Exploring everyday work as a dynamic non-event and adaptations to manage safety in intraoperative anaesthesia care: an interview study

BMC Health Services Research

Research Article

Mirjam Ekstedt¹  Karin Pukk-Härenstam²  Charlotte Klinga³  Karolina Olin⁴ 

[1] Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden;Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden;Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden;Paediatric Emergency Department, Karolinska University Hospital, Stockholm, Sweden;Department of Women and Children’s Health, Karolinska University Hospital, Stockholm, Sweden;Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden;Stockholm Research and Development Unit for Elderly Persons (FOU Nu), Region Stockholm, Stockholm, Sweden;Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden;Supervisory Centre, Wellbeing Services County of Southwest Finland, Turku, Finland;

关键词: Resilience;    Adaptive capacity;    Safety II;    Anaesthesia;    Complexity;    Teamwork;   

DOI  :  10.1186/s12913-023-09674-3

 received in 2022-07-13, accepted in 2023-06-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSafety has been described as a dynamic non-event and as constantly present in professionals’ work processes. Investigating management of complex everyday situations may create an opportunity to elucidate safety management. Anaesthesia has been at the frontline of enhancing patient safety – testing and implementing knowledge from other high-reliability industries, such as aviation, in the complex, adaptive system of an operating room. The aim of this study was to explore factors supporting anaesthesia nurses and anaesthesiologists in managing complex everyday situations during intraoperative anaesthesia care processes.MethodsIndividual interviews with anaesthesia nurses (n = 9) and anaesthesiologists (n = 6) using cognitive task analysis (CTA) on case scenarios from previous prospective, structured observations. The interviews were analysed using the framework method.ResultsDuring intraoperative anaesthesia care, management of everyday complex situations is sustained through preparedness, support for mindful practices, and monitoring and noticing complex situations and managing them. The prerequisites are created at the organization level. Managers should ensure adequate resources in the form of trained personnel, equipment and time, team and personnel sustainability and early planning of work. Management of complex situations benefits from high-quality teamwork and non-technical skills (NTS), such as communication, leadership and shared situational awareness.ConclusionAdequate resources, stability in team compositions and safe boundaries for practice with shared baselines for reoccurring tasks where all viewed as important prerequisites for managing complex everyday work. When and how NTS are used in a specific clinical context depends on having the right organizational prerequisites and a deep expertise of the relevant clinical processes. Methods like CTA can reveal the tacit competence of experienced staff, guide contextualized training in specific contexts and inform the design of safe perioperative work practices, ensuring adequate capacity for adaptation.

【 授权许可】

CC BY   
© The Author(s) 2023

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