columbia, Canada
| | - Daniel I McIsaac
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and Ottawa Hospital, Ottawa, Ontario, Canada
| | - François M Carrier
- Carrefour de l’innovation et santé des populations, Centre de recherche du CHUM, and Department of Anesthesiology and Division of Critical Care, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, CHU de Québec–Université Laval Research Centre, Université Laval, Québec City, Québec, Canada
| | - Colin McCartney
- Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wing C Chan
- Cancer Program, ICES, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Cancer Program, ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Cancer Program, ICES, Toronto, Ontario, Canada
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Angela Jerath
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Cancer Program, ICES, Toronto, Ontario, Canada
- Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Pablo Perez d’Empaire
- Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gianni Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Wilson Centre, University Health Network, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
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Dexter F, Hindman BJ, Bayman EO, Mueller RN. Patient and Operational Factors Do Not Substantively Affect the Annual Departmental Quality of Anesthesiologists' Clinical Supervision and Nurse Anesthetists' Work Habits. Cureus 2024; 16:e55346. [PMID: 38559506 PMCID: PMC10981928 DOI: 10.7759/cureus.55346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Although safety climate, teamwork, and other non-technical skills in operating rooms probably influence clinical outcomes, direct associations have not been shown, at least partially due to sample size considerations. We report data from a retrospective cohort of anesthesia evaluations that can simplify the design of prospective observational studies in this area. Associations between non-technical skills in anesthesia, specifically anesthesiologists' quality of clinical supervision and nurse anesthetists' work habits, and patient and operational factors were examined. METHODS Eight fiscal years of evaluations and surgical cases from one hospital were included. Clinical supervision by anesthesiologists was evaluated daily using a nine-item scale. Work habits of nurse anesthetists were evaluated daily using a six-item scale. The dependent variables for both groups of staff were binary, whether all items were given the maximum score or not. Associations were tested with patient and operational variables for the entire day. RESULTS There were 40,718 evaluations of faculty anesthesiologists by trainees, 53,772 evaluations of nurse anesthetists by anesthesiologists, and 296,449 cases that raters and ratees started together. Cohen's d values were small (≤0.10) for all independent variables, suggesting a lack of any clinically meaningful association between patient and operational factors and evaluations given the maximum scores. For supervision quality, the day's count of orthopedic cases was a significant predictor of scores (P = 0.0011). However, the resulting absolute marginal change in the percentage of supervision scores equal to the maximum was only 0.8% (99% confidence interval: 0.2% to 1.4%), i.e., too small to be of clinical or managerial importance. Neurosurgical cases may have been a significant predictor of work habits (P = 0.0054). However, the resulting marginal change in the percentage of work habits scores equal to the maximum, an increase of 0.8% (99% confidence interval: 0.1% to 1.6%), which was again too small to be important. CONCLUSIONS When evaluating the effect of assigning anesthesiologists and nurse anesthetists with different clinical performance quality on clinical outcomes, supervision quality and work habits scores may be included as independent variables without concern that their effects are confounded by association with the patient or case characteristics. Clinical supervision and work habits are measures of non-technical skills. Hence, these findings suggest that non-technical performance can be judged by observing the typical small sample size of cases. Then, associations can be tested with administrative data for a far greater number of patients because there is unlikely to be a confounding association between patient and case characteristics and the clinicians' non-technical performance.
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Affiliation(s)
| | | | - Emine O Bayman
- Biostatistics/Anesthesia, University of Iowa, Iowa City, USA
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Khoshnoodifar M, Emadi N, Mosalanejad L, Maghsoodzadeh S, Shokrpour N. A new practical approach using TeamSTEPPS strategies and tools: - an educational design. BMC MEDICAL EDUCATION 2024; 24:22. [PMID: 38178071 PMCID: PMC10768392 DOI: 10.1186/s12909-023-04803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 10/23/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Teamwork has played a critical role in ensuring patients' safety and preventing human errors in surgery. With advancements in educational technologies, including virtual reality, it is necessary to develop new teaching methods for interpersonal teamwork based on local needs assessments in countries with indigenous cultures. This study aimed to design and develop a new method of teaching teamwork in cesarean section surgery using virtual reality; we further evaluated the effects of this method on healthcare professionals' knowledge and attitudes about teamwork. METHODS This study was designed using the ADDIE instructional design model. The TeamSTEPPS Learning Benchmarks questionnaire was used to assess the educational needs of 85 participants who were members of the cesarean section surgery team. A specialized panel analyzed the extracted needs, and the scenario was compiled during the design stage. Finally, four virtual reality contents were created using 360-video H.265 format, which were prepared from specified scenarios in the development of the educational program. The TeamSTEPPS Learning Benchmarks questionnaire was used to measure knowledge, and the T-TAQ was used to measure the participants' attitudes. RESULTS Six micro- skills were identified as training needs, including briefing, debriefing, cross-monitoring, I'M SAFE checklist, call-out and check-back, and two-challenge rule. Intervention results showed that the virtual reality content improved teamwork competencies in an interprofessional team performing cesarean section surgery. A significant increase was observed in the mean score of knowledge and attitude after the intervention. CONCLUSION Through addressing the need for teamwork training, utilizing the TeamSTEPPS strategy, and incorporating new educational technologies like virtual reality, the collaboration among surgical team members can be enhanced.
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Affiliation(s)
- Mehrnoosh Khoshnoodifar
- E Learning Department, Virtual School of Medical Education and Management. Shahid, Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
| | - Navaz Emadi
- E-Learning in Medical Education, Department of E-Learning in Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
| | - Leili Mosalanejad
- Curriculum Planning, Medical Education Department, Jahrom University of Medical Sciences, Main Campus, Motahari Street, Jahrom, 7414813946, Iran, Islamic Republic of.
| | - Sara Maghsoodzadeh
- General Psychology, Research Centre for Neuromodulation and Pain, Shiraz, Iran, Islamic Republic of
| | - Nasrin Shokrpour
- Teaching English As a Foreign Language, Department of English Language, School of Paramedical Sciences, Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
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Turcotte M, Etherington C, Rowe J, Duong A, Kaur M, Talbot Z, Mansour F, Mohamed J, Zahrai A, Fournier K, Boet S. Effectiveness of interprofessional teamwork interventions for improving occupational well-being among perioperative healthcare providers: a systematic review. J Interprof Care 2023; 37:904-921. [PMID: 36373205 DOI: 10.1080/13561820.2022.2137116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 08/15/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
The occupational well-being of healthcare providers is crucial for safe and effective patient care, especially in the complex, high acuity operating room (OR) setting. There has been a recent proliferation of interventions to improve teamwork in the OR setting, but the impact of these interventions on clinician occupational well-being has yet to be systematically assessed. This systematic review aimed to summarize the impact of interprofessional teamwork interventions on occupational well-being among perioperative healthcare providers. We included all qualitative or quantitative peer-reviewed studies assessing a multidisciplinary teamwork intervention including members of at least two professions. We included seven studies which involved checklists (n = 2), simulation-based training (n = 2), and various teamwork development and training programs (n = 3). Five of the seven included studies reported no significant effect on job satisfaction, while one found a significant negative association between the intervention and job satisfaction (p < .0001), and another showed significant decrease in worker stress. Our findings highlight the gaps in our understanding of the impact of interprofessional teamwork interventions on healthcare worker well-being in the perioperative environment and the multi-level factors influencing OR teamwork, intervention implementation, and well-being across the different professions.
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Affiliation(s)
- Michelle Turcotte
- MD Program, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jennifer Rowe
- MD Program, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Ann Duong
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Manvinder Kaur
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Zoé Talbot
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Fadi Mansour
- MD Program, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Janna Mohamed
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
| | - Amin Zahrai
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Karine Fournier
- Health Sciences Library, University of Ottawa, Ottawa, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, Canada
- Translational and Molecular Medicine Program, University of Ottawa, Ottawa, Canada
- Department of Innovation in Medical Education, University of Ottawa Ottawa Canada
- Francophone Affairs, Faculty of Medicine, University of Ottawa Ottawa Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Faculty of Education, University of Ottawa, Ottawa, Canada
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Essex R, Kennedy J, Miller D, Jameson J. A scoping review exploring the impact and negotiation of hierarchy in healthcare organisations. Nurs Inq 2023; 30:e12571. [PMID: 37338510 DOI: 10.1111/nin.12571] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/21/2023]
Abstract
Healthcare organisations are hierarchical; almost all are organised around the ranking of individuals by authority or status, whether this be based on profession, expertise, gender or ethnicity. Hierarchy is important for several reasons; it shapes the delivery of care, what is prioritised and who receives care. It also has an impact on healthcare workers and how they work and communicate together in organisations. The purpose of this scoping review is to explore the qualitative evidence related to hierarchy in healthcare organisations defined broadly, to address gaps in macro-level healthcare organisational research, specifically focusing on the (1) impact of hierarchy for healthcare workers and (2) how hierarchy is negotiated, sustained and challenged in healthcare organisations. After a search and screening, 32 papers were included in this review. The findings of this review detail the wide-reaching impacts that hierarchy has on healthcare delivery and health workers. The majority of studies spoke to hierarchy's impact on speaking up, that is, how it shaped communication between staff with differential status: not only what was said, but how it had an impact on what was acceptable to say, by whom and at what time. Hierarchy was also noted to have substantial personal costs, impacting on the well-being of those in less powerful positions. These findings also provide insight into the complex ways in which hierarchy was negotiated, challenged and reproduced. Studies not only detailed the way in which hierarchy was navigated day to day but also spoke to the reasons as to why hierarchy is often entrenched and difficult to shift. A number of studies spoke to the impact that hierarchy had in sustaining gender and ethnic inequalities, maintaining historically discriminatory practices. Importantly, hierarchy should not be reduced to differences between or within the professions in localised contexts but should be considered at a broad organisational level.
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Affiliation(s)
- Ryan Essex
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Jack Kennedy
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Denise Miller
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Jill Jameson
- Institute for Lifecourse Development, University of Greenwich, London, UK
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Paquette S, Kilcullen M, Hoffman O, Hernandez J, Mehta A, Salas E, Greilich PE. Handoffs and the challenges to implementing teamwork training in the perioperative environment. Front Psychol 2023; 14:1187262. [PMID: 37397334 PMCID: PMC10310998 DOI: 10.3389/fpsyg.2023.1187262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Perioperative handoffs are high-risk events for miscommunications and poor care coordination, which cause patient harm. Extensive research and several interventions have sought to overcome the challenges to perioperative handoff quality and safety, but few efforts have focused on teamwork training. Evidence shows that team training decreases surgical morbidity and mortality, and there remains a significant opportunity to implement teamwork training in the perioperative environment. Current perioperative handoff interventions face significant difficulty with adherence which raises concerns about the sustainability of their impact. In this perspective article, we explain why teamwork is critical to safe and reliable perioperative handoffs and discuss implementation challenges to the five core components of teamwork training programs in the perioperative environment. We outline evidence-based best practices imperative for training success and acknowledge the obstacles to implementing those best practices. Explicitly identifying and discussing these obstacles is critical to designing and implementing teamwork training programs fit for the perioperative environment. Teamwork training will equip providers with the foundational teamwork competencies needed to effectively participate in handoffs and utilize handoff interventions. This will improve team effectiveness, adherence to current perioperative handoff interventions, and ultimately, patient safety.
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Affiliation(s)
- Shannon Paquette
- Office of Undergraduate Medical Education, UT Southwestern Medical Center, Dallas, TX, United States
| | - Molly Kilcullen
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Olivia Hoffman
- Division of Critical Care Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Jessica Hernandez
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ankeeta Mehta
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Philip E. Greilich
- Department of Anesthesiology and Pain Management, Health System Chief Quality Office, Office of Undergraduate Medical Education, UT Southwestern Medical Center, Dallas, TX, United States
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