Assessing the similarity of mental models of operating room team members and implications for patient safety: a prospective, replicated study

BMC Medical Education, Aug 2016

Background Patient safety depends on effective teamwork. The similarity of team members’ mental models - or their shared understanding–regarding clinical tasks is likely to influence the effectiveness of teamwork. Mental models have not been measured in the complex, high-acuity environment of the operating room (OR), where professionals of different backgrounds must work together to achieve the best surgical outcome for each patient. Therefore, we aimed to explore the similarity of mental models of task sequence and of responsibility for task within multidisciplinary OR teams. Methods We developed a computer-based card sorting tool (Momento) to capture the information on mental models in 20 six-person surgical teams, each comprised of three subteams (anaesthesia, surgery, and nursing) for two simulated laparotomies. Team members sorted 20 cards depicting key tasks according to when in the procedure each task should be performed, and which subteam was primarily responsible for each task. Within each OR team and subteam, we conducted pairwise comparisons of scores to arrive at mean similarity scores for each task. Results Mean similarity score for task sequence was 87 % (range 57–97 %). Mean score for responsibility for task was 70 % (range = 38–100 %), but for half of the tasks was only 51 % (range = 38–69 %). Participants believed their own subteam was primarily responsible for approximately half the tasks in each procedure. Conclusions We found differences in the mental models of some OR team members about responsibility for and order of certain tasks in an emergency laparotomy. Momento is a tool that could help elucidate and better align the mental models of OR team members about surgical procedures and thereby improve teamwork and outcomes for patients.

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Assessing the similarity of mental models of operating room team members and implications for patient safety: a prospective, replicated study

Nakarada-Kordic et al. BMC Medical Education Assessing the similarity of mental models of operating room team members and implications for patient safety: a prospective, replicated study Ivana Nakarada-Kordic 0 Jennifer M. Weller 0 2 Craig S. Webster 0 David Cumin 1 Christopher Frampton 4 Matt Boyd 3 Alan F. Merry 1 2 0 Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland , Private Bag 92019, Auckland 1142 , New Zealand 1 Department of Anaesthesiology, School of Medicine, University of Auckland , Auckland , New Zealand 2 Auckland City Hospital , Auckland , New Zealand 3 Wellington , New Zealand 4 Department of Medicine, Christchurch School of Medicine and Health Sciences, University of Otago , Christchurch , New Zealand Background: Patient safety depends on effective teamwork. The similarity of team members' mental models - or their shared understanding-regarding clinical tasks is likely to influence the effectiveness of teamwork. Mental models have not been measured in the complex, high-acuity environment of the operating room (OR), where professionals of different backgrounds must work together to achieve the best surgical outcome for each patient. Therefore, we aimed to explore the similarity of mental models of task sequence and of responsibility for task within multidisciplinary OR teams. Methods: We developed a computer-based card sorting tool (Momento) to capture the information on mental models in 20 six-person surgical teams, each comprised of three subteams (anaesthesia, surgery, and nursing) for two simulated laparotomies. Team members sorted 20 cards depicting key tasks according to when in the procedure each task should be performed, and which subteam was primarily responsible for each task. Within each OR team and subteam, we conducted pairwise comparisons of scores to arrive at mean similarity scores for each task. Results: Mean similarity score for task sequence was 87 % (range 57-97 %). Mean score for responsibility for task was 70 % (range = 38-100 %), but for half of the tasks was only 51 % (range = 38-69 %). Participants believed their own subteam was primarily responsible for approximately half the tasks in each procedure. Conclusions: We found differences in the mental models of some OR team members about responsibility for and order of certain tasks in an emergency laparotomy. Momento is a tool that could help elucidate and better align the mental models of OR team members about surgical procedures and thereby improve teamwork and outcomes for patients. Multidisciplinary teamwork; Shared mental models; Operating room teams; Patient safety Background Effective teamwork is essential for patient safety [ 1–5 ]. Failures in teamwork and communication are common in the operating room (OR) and often lead directly to compromised patient care and reduced productivity [ 6–11 ]. The tasks of the surgical, anaesthetic, and nursing subteams are closely interlinked and inter-dependent [ 5, 12 ]. Members of the OR team should have a common understanding of the plan for patient management [ 13 ] and of the roles and responsibilities of each individual. However, the composition of OR teams changes frequently, members come from different professional backgrounds, and decisions may be needed under time pressure, sometimes with ambiguous or incomplete clinical information. Differences in understanding of the situation, the plan, and the key roles and responsibilities of individual team members may arise, and may impact on patient outcomes, particularly in crises, when time is severely limited [ 14, 15 ]. Humans function on the basis of their personal understanding of their situation at any time, which is likely to be unique and to represent reality to a varying degree. Apparently bizarre accidents can often be explained on the basis of discrepancies between this internal view of the world, and the facts that actually pertained at the time [ 9, 16 ]. This internal representation of reality has been named the person’s “mental model” [17]. Within a team, each member will have his or her own mental model of the situation and the plan, and of when and by whom various tasks should be done [ 18 ]. The extent to which these models overlap (like the common intersect of several circles on a Venn diagram) has been called the teams’ “shared mental model” [ 19, 20 ]. In practice, the degree of overlap or “sharing” may vary between different subsets of the team, and may change, dynamically, over time. There is likely to be a core set of information that must be shared by all key players if teamwork is to be effective on a regular basis [21], and for team members to be able to adapt to unexpected situations and predict each other’s actions and needs [ 22, 23 ]. Substantially shared mental models are presumed to be the cognitive basis of the smooth and effortless coordination observed in many expert teams working in high-intensity environments [3] such as (...truncated)


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Ivana Nakarada-Kordic, Jennifer Weller, Craig Webster, David Cumin, Christopher Frampton, Matt Boyd, Alan Merry. Assessing the similarity of mental models of operating room team members and implications for patient safety: a prospective, replicated study, BMC Medical Education, 2016, pp. 229, 16, DOI: 10.1186/s12909-016-0752-8