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Annual Meeting 2019 Presentations

PS3-06: HOW DOES WORK CONTEXT INFLUENCE HELPING BEHAVIOURS IN INTERDISCIPLINARY SURGICAL TEAMS? A MULTIDISCIPLINARY PERSPECTIVE.
Erin Kennedy, RNEC, PHCNP, PhDc1, Chris Watling, MD, PhD1, Sayra Cristancho, PhD1, Lorelei Lingard, PhD1, Roberto Hernandez-Alejandro2, Jeanna Parsons-Leigh, PhD1; 1The University of Western Ontario, 2The University of Rochester Medical Center

 

Background: In surgical environments, work is and must be variable and flexible, requiring practitioners to recognize what they don’t know and seek help when required.  Given that much of care delivery occurs within teams, how surgeons navigate the complexity of collaborative care whilst attending to their own knowledge/skill gaps can be difficult.  Recent research on the help seeking practices of expert surgeons suggests that help seeking is a complex phenomenon: when and how help seeking unfolds depends on organizational culture and social relations among colleagues. This work has offered insight into how and why individual surgeons seek help in the face of clinical challenges, but it has not yet considered the influence of a clinical team on the help seeking phenomenon..  Our study aims to understand how work context influences collaborative team functionality in surgery with respect to helping behaviours.

Methods: We conducted 3 observations and 13 semi-structured interviews with participants from transplant teams.  Following constructivist grounded theory methodology, data collection and inductive analysis were conducted iteratively. This methodology was selected for its ability to explore complex social processes such as helping behaviors and to use sensitizing concepts including collective competence, systems thinking and psychological safety. 

Results: We found several intersecting features of workplace context that promoted or inhibited helping engagement in surgical teams.  These contextual features included: 1) structure of the physical and hierarchical environment, 2) workplace diversity, 3) institutional support for risk taking/innovation, 4) strength of relationships, and 5) perception of a “speak-up” culture. 

Conclusion: If we desire to create and support surgical teams that effectively and safely deliver high quality care, we must consider the individual attributes as well as the work context in which individuals and teams are situated.  Traditionally, literature has focused on the individual with respect to helping engagement.  Our study offers clear targets for institutional and organizational change that would more effectively support helping behaviours required to ensure safer, high quality care.