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Supporting structures for team situation awareness and decision making: insights from four delivery suites
Author(s) -
Mackintosh Nicola,
Berridge EmmaJane,
Freeth Della
Publication year - 2009
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2008.00953.x
Subject(s) - teamwork , context (archaeology) , knowledge management , patient safety , process management , psychology , computer science , business , management , political science , health care , paleontology , law , economics , biology
Rationale, aims and objectives ‘Human factors’ (non‐technical skills such as communication and teamwork) have been strongly implicated in adverse events during labour and delivery. The importance of shared ‘situation awareness’ between team members is highlighted as a key factor in patient safety. Arising from an ethnographic study of safety culture in the delivery suites of four UK hospitals, the aim of this study is to describe the main mechanisms supporting team situation awareness (TSA) and examine contrasting configurations of supports. Methods Stage I: 177 hours of lightly structured non‐participant observation (sensitizing concepts: safety culture, non‐technical skills, teamwork and decision making) analysed to identify a core organizing concept, main supporting categories and preliminary conceptual models. Stage II: (approximately 11 months after first observations) 104 hours of observation to test and elaborate stage I analyses. Results Handover, whiteboard use and a coordinator role emerged as the key processes facilitating work and team coordination. The interplay between these supporting processes and the contextual features of each site promoted or inhibited TSA. Three configurations of supports for TSA were evident. These are described. Conclusions Context configurations of supporting mechanisms and artefacts influence TSA, with implications for the maintenance of patient safety on delivery suites. A balanced model of supports for TSA is commended. Examining contrasting configurations helps reveal how local mechanisms or organizational, environmental and temporal factors might be manipulated to improve TSA.