Observations in the OR Gateway to a Culture of Patient Safety! Allison Muniak Carol-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 Range 32.6 – 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)

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