Exploring Shared Mental Models of Surgical Teams in Video-Assisted Thoracoscopic Surgery Lobectomy

Kirsten Gjeraa; Peter Dieckmann; Lene Spanager; René H Petersen; Doris Østergaard; Yoon S Park; Lars Konge

doi:10.1016/j.athoracsur.2018.08.010

Exploring Shared Mental Models of Surgical Teams in Video-Assisted Thoracoscopic Surgery Lobectomy

Kirsten Gjeraa, Peter Dieckmann, Lene Spanager, René H Petersen, Doris Østergaard, Yoon S Park, Lars Konge

Department of Clinical Medicine

1 Citation (Scopus)

Abstract

BACKGROUND: Nontechnical skills are important for safe and efficient surgery. Teams performing video-assisted thoracoscopic surgery (VATS) lobectomy express that it is of utmost importance to have a shared mental model (SMM) of the patient, current situation, and team resources. However, these SMMs have never been explored in a clinical setting. The aim of this observational study was to measure the similarity of SMMs within teams performing VATS lobectomy.

METHODS: In this national, multicenter study, SMMs of teams performing VATS lobectomy (n = 64) were measured by preoperative and postoperative questionnaires that were completed by all team members (n = 172). Participants' responses were compared within each team to explore SMMs of risk assessment, familiarity, technical skills, nontechnical skills, and problems.

RESULTS: Analysis showed poor agreement between team members with respect to risk assessment, but higher levels of agreement were found for assessments of familiarity, technical skills, and nontechnical skills within the team (Cronbach's alpha = 0.90), most notably for surgical subteams (ie, surgeon plus assistant surgeon plus surgical nurses). During the surgical procedure, the most frequent problems were related to anesthesia, and these were most often recognized by the surgeons. The operating room nurses were the least aware of each other's and the surgeons' problems.

CONCLUSIONS: Significant variation exists in the SMMs among VATS team members, with poor agreement regarding the patient and current situation, but better agreement with respect to team resources. Focus on preoperative and perioperative team reflexivity, in addition to explicit communication within unfamiliar teams, may provide opportunities to enhance SMMs, with possible downstream effects on team performance.

Original language	English
Journal	The Annals of Thoracic Surgery
Volume	107
Issue number	3
Pages (from-to)	954-961
ISSN	0003-4975
DOIs	https://doi.org/10.1016/j.athoracsur.2018.08.010
Publication status	Published - Mar 2019

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10.1016/j.athoracsur.2018.08.010

https://www.annalsthoracicsurgery.org/article/S0003-4975(18)31352-3/pdf

Cite this

@article{a2ac01c9c06f4443a4867c9d7e9fa58d,

title = "Exploring Shared Mental Models of Surgical Teams in Video-Assisted Thoracoscopic Surgery Lobectomy",

abstract = "BACKGROUND: Nontechnical skills are important for safe and efficient surgery. Teams performing video-assisted thoracoscopic surgery (VATS) lobectomy express that it is of utmost importance to have a shared mental model (SMM) of the patient, current situation, and team resources. However, these SMMs have never been explored in a clinical setting. The aim of this observational study was to measure the similarity of SMMs within teams performing VATS lobectomy.METHODS: In this national, multicenter study, SMMs of teams performing VATS lobectomy (n = 64) were measured by preoperative and postoperative questionnaires that were completed by all team members (n = 172). Participants' responses were compared within each team to explore SMMs of risk assessment, familiarity, technical skills, nontechnical skills, and problems.RESULTS: Analysis showed poor agreement between team members with respect to risk assessment, but higher levels of agreement were found for assessments of familiarity, technical skills, and nontechnical skills within the team (Cronbach's alpha = 0.90), most notably for surgical subteams (ie, surgeon plus assistant surgeon plus surgical nurses). During the surgical procedure, the most frequent problems were related to anesthesia, and these were most often recognized by the surgeons. The operating room nurses were the least aware of each other's and the surgeons' problems.CONCLUSIONS: Significant variation exists in the SMMs among VATS team members, with poor agreement regarding the patient and current situation, but better agreement with respect to team resources. Focus on preoperative and perioperative team reflexivity, in addition to explicit communication within unfamiliar teams, may provide opportunities to enhance SMMs, with possible downstream effects on team performance.",

author = "Kirsten Gjeraa and Peter Dieckmann and Lene Spanager and Petersen, {Ren{\'e} H} and Doris {\O}stergaard and Park, {Yoon S} and Lars Konge",

year = "2019",

month = mar,

doi = "10.1016/j.athoracsur.2018.08.010",

language = "English",

volume = "107",

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T1 - Exploring Shared Mental Models of Surgical Teams in Video-Assisted Thoracoscopic Surgery Lobectomy

AU - Gjeraa, Kirsten

AU - Dieckmann, Peter

AU - Spanager, Lene

AU - Petersen, René H

AU - Østergaard, Doris

AU - Park, Yoon S

AU - Konge, Lars

PY - 2019/3

Y1 - 2019/3

N2 - BACKGROUND: Nontechnical skills are important for safe and efficient surgery. Teams performing video-assisted thoracoscopic surgery (VATS) lobectomy express that it is of utmost importance to have a shared mental model (SMM) of the patient, current situation, and team resources. However, these SMMs have never been explored in a clinical setting. The aim of this observational study was to measure the similarity of SMMs within teams performing VATS lobectomy.METHODS: In this national, multicenter study, SMMs of teams performing VATS lobectomy (n = 64) were measured by preoperative and postoperative questionnaires that were completed by all team members (n = 172). Participants' responses were compared within each team to explore SMMs of risk assessment, familiarity, technical skills, nontechnical skills, and problems.RESULTS: Analysis showed poor agreement between team members with respect to risk assessment, but higher levels of agreement were found for assessments of familiarity, technical skills, and nontechnical skills within the team (Cronbach's alpha = 0.90), most notably for surgical subteams (ie, surgeon plus assistant surgeon plus surgical nurses). During the surgical procedure, the most frequent problems were related to anesthesia, and these were most often recognized by the surgeons. The operating room nurses were the least aware of each other's and the surgeons' problems.CONCLUSIONS: Significant variation exists in the SMMs among VATS team members, with poor agreement regarding the patient and current situation, but better agreement with respect to team resources. Focus on preoperative and perioperative team reflexivity, in addition to explicit communication within unfamiliar teams, may provide opportunities to enhance SMMs, with possible downstream effects on team performance.

AB - BACKGROUND: Nontechnical skills are important for safe and efficient surgery. Teams performing video-assisted thoracoscopic surgery (VATS) lobectomy express that it is of utmost importance to have a shared mental model (SMM) of the patient, current situation, and team resources. However, these SMMs have never been explored in a clinical setting. The aim of this observational study was to measure the similarity of SMMs within teams performing VATS lobectomy.METHODS: In this national, multicenter study, SMMs of teams performing VATS lobectomy (n = 64) were measured by preoperative and postoperative questionnaires that were completed by all team members (n = 172). Participants' responses were compared within each team to explore SMMs of risk assessment, familiarity, technical skills, nontechnical skills, and problems.RESULTS: Analysis showed poor agreement between team members with respect to risk assessment, but higher levels of agreement were found for assessments of familiarity, technical skills, and nontechnical skills within the team (Cronbach's alpha = 0.90), most notably for surgical subteams (ie, surgeon plus assistant surgeon plus surgical nurses). During the surgical procedure, the most frequent problems were related to anesthesia, and these were most often recognized by the surgeons. The operating room nurses were the least aware of each other's and the surgeons' problems.CONCLUSIONS: Significant variation exists in the SMMs among VATS team members, with poor agreement regarding the patient and current situation, but better agreement with respect to team resources. Focus on preoperative and perioperative team reflexivity, in addition to explicit communication within unfamiliar teams, may provide opportunities to enhance SMMs, with possible downstream effects on team performance.

U2 - 10.1016/j.athoracsur.2018.08.010

DO - 10.1016/j.athoracsur.2018.08.010

M3 - Journal article

C2 - 30292841

SN - 0003-4975

VL - 107

SP - 954

EP - 961

JO - The Annals of Thoracic Surgery

JF - The Annals of Thoracic Surgery

IS - 3

ER -

Exploring Shared Mental Models of Surgical Teams in Video-Assisted Thoracoscopic Surgery Lobectomy

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