A successful surgery is the result of the seamless collaboration between the members of the surgical team. Just like a well-oiled machine, a harmonious team operates smoothly, with every member in sync and contributing to the overall success.
In this two-part blog series, we're diving deeper into the mechanics of surgical teamwork, focusing specifically on the concept of "team familiarity." By breaking this down into its essential components, we aim to uncover how we can harness the advantages of consistent, experienced teams to achieve better outcomes. What practical strategies can we adopt to ensure our teams perform at their peak?
The operating room (OR) is where a core multidisciplinary team comes together to deliver each procedure, often following shift-based or specialty-based schedules. The collective experience gained from working together over time is what we call "familiarity." Teams that have worked closely for months or even years exhibit a high level of familiarity.
Research consistently shows that familiarity leads to better team performance, especially when it comes to reducing operative time. Other benefits include fewer surgical errors, smoother operations, shorter hospital stays, and lower reoperation rates, though these results vary across studies.
Despite the clear advantages of familiarity, hospital structures can make it challenging to maintain consistent, familiar teams due to the constant rotation of unfamiliar professionals. This presents both a challenge and an opportunity for innovation. How can we extract the key elements of familiarity and apply them within our current systems? Is there a way to simulate or replicate some of these features? Could technology play a role in bridging this gap?
One key aspect of familiarity is the development of a "shared mental model," a concept explored in a literature review published in the *AORN Journal*. Transactive memory theory suggests that as teams gain experience, they build trust and understanding of each other's capabilities. This enables clearer task delegation and better anticipation of teammates' actions. Shared mental models are integral to teamwork and training exercises like debriefings and huddles.
By identifying the characteristics of familiar teams, we can attempt to capture and externalize their shared mental model. This could allow newcomers to access the collective knowledge of the team. There are parallels between shared mental models and modern information technologies, such as cloud storage and machine learning. With today's data-sharing capabilities, can technology help us tap into and disseminate a team's shared mental model? Could this enable us to mimic the strengths of familiarity and integrate them into everyday surgical practices?
Surgical workflows, while rooted in standard best practices, often vary depending on the unit, team, or even the individual surgeon. Capturing a team's mental model begins with documenting these workflows and making them easily accessible. Surgical "preference cards" are one example, listing the tools a surgeon prefers for each procedure.
Incision's *Assist* app takes this a step further by enabling OR teams to digitize their protocols, equipment, and unique processes. This information is organized via a mobile app, categorized by specialty, procedure, and team. It includes input from multiple disciplines—surgery, perioperative nursing, surgical technology, and anesthesia—and is structured to mirror real-world OR dynamics. Established and new team members, including temporary staff, can access these resources instantly.
Another hallmark of familiar teams is their ability to anticipate each other's actions. Surgeons and scrub nurses who frequently work together usually have a good sense of how the other will respond during procedures. They understand what’s needed at any given moment and how to handle unexpected issues. This anticipation stems from their shared mental model and facilitates smoother, more efficient operations.
For instance, familiar teams minimize disruptions, such as those caused by corrective actions or equipment shortages. Studies in neurosurgery found fewer workflow disruptions in teams with high surgeon-scrub nurse familiarity. Similarly, cardiac surgery teams that work together regularly report fewer surgical flow interruptions, errors, and teamwork breakdowns. In urology, greater familiarity correlates with fewer "inconvenience events" during robot-assisted prostatectomies.
Understanding individual preferences and work habits is another crucial element of familiar teams. Even within the same unit, different surgeons may have distinct approaches. Long-standing team members become accustomed to these differences, but unfamiliar staff might not. This can lead to delays, miscommunication, and frustration.
In a multi-center study, 88% of users of *Assist* reported feeling better prepared for their time in the OR. Newcomers, in particular, benefited, enabling them to actively participate more effectively. Seventy percent of participants felt more comfortable and confident handling specific equipment and protocols with certain teams and surgeons.
The financial implications of familiarity are substantial. OR time costs range from $36 to $150 per minute, or $2220 to $9000 per hour, depending on location and setting. Shorter operative times, quicker preparation, and reduced case turnover times translate into significant cost savings.
While logistical hurdles remain in maintaining familiar teams in daily rotations, technology offers innovative solutions. Tools like *Assist* have proven effective in enhancing staff familiarity with equipment and protocols, improving preparedness, boosting confidence, and enhancing overall performance.
Looking ahead, the integration of collaborative platforms, data sharing, and advanced technologies holds immense promise for surgical teams. Breaking down the barriers between teams and optimizing communication can make the benefits of familiarity accessible to all. At Incision, we're committed to fostering conversations, strengthening team bonds, and educating through engaging content. Together, we can learn and grow, paving the way for a brighter future in surgical teamwork.
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