MAPPING TEAM DYNAMICS AND TRAFFIC IN THE OPERATING THEATRE: IDENTIFICATION OF ROLES AND STRESSORS IN INFECTION RELATED PRACTICE AND ITS COMMUNICATION WITH SURGICAL TEAMS

Abstract

Intro: To optimise surgical outcomes and minimise the risk of infections, effective communication and teamwork are essential in the operating theatre (OT). In this pilot study, we mapped the OT team dynamics and roles in infection and safety-related practices. Methods: Between November 2021 and February 2022, data were gathered from adult surgical teams at a tertiary hospital in India. Data included direct ethnographic observations of OT activities and interactions, sociograms of targeted infection and safety-related communication, measurement of OT traffic, and focus group discussions with teams. Qualitative data were coded and analysed using a grounded theory approach. Quantitative data were analysed using descriptive statistics. Findings: Data gathered from 51 hours of direct observations across ten surgical pathways include 16 sociograms and 15 traffic-flow maps. Team hierarchies and dynamics are directly influenced by the senior surgeon. The OT staff adhere to implicitly understood roles, creating a missed opportunity for infection-related interventions. Instances of non-verbal communication are common, especially for routine activities. While the surgical and anaesthetic residents and technicians lead most tasks during procedures, the scrub nurse acts as a mediator coordinating and activating tasks among role players across hierarchies. Despite this role, the plan of events is not always communicated to them ahead of the procedure resulting in multiple door openings to source equipment and disposables. Traffic flow, counted by the number of door openings reach up to 14-15 per five minutes, with implications for infection management. Communication around the WHO checklist was limited. Conclusion: While interventions exist to optimise care in the OT, implementation challenges remain. Assigning explicit roles and responsibilities for actioning, including the WHO checklist completion, to specific team members is critical. On reflexive feedback to teams, the visual methods utilised provided an effective means for team reflection and an awareness of practices that may compromise infection management and patient safety.