From the Cockpit to the OR: Teamwork in Safety Critical Environments

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From the Cockpit to the ORTeamwork in Safety
Critical Environments
J. Bryan Sexton The University of Texas Human
Factors Research Project Austin, Texas

• Northern California Chapter
• American College of Surgeons
• May 12, 2001
• Holiday Inn
• 1500 Van Ness Avenue Plenary Session II Gold
  Rush A, Lower lobby level
• San Francisco, California Clinical Scenarios and
  Approaches to Error Reduction

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Human Factors Research Project The
University of Texas

• Professor Robert L. Helmreich, Principal
  Investigator
• Work Environments Cockpit, Space Station,
  Antarctic Winter-over stations, ORs and ICUs.
• Research Focus how members of groups interact to
  manage threats and human error

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The complexity of commercial flight operations

• More flights, more often
• More complex procedures / smaller budgets
• More litigation
• The CNN factor increasing public scrutiny
• More automation / technology
• Bringing together disparate groups (with diverse
  backgrounds and training) to exchange
  safety-critical information

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Accidents per million departures
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Contemporary View

• Recent research has demonstrated the importance
  of contextual factors in which communications and
  teamwork break down
• The result is failure to manage threats and human
  error
• Contextual factors include organizational and
  professional cultures and failure to employ
  countermeasures against threat and error
• James Reason has called these latent factors

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American Airlines - Littlerock
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• Rather than being the main instigators of an
  accident, operators tend to be the inheritors of
  system defects.. Their part is that of adding
  the final garnish to a lethal brew that has been
  long in the cooking.
• James Reason, Human Error, 1990

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Lesson Learned

• Training shifted focus from individual technical
  skills to group level interpersonal skills
• Briefing
• Effective communication

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Studies of Adverse Events in Medicine

• United Kingdom Vincent, et al. (2001 BMJ)
• 10.8 patients experienced an adverse event
• United States Leape, et al. (1991 N Engl J Med)
• 3.7 patients experienced an adverse event
• Austrailia Wilson, Runcimann, et al. (1995 Med J
  Aust)
• 16.6 patients experienced an adverse event

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• Surveys of Medical Personnel

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• Over 80 of all medical personnel surveyed felt
  that briefings
• (preoperative discussions) are an important part
  of safety and
• Teamwork, yet in practice, such discussions are
  seldom seen

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Conflict Resolution

• Conflict was observed in 10 of flights and 10
  of surgeries

• Resolved in 20 of instances in operating room

• Resolved in 80 of instances in cockpit

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Summary

• Operating room personnel report that
  communication is a primary target for improving
  patient safety
• There is a lack of consensus as to what
  constitutes good communication and teamwork
  (between and within disciplines)
• The OR is a much more dynamic, much more complex
  environment than the cockpit
• Current research at our lab and elsewhere is
  addressing the relationship between teamwork
  behaviors and patient outcome variables

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The University of Texas Human Factors Research
Project
www.psy.utexas.edu/psy/helmreich/nasaut.htm or
keyword search UT Human Factors