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Adaptation and innovation: a grounded theory study of procedural variation in the academic surgical workplace
Author(s) -
Apramian Tavis,
Watling Christopher,
Lingard Lorelei,
Cristancho Sayra
Publication year - 2015
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/jep.12398
Subject(s) - grounded theory , variation (astronomy) , sociocultural evolution , adaptation (eye) , psychological intervention , psychology , experiential learning , nonprobability sampling , social psychology , qualitative research , sociology , pedagogy , social science , population , physics , demography , neuroscience , psychiatry , astrophysics , anthropology
Rationale, aims and objectives Surgical research struggles to describe the relationship between procedural variations in daily practice and traditional conceptualizations of evidence. The problem has resisted simple solutions, in part, because we lack a solid understanding of how surgeons conceptualize and interact around variation, adaptation, innovation, and evidence in daily practice. This grounded theory study aims to describe the social processes that influence how procedural variation is conceptualized in the surgical workplace. Method Using the constructivist grounded theory methodology, semi‐structured interviews with surgeons ( n = 19) from four N orth A merican academic centres were collected and analysed. Purposive sampling targeted surgeons with experiential knowledge of the role of variations in the workplace. Theoretical sampling was conducted until a theoretical framework representing key processes was conceptually saturated. Results Surgical procedural variation was influenced by three key processes. Seeking improvement was shaped by having unsolved procedural problems, adapting in the moment, and pursuing personal opportunities. Orienting self and others to variations consisted of sharing stories of variations with others, taking stock of how a variation promoted personal interests, and placing trust in peers. Acting under cultural and material conditions was characterized by being wary, positioning personal image, showing the logic of a variation, and making use of academic resources to do so. Our findings include social processes that influence how adaptations are incubated in surgical practice and mature into innovations. Conclusions This study offers a language for conceptualizing the sociocultural influences on procedural variations in surgery. Interventions to change how surgeons interact with variations on a day‐to‐day basis should consider these social processes in their design.