טכניון מכון טכנולוגי לישראל
הטכניון מכון טכנולוגי לישראל - בית הספר ללימודי מוסמכים  
Ph.D Thesis
Ph.D StudentDana Vashdi
SubjectTeam Reflexivity in the Operating Room: Theory, Intervention
and Outcomes
DepartmentDepartment of Industrial Engineering and Management
Supervisors Mr. Bamberger Peter
Professor Emeritus Erez Miriam
Full Thesis textFull thesis text - English Version


Abstract

This research examines, implements and then tests the impact a structured team reflexivity process has on the performance and outcomes of surgical teams. In the first paper incorporated in this dissertation, we adopt an action-research approach to examine the applicability of briefing-debriefing sessions -- a team-based, reflexive learning model being used in the Israel Air Force -- to the surgical departments of a major, civilian tertiary center in Israel, and explore the potential impact of such a model on the incidence of preventable adverse events in these departments. Taking into account the similarities and differences between the two team contexts (i.e., surgical team and flight crew contexts), we examine potential barriers to the implementation of such a briefing-debriefing technology in the surgical world, discuss the ways in which such barriers have been largely overcome, and present a model for implementation.  Additionally we generate propositions regarding the way in which briefing-debriefing frameworks might enhance the quality-related outcomes of hospital surgical teams. We pay particular attention to those aspects of the team-based learning model - such as a focus on status-free transparency and systems-based analysis - intended to promote double-, as opposed to simply single-loop learning.  In the second paper incorporated in this dissertation, we implement the model suggested in the first paper, and introduce the briefing-debriefing process to surgical teams from three surgical wards in the tertiary health care center. We examine the degree to which the adoption of such a structured team reflective practice may be associated with enhanced team performance in an action team context, by comparing the performance of teams that conducted a briefing-debriefing process to those that did not.  Our findings suggest that task complexity moderates the relationship between conducting a briefing-debriefing and performance as measured by the percent of requirements met by the anesthesiologists and by the nurses. We also find that workload sharing mediates the relationship between conducting a briefing-debriefing and performance which is measures as the occurrence of an adverse event. Conducting a briefing-debriefing process promotes more workload sharing between team members which in turn reduces the occurrence of adverse events. Finally, we find that the number of supportive communications mediates the moderated relationship between conducting a briefing-debriefing and performance as measured by the percent of requirements met by the anesthesiologists. Conducting a briefing-debriefing (especially in high complexity surgeries) produces less supportive communications which in turn increased the percent of requirements met by the anesthesiologists.