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The study

Transient Teams in the Operating Theatre

This study looks at the operating theatre as a site of multimodal communication. It addresses a key challenge for the National Health Service and other major organizations across the world by investigating professional communication in ‘transient’ teams–that is, communication between professionals who work on recurring tasks, such as surgical operations, in teams that exist only for the duration of the task, or even only for parts of it. Thus these professionals step in and out of newly formed teams, participating in the performance of complex tasks, often with colleagues whom they have never met before. Health care services are increasingly delivered by such transient teams. That has a profound effect on the development of shared knowledge and expertise. Transient teams cannot draw on shared histories of collaboration and provide limited opportunities for creating routines tailored to the particularities of the work environment. The study will systematically record, analyze and address in detail the communication between nurses and surgeons in the operating theatre, not only examining problems of communication, but also the instances where interaction is highly effective; and compare the communication of surgeons and scrub nurses who have worked together for several years with the communication of those who have only recently started collaborating.

Background

The study addresses a key challenge for the National Health Service (NHS) in the United Kingdom (UK) and other major organizations across the world by investigating professional communication in ‘transient’ teams–that is, communication between professionals who work on recurring tasks, such as surgical operations, in teams that exist only for the duration of the task, or even only for parts of it. Thus these professionals step in and out of newly formed teams, participating in the performance of complex tasks, often with colleagues whom they have never met before. Health care services are increasingly delivered by such transient teams (Finn and Waring 2006). Contingencies inherent in health care (e.g., emergencies), high workload, increasing reliance on temporary staff, regulatory caps on working hours (European Working Time Directive) and demands of the workforce (e.g., part-timing) all contribute to the promotion of transient teams. That has a profound effect on the development of shared knowledge and expertise. Transient teams cannot draw on shared histories of collaboration and provide limited opportunities for creating routines tailored to the particularities of the work environment. Thus there is a tension between the need for flexibility and the need for continuity in order to deliver efficient and high quality health care services (Currie and Suhomlinova 2006). At the same time, significant parts of the UK healthcare workforce, particularly in London, has been trained overseas (Buchan, Jobanputra et al. 2005; Hutt and Buchan 2005), bringing different, socially and culturally shaped professional experiences to the team and raising the need for opportunities to produce and retain shared understandings. Our group’s observational research in the operating theatre has recently shown a glimpse of how these wider social, economic and organizational trends are manifest in the communication between nurses and surgeons, for instance, in misunderstandings about instrument requirements (Bezemer, Cope et al. in press). The proposed study aims to seize a unique opportunity to build on this prior research and systematically record, analyze and address in detail the communication between nurses and surgeons in the operating theatre, not only examining problems of communication, but also the instances where interaction is highly effective. Through detailed audio and video analysis of the moment-by-moment unfolding of multimodal (i.e., verbal and non-verbal) communication and its institutional context (Bezemer and Jewitt 2009; Heath, Hindmarsh et al. 2010; Kress 2010) the study will provide evidence of the effects of transient teamwork in a highly complex work place, where communication has real consequences for patient-safety, staff well-being, and the overall quality of healthcare (Lingard, Espin et al. 2004; Nestel and Kidd 2006; Williams, Silverman et al. 2007).

Aims and objectives

The aims of the project are:

  1. To investigate inter-professional communication in the operating theatre;
  2. To investigate the production of shared knowledge in contexts of instability and diversity;
  3. To develop, test and refine methods of improving communication in the workplace.

In order to achieve these aims we will carry out a case study in the operating theatres of a major NHS teaching hospital in London with the following objectives:

  1. To record and analyze the moment-by-moment unfolding of multimodal communication between specialized theatre nurses and surgeons;
  2. To compare patterns of communication between established and transient teams of theatre nurses and surgeons;
  3. To explore the potentialities and constraints of video recordings of communication as      resources for professional development.

Main work on which the research will draw

The study will adopt an ethnographic approach to communication, bringing together detailed analysis of multimodal communication with analysis of its wider institutional context. It will draw on three lines of work:

  • Sociological, social semiotic and educational studies of workplace-based learning (Atkinson 1981; Lave and Wenger 1991; Goodwin 1994; Sinclair 1997; Pope, Smith et al. 2003; Bezemer 2007; Goodwin 2007; Hindmarsh and Pilnick 2007; Svensson, Heath et al. 2007; Bezemer and Jewitt 2009; Koschmann, Lebaron et al. forthcoming; Bezemer, Murtagh et al. in press);
  • Discourse and sociolinguistic studies of communication in the workplace (Gumperz 1982; Pettinari 1988; Clyne 1994; Bremer, Roberts et al. 1996; Roberts, Sarangi et al. 2000; Di Luzio, Gunther et al. 2001; Cicourel 2003; House, Kasper et al. 2003; Stubbe, Lane et al. 2003; Bezemer, Cope et al. in press).
  • Clinical (educational) studies (Keddy, Jones et al. 1986; Hojat, Nasca et al. 2001; Lingard, Reznick et al. 2002; Bull and Fitzgerald 2004; Lingard, Espin et al. 2004; Nestel and Kidd 2006; Blom, Verdaasdonk et al. 2007; Mitchell and Flin 2008; Arora, Hull et al. 2010).

Key features of the study

  • It addresses a timely issue and shared concern of clinicians, policy makers and a range of other professional environments in the public sector and academia;
  • It builds a unique data set: only a handful of social scientists have collected and analyzed video data in the operating theatre;
  • It uses an innovative methodology, bringing together ethnographic and multimodal analysis of communication and actively involving those who are being researched in the analysis;
  • It is highly interdisciplinary, bringing together an unusual team of professionals: clinicians
  • and social scientists, clinical researchers and clinical practitioners, nurses and surgeons.

Discussion

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