Operating Room Teamwork among Physicians and Nurses: Teamwork in the Eye of the Beholder

Makary, Martin A.; Sexton, J. Bryan; Freischlag, Julie A.; Holzmueller, Christine G.; Millman, E. Anne; Rowen, Lisa; Pronovost, Peter J.

doi:10.1016/j.jamcollsurg.2006.01.017

« Previous Next »Journal of the American College of Surgeons
Volume 202, Issue 5 , Pages 746-752, May 2006

Operating Room Teamwork among Physicians and Nurses: Teamwork in the Eye of the Beholder

Presented at the American College of Surgeons 91st Annual Clinical Congress, San Francisco, CA, October 2005.

Martin A. Makary, MD, MPH
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins Quality and Safety Research Group, Johns Hopkins Medical Institutions, Baltimore, MD
- Correspondence address: Martin A Makary, MD, MPH, Department of Surgery and Health Policy and Management, Johns Hopkins University School of Medicine, Johns Hopkins Medical Institutions, 4940 Eastern Ave, Bldg A-5, Baltimore, MD 21224
J. Bryan Sexton, PhD
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Quality and Safety Research Group, Johns Hopkins Medical Institutions, Baltimore, MD
Julie A. Freischlag, MD, FACS
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
Christine G. Holzmueller, BLA
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Quality and Safety Research Group, Johns Hopkins Medical Institutions, Baltimore, MD
E. Anne Millman, MS
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins Quality and Safety Research Group, Johns Hopkins Medical Institutions, Baltimore, MD
Lisa Rowen, RN, DNSc
- Department of Nursing, John Hopkins University School of Nursing, Baltimore, MD
Peter J. Pronovost, MD, PhD
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Nursing, John Hopkins University School of Nursing, Baltimore, MD
- Johns Hopkins Quality and Safety Research Group, Johns Hopkins Medical Institutions, Baltimore, MD

Received 15 November 2005; received in revised form 20 January 2006; accepted 30 January 2006.

Background

Teamwork is an important component of patient safety. In fact, communication errors are the most common cause of sentinel events and wrong-site operations in the US. Although efforts to improve patient safety through improving teamwork are growing, there is no validated tool to scientifically measure teamwork in the surgical setting.

Study design

Operating room personnel in 60 hospitals were surveyed using the Safety Attitudes Questionnaire. Surgeons, anesthesiologists, certified registered nurse anesthetists, and operating room nurses rated their own peers and each other using a 5-point Likert scale (1 = very low, 5 = very high).

Results

Overall response rate was 77.1% (2,135 of 2,769). Ratings of teamwork differed substantially by operating room caregiver type, with the greatest differences in ratings shown by physicians: surgeons (F[4, 2058] = 41.73, p < 0.001), and anesthesiologists (F[4, 1990] = 53.15, p < 0.001). The percent of operating room caregivers rating the quality of collaboration and communication as “high” or “very high” was different by caregiver role and whether they were rating a peer or another type of caregiver: surgeons rated other surgeons “high” or “very high” 85% of the time, and nurses rated their collaboration with surgeons “high” or “very high” only 48% of the time.

Conclusions

Considerable discrepancies in perceptions of teamwork exist in the operating room, with physicians rating the teamwork of others as good, but at the same time, nurses perceive teamwork as mediocre. Given the importance of communication and collaboration in patient safety, health care organizations should measure teamwork using a scientifically valid method. The Safety Attitudes Questionnaire can be used to measure teamwork, identify disconnects between or within disciplines, and evaluate interventions aimed at improving patient safety.

Abbreviations and Acronyms: CRNA, certified registered nurse anesthetists , OR, operating room , SAQ, Safety Attitudes Questionnaire