Post on 18-Dec-2015
Observations in the OR
Gateway to a Culture of Patient Safety!
Allison MuniakCarol-Anne Moulton
What are observations?
A data collection method used to gather detailed information about a situation, event, workflow and used to describe the setting, activities, participants, and the meaning of the observations from the observer's perspective (Patton, 2002).
Why Observe?
• What is happening?– Exploration / Curiosity
• How is it happening?– Workflow and Task Analysis
• Is it happening correctly?– Auditing / Compliance
How are observations occurring in your current work environment?
Have you been observed?
Have you been an observer?
When to observe?
• Technical assessment• Teaching / Competency• What am I not seeing in my OR?• Team observations and interactions• Overall system interactions
Advantages
• Can observe what people actually do or say, rather than what they say they do.
• See real life situations, allowing us to access the context and meaning surrounding what people say and do.
14 Operating Rooms in BC
Percentage of OR caregivers reporting “High” or “Very High” levels of communication and collaboration with other OR caregivers across 14 participating hospitals
Disadvantages
• Hawthorne Effect – role of the observer and what effect he or she has on the people and situations observed.
• Perception Bias / Subjectivity• Time-consuming• Ethical dilemmas inherent in observing real life
situations for research purposes.
Ins /Outs
• Introduce observers into the OR• Minimize ‘Hawthorne Effect’• 22 cases across specialties
How did we do this?
• Two ‘researchers’– Anyone can do this!
• Basic paper tool to measure– Time (15 min increments)– Main door– Core door– Role (A1, S1, N1, N2, etc.)– Classification
Phase I
• 22 cases• Identified role, door, ‘intention’• 1929 counts of ins and outs• Surgical Safety Checklist
– Incomplete– Safety Huddle
Average Total
67.2 ins/outs per hour
Range32.6 – 127.4 ins/outs per hour
Carol Anne
Resistance to Observation / Coaching
• People want to be autonomous
• People want to manage their own image and not deal with potential criticism
• People think they are good enough
Inattentional Blindness
• Visual perception of unexpected objects• The failure to notice a fully-visible, but
unexpected object because attention was engaged on another task, event, or object.
(Arien Mack and Irvin Rock, 1999)
https://www.youtube.com/watch?v=Ahg6qcgoay4
How to observe like you’re not observing?
What would a poor observation look like?
• How do you ‘show up’? What are you wearing?• Blending in (no clipboards!)• Clarifying why you are there• Awareness of bias and Hawthorne Effect• Situation awareness
How to observe like you’re not observing?
Observe confusion - how many times does a someone look confused?
About the clip…
• What did you see and experience in this movie?
• What went well? • What could have gone better?• Was communication clear?• Were roles and responsibilities understood?• Were errors made or avoided?
• Get into groups of 3• Observer, story-teller, listener• The story-teller will have 5 minutes to share their
story to the listener.• The listener can respond through the story any way
they see fit (just listening, asking questions, clarifying, etc).
• The observer can observe the story-teller, the listener, or both.
• The observer will have 5 minutes to discuss what was observed with the listener and story-teller.– Note communication style, non-verbal body language, or
anything else you find interesting that you observed.
Power Distance Index
The higher the power distance in a culture, the less likely those in subordinate roles will question the actions or directions of individuals in authority.
“Power distance is the extent to which the less powerful members of organizations and institutions accept and expect that power is distributed unequally.”
Questions to ask yourself?
• Are you aware of how others react to you? • Do they start or stop talking when you enter
the room? • Do you feel you cannot talk to higher levels in
the organization without permission.• Does your organization encourage the use of
titles and position